HHS Issues Proposed Guidance on Medicaid Pay Bump for Primary Care Services

by Rebecca Farley on May 10, 2012

HHS Secretary Kathleen Sebelius

The Department of Health and Human Services has released a proposed rule outlining the approach it intends to take in implementing a temporary Medicaid physician payment increase for primary care services.

The pay bump was enacted as part of the Affordable Care Act and is aimed at increasing Medicaid beneficiaries’ access to primary care services by addressing the low rates paid to physicians under the program. For 2013 and 2014, Medicaid payment rates for primary care services furnished by primary care physicians will be raised to equal Medicare payments for those services. The law defines “primary care physicians” as physicians with a primary specialty of family medicine, internal medicine, or pediatrics.

The new proposed rule offers additional guidance on this definition. It would allow all subspecialists within the three specialty designations – including pediatric subspecialists – to be eligible for the increased payments for primary care services. Increased payments are not available to physicians practicing within Federally Qualified Health Centers or Rural Health Clinics. The proposed rule also provides details on how the payment increase will be applied to physicians working in a managed care arrangement.

States will be responsible for implementing the payment increase within the outlines of the HHS guidance. HHS is accepting public comments on the proposed rule for 30 days. The full text of the proposed rule is available here.


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