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Temporary Medicaid primary care rate increase ends

Despite strong opposition from the Wisconsin Medical Society—and organized medicine—the Affordable Care Act’s (ACA) two-year Medicaid Primary Care Incentive Payment ended as scheduled Dec. 31, 2014.

The temporary incentive was a provision included in the ACA to bring the reimbursement rates for Medicaid primary care services into parity with Medicare primary care rates, as the ACA expanded access to the uninsured, partially through Medicaid. Designed to encourage physicians and other providers to accept new Medicaid patients and increase access, the incentive boosted Medicaid reimbursement for primary care services by as much as 46 percent over two years, according to a recent report from the Urban Institute.

The Society advocated actively to extend the increase (see this Sept. 25 Medigram article) and was in communication with U.S. Rep. Ron Kind’s office, which was attempting to extend the increase during the negotiations of the $1.1 trillion funding bill. However, Congress passed the bill in December without extending the increase.

Fortunately, many physicians in Wisconsin took advantage of the increase while it lasted. Eligible physicians were those who submitted claims with at least 60 percent of procedure codes coming from the code group identified by the rule or practiced as primary care providers certified with an eligible specialty or subspecialty by one of the certifying boards named in the Centers for Medicare and Medicaid Services (CMS) Final Rule (CMS-2370-F). Nearly 6,000 Wisconsin physicians self-attested and approximately 800,000 encounters were identified by the state’s Department of Health Services as eligible for the incentive increase in 2013 alone.

Back to January 8, 2015 Medigram