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Increasing Medicaid Primary Care Fees for Certain Physicians in 2013 and 2014...
Increasing Medicaid Primary Care Fees for Certain Physicians in 2013 and 2014: A Primer on the Health Reform Provision and Final Rule Executive Summary
Under the ACA, beginning in 2014, millions of uninsured Americans will gain Medicaid in states that implement the Medicaid expansion. To help ensure access to meet expected higher demands for care in Medicaid, the health reform law requires states to pay certain physicians Medicaid fees at least equal to Medicare’s for many primary care services in 2013 and 2014. The idea behind the fee increase is to boost physician participation in Medicaid and to provide increased support for physicians who already participate and who might expand their Medicaid service. The fee increase is federally funded. On November 6, 2012, CMS published a Final Rule outlining how states are to implement the higher fees. This brief explains major elements of the statute and rule.
Key provisions
Bringing Medicaid primary care fees up to Medicare fee levels, and financing the fee increase with federal dollars, will likely have important impacts on qualified physicians, access to care, and the states. In 2013, average Medicaid fees for the ACA primary care services will rise by an estimated 73%. If the Medicaid fee increase succeeds in increasing physician participation in Medicaid, as intended, primary care access for beneficiaries should expand, helping states and the health care system prepare for significantly increased Medicaid enrollment due to the ACA. State data on changes in physician participation and primary care use relative to 2009 will be of keen interest as decision-makers evaluate the fee increase and consider policy beyond 2014.
http://www.kff.org/medicaid/upload/8397.pdf
Under the ACA, beginning in 2014, millions of uninsured Americans will gain Medicaid in states that implement the Medicaid expansion. To help ensure access to meet expected higher demands for care in Medicaid, the health reform law requires states to pay certain physicians Medicaid fees at least equal to Medicare’s for many primary care services in 2013 and 2014. The idea behind the fee increase is to boost physician participation in Medicaid and to provide increased support for physicians who already participate and who might expand their Medicaid service. The fee increase is federally funded. On November 6, 2012, CMS published a Final Rule outlining how states are to implement the higher fees. This brief explains major elements of the statute and rule.
Key provisions
<…>100% federal match. The federal government will fund the full cost of the fee increase, up to the difference between Medicaid fees as of July 1, 2009 and Medicare fees in 2013 and 2014. The estimated federal costs are $11.9 billion. States with current fees below their 2009 fees have to fund their regular share of that difference; the 100% federal match applies only to increases over July 1, 2009 rates. By the same token, states whose current fees exceed their 2009 fees will realize savings, estimated to total $545 million. Managed care. The ACA requires that qualified physicians in MCOs also receive the full benefit of the fee increase, whether the MCO pays them on a fee-for-service, capitation, or other basis. States have considerable flexibility in implementing this requirement, but they must submit methodologies for identifying what MCO payments to qualified physicians would have been for ACA primary care services as of July 1, 2009, and for identifying the portion of their 2013 and 2014 capitation payments attributable to the fee increase, for which the 100% federal match is available.
<…>
Bringing Medicaid primary care fees up to Medicare fee levels, and financing the fee increase with federal dollars, will likely have important impacts on qualified physicians, access to care, and the states. In 2013, average Medicaid fees for the ACA primary care services will rise by an estimated 73%. If the Medicaid fee increase succeeds in increasing physician participation in Medicaid, as intended, primary care access for beneficiaries should expand, helping states and the health care system prepare for significantly increased Medicaid enrollment due to the ACA. State data on changes in physician participation and primary care use relative to 2009 will be of keen interest as decision-makers evaluate the fee increase and consider policy beyond 2014.
http://www.kff.org/medicaid/upload/8397.pdf
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