CMS Issues Final Rules on Medicaid, Medicare Provider Payment Rates

On Thursday, CMS issued a final rule for a provision of the Affordable Care Act scheduled to take effect in January that temporarily increases Medicaid's payment rate for primary care physicians to match Medicare payment rates, Modern Healthcare reports.

The rule specifies that the federal government pay 100% of the difference between the Medicaid state rates and the applicable Medicare rate as of July 1, 2009. The rule applies only in calendar years 2013 and 2014 (Daly, Modern Healthcare, 11/1).

The payment increase applies to physicians practicing in family medicine, general internal medicine, pediatric medicine and related subspecialties, such as board certified pediatric cardiologists. The rule clarifies that primary care services delivered by medical professionals working under the personal supervision of a qualifying physician, such as nurse practitioners, also are eligible for the higher payment rate (Reichard, CQ HealthBeat, 11/1).

Physicians React

In a news release, the American Academy of Family Physicians praised the increase, stating that it will help prevent more physicians from no longer accepting Medicaid beneficiaries as new patients.

However, AAFP President Jeffrey Cain said, "Unless Congress acts to permanently extend and fund this provision, a sudden return to disparate and inadequate payment for primary care services needed by Medicaid patients after only two years will again threaten to restrict their access to such needed services" (Modern Healthcare, 11/1).

Medicare Sets 2013 Physician Fee Schedule

In related news, CMS on Thursday issued a final rule that would increase Medicare reimbursements for family physicians in 2013 by 7%, and reimbursements for other primary care providers by 3% to 5%, MedPage Today reports.

Under the rule, providers will receive a separate payment for coordinating care during the first 30 days of patients transitioning from a hospital or skilled nursing facility back to the community (Pittman, MedPage Today, 11/1).

The final rule also would narrow the number of physician practices affected by the physician value-based payment modifier from those with at least 25 medical professionals to those with 100 or more eligible professionals. The physician value-based payment modifier is a tool that adjusts payments to individual physicians or physician groups by comparing the quality of care they provide Medicare beneficiaries with costs (Adams, CQ HealthBeat, 11/1).

In a news release, the American Medical Associated said it was "pleased" with the new rule, but that it "reminds patients, physicians and Congress that the time to act to prevent looming Medicare cuts is now. Without quick Congressional action, physicians who care for Medicare patients will be hit with a 26.5 percent cut in payments on January 1 due to the flawed Medicare physician payment formula" (AMA release, 11/1).