Rule Would Boost Payment for Primary Care

The Centers for Medicare and Medicaid Services expects soon to publish a proposed rule that will have significant revenue ramifications for primary care physicians.

Mandated under Section 1202 of the Affordable Care Act, the rule would require state Medicaid agencies to pay at least the Medicare rates in affect for 2013 and 2014 for primary care services. These include services delivered by physicians with a specialty designation of family medicine, general internal medicine or pediatric medicine.

“This rule would implement the statutory payment provisions uniformly across all states,” according to a CMS explanation. “Specifically, this proposed rule would define, for purposes of enhanced federal match, eligible primary care providers and identify eligible primary care services, as well as specify how the enhanced payment should be calculated. This proposed rule also would provide general guidelines for implementing the enhanced payment for managed care services.”

CMS has sent the proposed rule for review to the Office of Management and Budget, which is one of the last steps before publication in the Federal Register.