On May 9, 2012, CMS issued a proposed rule to implement a provision of the Affordable Care Act which provides increased payments for certain Medicaid primary care services. Under the proposed rule, primary care services delivered by a physician with a specialty designation of family medicine, general internal medicine, pediatric medicine, or related subspecialties would be reimbursed at the Medicare rates in effect for calendar years 2013 and 2014, in lieu of their usual state-established Medicaid rates.
Primary care services must be delivered under the Medicaid physician services benefit to be eligible for the increased payments. Consequently, primary care services rendered by practitioners working under the supervision of a qualifying physician and billing under that physician’s Medicaid provider number – a nurse practitioner, for example – would be eligible for higher payment. CMS also clarified in the proposed rule that all of the requirements related to the increased payments apply to services reimbursed by Medicaid managed care plans.
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