CMS has released a proposed rule and accompanying fact sheet on 2013 and 2014 payment increases for Medicaid primary care services delivered by primary care providers. CMS proposes to define primary care providers as physicians Board-certified with specialty designations of family medicine, general internal medicine, or pediatric medicine or related subspecialists recognized by the American Board of Medical Specialties, or, physicians who are not Board-certified but practice primary care and have furnished evaluation and management (E&M) services and vaccine administration services for at least 60 percent of their Medicaid codes billed during the most recent calendar year.
The payment increase would apply to certain services CMS designates as “primary care services,” including E&M and certain vaccine administration codes. The payment increase applies to services paid through traditional state Medicaid programs and Medicaid managed care plans. The two-year payment increase stems from the Patient Protection and Affordable Care Act and will coincide with an estimated additional 16 million new Medicaid beneficiaries who will become eligible for the program in 2014.