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Medicaid payments to increase for primary care

Thursday November 1, 2012
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The Department of Health and Human Services has finalized a rule establishing higher payments for primary care practices that care for Medicaid beneficiaries.

The rule, established by the Affordable Care Act and taking effect Jan. 1, 2013, through the end of 2014, raises rates to ensure physicians receive the same payment rates for treating Medicare and Medicaid beneficiaries, without raising costs for state Medicaid programs.

The rule is intended to encourage primary care practices to accommodate several millions of new patients who are scheduled to enroll in Medicaid as part of the expansion of that program in accordance with the ACA. The Congressional Budget Office has estimated that 7 million people will enroll in Medicaid and the Children’s Health Insurance Program when the expansion begins in 2014.

Former Massachusetts Gov. Mitt Romney has said he would seek to repeal the ACA if elected president Nov. 6. However, the Obama administration is proceeding as if the law will continue in its current form.

The rule applies to physician practices in family medicine, general internal medicine and pediatric medicine, and related subspecialists. The rule clarifies that the higher payment will be made for primary care services rendered by clinicians, such as nurse practitioners, working under the personal supervision of any qualifying physician.

"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."

In addition to payment improvements, the ACA contains numerous initiatives designed to bolster primary care and strengthen the primary care workforce, including new investments in NP and physician assistant training, an expansion of medical residency positions for primary care physicians and a significant expansion of the National Health Service Corps, which provides scholarships and loan repayments to primary care providers who practice in underserved areas.

More information on the new rule is available in a Centers for Medicare & Medicaid fact sheet: http://tinyurl.com/b3co5d9.

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