- Copyright © 2013 by the American Academy of Pediatrics
Pediatricians in a number of states are seeing increased Medicaid payments for certain primary care services, and physicians in additional states can expect increases soon.
A provision of the Affordable Care Act (ACA) requires that primary care physicians with specialty designations of pediatric medicine, family medicine and/or general internal medicine receive increased Medicaid payments for certain evaluation and management and vaccine administration services to Medicare levels for 2013-’14.
In June, the Academy participated in a call with the Centers for Medicare & Medicaid Services (CMS) to discuss the status of the Medicaid payment increase and remaining hurdles to full implementation. Joining the Academy on the call were the American Medical Association, American Academy of Family Physicians, American Osteopathic Association and American College of Physicians.
States have been working to implement the increase for both Medicaid fee-for-service and managed care arrangements since CMS released the final rule in November 2012. State plans to determine the increased rates were due to CMS by March 31, and CMS had 90 days to review and approve them. However, this process meant that six months into 2013, the vast majority of states had yet to begin paying physicians at the higher levels.
CMS indicated that 19 states (Alabama, Arkansas, Florida, Idaho, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maryland, Maine, Michigan, Missouri, Montana, Ohio, Pennsylvania, South Carolina, Vermont and Wyoming) began making increased payments to eligible physicians participating in Medicaid fee-for-service plans in June. CMS also indicated another five states (Colorado, Connecticut, Mississippi, Oregon and Washington) would begin paying physicians in Medicaid fee-for-service plans in July.
As for Medicaid managed care programs, CMS said two states (Maryland and Massachusetts) began paying eligible physicians in June, while another seven states (Colorado, Florida, Indiana, Mississippi, Ohio, Oregon and Pennsylvania) should begin paying physicians in managed care programs soon.
While progress is encouraging, the Academy recognizes that there still is work to do to ensure that all eligible pediatricians in all states receive their increased Medicaid payments as soon as possible. The Academy continues to work at all levels to advocate for a more prompt implementation of the Medicaid payment increase.
For more information on the ACA 2013-’14 Medicaid payment increase, including state self-attestation forms and other documents, visit www.aap.org/medicaidpaymentincrease.