KHN Morning Briefing

Summaries of health policy coverage from major news organizations

CMS Raises Medicaid Rates For Some Doctors

The Centers for Medicare and Medicaid Services announced that, as a part of the health law, primary care and other physicians will see higher payments.

Modern Healthcare: CMS Details Medicaid Primary-Care Payments Boost
The CMS issued a final rule late Thursday temporarily increasing primary-care physician payments from Medicaid. The rule (PDF), which implements a provision of the Patient Protection and Affordable Care Act, details the extent and target of the increase, which takes effect in January and lasts through 2014. The provision is designed to match Medicare rates, but the rule specifically covers only the difference between the Medicare rate and states' Medicaid rates as of July 1, 2009. The additional federal funding may not be enough to increase the rate to Medicare levels because some states have enacted Medicare provider rate cuts since mid-2009 (Daly, 11/1).

CQ HealthBeat: HHS Issues Final Rule Boosting Medicaid Payments For Primary Care
The payment increase is for primary care services delivered by a physician in family medicine, general internal medicine, or pediatric medicine. It also goes to “related sub specialists,” according to a Centers for Medicare and Medicaid Services (CMS) summary, including pediatric cardiologists who are board certified in their specialty. The rule also says the higher payments will be made for primary care services delivered by other medical professionals, such as nurse practitioners, working under the personal supervision of a qualifying physician (Reichard, 11/1).

Kaiser Health News: Capsules: OB/GYNs And ER Docs Excluded From Health Law's Medicaid Pay Hike
While Medicaid doctors’ fees vary by state, they are generally far below those paid by Medicare and private plans. The change, which will cost $11 billion and be funded by the federal government, means a 64 percent average pay increase, according to an Urban Institute analysis of the rates in 2010.
Though the pay hike takes effect Jan. 1, it will likely be several months until many doctors see the higher reimbursements, because states have until March 31 to file paperwork with CMS to detail how they will pay out the money (Galewitz, 11/2). 

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