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Final rule equalizes Medicaid payment rates for primary care physicians


By: 
Mary Mosquera

Physicians who treat Medicaid patients will get a pay raise in two months when Medicaid reimbursement rates becoming equal to Medicare reimbursement rates for primary care services. 

The final rule released Nov. 1 establishes the requirement under the health reform law for parity in payments with Medicare levels in 2013 and 2014 for physicians serving Medicaid beneficiaries and who practice in family medicine, general internal medicine, pediatric medicine and related subspecialties. The payment increase goes into effect in January.

The final rule comes just days before voters will decide who will be the next president, the outcome of which may determine the future of the Patient Protection and Affordable Care Act (PPACA).

The rule raises rates to make sure doctors are paid the same for treating Medicare and Medicaid patients. It does not raise costs for states, according to Health and Human Services (HHS) Secretary Kathleen Sebelius.

“The health care law will help physicians serve millions of Americans across the country. By improving payments for primary care services, we are helping Medicaid patients get the care they need to stay healthy and treat small health problems before they become big ones,” she said in an announcement.

At a recent conference, Matt Salo, executive director of the National Association of Medicaid Directors, commented on the traditionally low reimbursements for Medicaid providers, saying, “Even when times are good we try to pay providers too little."

The final rule also explains how the Centers for Medicare & Medicaid Services and the states will work together to make the increased payments operational. CMS provides multiple options for states to allow for flexible implementation in fee-for-service and managed care settings. The rule permits states to either “lock” rates at the level of the Medicare physician fee schedule in effect at the beginning of 2013 and 2014 or modify the rates in alignment with all updates by Medicare.

The increased payments also apply to services reimbursed by Medicaid managed care plans.  States must incorporate the increased payment into contracts with such entities, according to the final rule. 

 

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