Joseph Rugg's Health Law Blog

CMS, in a press release on Thursday, November 1, announced the adoption of the final rule implementing the part of the Affordable Care Act that primary care physicians be paid 100% of the Medicare rate when they treat Medicaid beneficiaries.  The final rule is over 100 pages long and provides —

Under this provision, certain physicians who provide eligible primary care services will be paid the Medicare rates in effect in calendar years (CY) 2013 and 2014 instead of their usual state-established Medicaid rates, which may be lower than federally established Medicare rates.  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 subspecialists.  States will receive 100 percent federal financial participation (FFP) for the difference between the Medicaid state plan payment amount as of July 1, 2009, and the applicable Medicare rate.

The rule provides information about how CMS and states will work together to make the increased payments operational.  More information can be found in the CMS Fact Sheets.