To recruit more doctors to treat poor patients who will be newly eligible for health coverage under the Affordable Care Act (ACA), the Centers for Medicare & Medicaid (CMS) last week released regulations implementing rate increases for primary care physicians who treat Medicaid patients. As called for by the ACA, primary care physicians will see their fees raised to Medicare levels. The increases are financed 100 percent by the federal government and will last for two years.
For purposes of this regulation, primary care is defined as family medicine, general internal medicine, pediatric medicine or related pediatric subspecialties. Pediatric subspecialists must be recognized by the American Board of Medical Specialties, American Board of Physician Specialties or the American Osteopathic Association to receive the increased fees. If a physician is not board certified, eligibility can be determined by the physician’s billing history. Physicians will qualify if 60 percent of the codes they bill are for evaluation and management codes and vaccine administration codes covered by this rule. CMS will allow physicians to self-attest to their board certification or billing history.
This final rule also updates the maximum fees that providers may charge for the administration of pediatric vaccines to federally vaccine-eligible children under the Vaccines for Children program.
According to CMS, states must also incorporate the increased payment rates into their contracts with managed care plans so that primary care physicians contracting with Medi-Cal managed care plans see the higher rates.
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