Medicaid Primary Care Benefits Increase

The CMS issued a final rule late Thursday temporarily increasing primary care physician payments from Medicaid.

The rule (PDF), which implements a provision of the Patient Protection and Affordable Care Act, details the extent and target of the increase, which takes effect in January and lasts through 2014.

The provision is designed to match Medicare rates, but the rule specifically covers only the difference between the Medicare rate and states' Medicaid rates as of July 1, 2009. The additional federal funding may not be enough to increase the rate to Medicare levels because some states have enacted Medicare provider rate cuts since mid-2009.



"The healthcare law will help physicians serve millions of Americans across the country," HHS Secretary Kathleen Sebelius said in a news release. "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."

The rule specifies that federal funding will be provided to states to increase payments for physicians practicing in family medicine, general internal medicine, pediatric medicine and related subspecialties. It also clarifies that primary-care services provided by practitioners working under the personal supervision of any qualifying physician can qualify for the higher payment rate.

The CMS, in the rule, gives states several options for implementing the rate increase in fee-for-service and managed-care settings. For example, states either can pay in accordance with all Medicare locality adjustments within the state or develop a rate for each code based on the mean Medicare rate for all counties in the state.



The American Academy of Family Physicians, in a news release, hailed the increase as a way to keep more physicians from joining the nearly 20% who have stopped accepting new Medicaid patients. However, the temporary nature of the increase will limit its benefits, the AAFP said.

"Unless Congress acts to permanently extend and fund this provision, a sudden return to disparate and inadequate payment for primary care services needed by Medicaid patients after only two years will again threaten to restrict their access to such needed services," Dr. Jeffrey Cain, president of AAFP, said in the release.

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