MEDICAID FEES TO INCREASE JANUARY 2013
Beginning January, 2013, state Medicaid programs must begin paying physicians more for providing primary care services. The Affordable Care Act boosts traditionally low Medicaid rates to Medicare levels for 2013 and 2014 for certain primary care services. For Arkansas, this will mean rate increases averaging 25 percent or more.
The increased primary care payments will be available to physicians specializing in family medicine, general internal medicine, or pediatric medicine. AMS understands that adult and pediatric subspecialists such as cardiologists, endocrinologists, and gastroenterologists, can also take advantage of the increased payments. AMS is currently working with Arkansas Medicaid officials to submit an amendment to the AMS v. Reynolds consent decree in order to implement the changes. The consent decree came out of a lawsuit brought by the AMS in the 1990’s, the result of which is an order from federal court that Medicaid cannot unilaterally change physician fees without support from the Arkansas Medical Society.
The specific services covered by the rule are: E&M codes 99201 through 99499 and vaccine administration codes 90460, 90461, 90471, 90472, 90473 and 90474 (or successor codes, where applicable). CMS has also finalized rules to create higher payment for following E&M codes that are not paid by Medicare:
- New Patient/Initial Comprehensive Preventive Medicine-codes 99381 – 99387;
- Established Patient/Periodic Comprehensive Preventive Medicine-codes 99391 – 99397;
- Counseling Risk Factor Reduction and Behavior Change Intervention-codes 99401 – 99404, 99408, 99409, 99411, 99412, 99420 and 99429;
- E&M/Non Face-to-Face physician service-codes 99441 – 99444.
More to come as Arkansas Medicaid determines how to implement these changes.