Officials at the U.S. Centers for Medicare and Medicaid Services, part of the Department of Health and Human Services, issued a final rule to implement a provision of the Affordable Care Act that provides for the increased payments.
The payment increase applies to primary care services delivered by a physician with a specialty designation of family medicine, general internal medicine or pediatric medicine or related sub-specialists.
Specifically, states will receive 100 percent federal financial participation for the difference between the Medicaid state plan payment amount as of July 1, 2009, and the applicable Medicare rate.
Eligible primary care services will be paid the Medicare rates in calendar years 2013 and 2014 instead of their usual state-established Medicaid rates, which may be lower than federally established Medicare rates.
The rule provides information on how the policy applies to the Vaccines for Children program.
Under the Affordable Care Act, primary care services eligible for the higher Medicaid payment must be delivered by a physician who specializes in family medicine, general internal medicine, or pediatric medicine -- or certain physician sub-specialists such as pediatric cardiologists or practitioners including nurse practitioners working under the personal supervision of a qualifying physician.
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