Deborah Bachrach Discusses Rule Increasing Pay for Medicaid Primary Care Physicians

Deborah Bachrach Discusses Rule Increasing Pay for Medicaid Primary Care Physicians

"Medicaid Sets Temporary Payment Increase for Primary Care"
American Medical News

November 12, 2012 - Manatt's Deborah Bachrach, a special counsel in the firm's Healthcare Division, discussed with American Medical News a recently issued final rule that sets Medicaid payments for primary care servicers at 100% of Medicare rates for calendar years 2013 and 2014.

American Medical News reports that the Centers for Medicare & Medicaid Services (CMS) released on November 1 a long-awaited final rule that temporarily hikes Medicaid payment to Medicare levels for primary care servicers. States will receive $11 billion from the federal government during the two-year period to administer the enhanced pay rates. The ACA authorized the temporary pay parity provision. 

Bachrach told the publication that the health system reform law was fairly prescriptive in terms of the types of doctors who would qualify for this pay increase. Physicians who deliver primary care services in the fields of family, general internal or pediatric medicine are eligible, as are subspecialists in these fields. Recipients of the enhanced rates either must be board certified, or at least 60% of the codes they submit to Medicaid in 2012 must be for primary care services.

CMS, in the final rule, also said it would allow nurse practitioners and physician assistants to qualify for the pay bump, provided they're under the supervision of physicians who also qualify for the increase, said Bachrach.

Although more specialists are needed in Medicaid, "the terms of the statute itself don't permit CMS to go any further" than those eligibility designations, she said.

Read the article here.

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