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AHCCCS continues to monitor whether Congress will authorize continued federal funding for enhanced reimbursement for eligible primary care services for dates of service on and after January 1, 2015. To date, no such funding has been allocated. Should Congress not approve the enhanced payments for 2015 in the next few months, AHCCCS will discontinue the enhanced reimbursement for eligible primary care services for dates of service beginning January 1, 2015.
Congress has occasionally authorized expenditures that take effect retroactively. In the event that Congress approves the enhanced federal funding for eligible primary care services after January 1, 2015, AHCCCS will notify providers and MCO’s of the process for obtaining such reimbursement.
Summary of information related to enhanced rates for Primary Care Services
Pursuant to federal law the AHCCCS Administration will be increasing reimbursement for primary care services furnished by or under the personal supervision of certain physicians for dates of service January 1, 2013 through December 31, 2014. The increased payments are required by Sections 1902(a) (13), 1902 (jj), 1905 (dd) and 1932(f) of the Social Security Act and federal regulations in 42 CFR Parts 438, 441, and 447. These regulations are described in the final rule published in 77 Federal Register 66670 on November 6, 2012.
The increased payments are mandated by Section 1202 of the Affordable Care Act (ACA) which requires Medicaid programs to pay fees to designated physicians that are no less than the Medicare fee schedule in effect for 2013 and 2014 or the fee schedule rate that would result from applying the 2009 Medicare physician fee schedule conversion factor to the 2013 or 2014 Medicare payment rates, whichever is greater. The increased payment requirements apply to primary care and vaccine administration services described by the following codes:
Current Procedural Terminology (CPT) Evaluation and Management (E&M) Codes 99201 through 99499, and
Increased payment rates may apply to nurse practitioners (NP) and physician assistants (PA) when they practice under the supervision of a qualified physician.
Physicians who meet the criteria below must complete the online Attestation form to receive enhanced reimbursement.
Self-attest as practicing in family medicine, general internal medicine or pediatric medicine or a subspecialty of family medicine, general internal medicine, or pediatric medicine recognized by the American Board of Medical Specialties, the American Osteopathic Association, or the American Board of Physician Specialties.
AND the physician must also self-attest to being either:
1) Board certified with a specialty designation of family medicine, general internal medicine, or pediatric medicine, or a subspecialty of family medicine, general internal medicine, or pediatric medicine recognized by the American Board of Medical Specialties, the American Osteopathic Association, or the American Board of Physician Specialties ( refer to the application form)
2) A primary care physician or subspecialist who works in one or more of the above specialty designations but who does not have a certification specified in number 1 above but has billed at least 60% of Medicaid (AHCCCS) services using the E&M and vaccine administration codes listed above. For physicians registered as AHCCCS providers in Calendar Year (CY) 2012, the 60% billing requirement applies to Medicaid (AHCCCS) claims billed during the 2012 calendar year. For physicians who registered as AHCCCS providers in CY 2013 or 2014, the 60% billing requirement applies to Medicaid (AHCCCS) claims billed for the month prior to the successful attestation.
Recent CMS clarification
We have recently received further guidance from CMS (Center for Medicare & Medicaid Services) regarding the provider qualifications for primary care service enhanced payments for physicians who self-attest that they are board certified. In order to qualify for the enhanced reimbursement, under the board certification option, physicians must attest as being board certified (as outlined above) by providing the begin date and the end date (or renewal date) of the board certification.
PCP Board Certifications for Enhanced Payments– Deadline Extension
For those providers who received a request to submit a copy of their board certification, the deadline
for submission has been extended to July 31, 2013.
In addition, CMS recently received information from the American Board of Medical Specialties (ABMS) attesting that the American Board of Allergy and Immunology (ABAI) is an ABMS-recognized sub-discipline of the American Board of Pediatrics and the American Board of Internal Medicine, making their board certification eligible for enhanced payments. As with all other board certifications, the certification from ABAI must be current to qualify for enhanced payments.
If you fall into this category, please complete:
Certification and Attestation for PC Rate Increase Form A
NOT AVAILABLE AFTER 12/31/14
and
Revised Primary
Care Physician Certification formNOT AVAILABLE AFTER 12/31/14
or
Form BNOT AVAILABLE AFTER 12/31/14
and fax to Provider Registration at 602-256-1474.
Online Attestation:
After reviewing the instructions below - follow this link to the AHCCCS Online website
NOTE: If you are unable to attest online, please email OIGProvider@azahcccs.gov to request paper forms.
Online Attestation for a Physician (MD) and/or Osteopath (DO) NOT AVAILABLE AFTER 12/31/14 :
All corrections/changes, after attestation, will need to be sent to
OIGProvider@azahcccs.gov, and may be required to complete additional forms
For a physician who has attested and wants to include PAs or NPs under his/her supervision the Supplemental Form B must be completed for each NP and PA. To complete the Supplemental Form B:
All corrections/changes, after attestation, will need to be sent to
OIGProvider@azahcccs.gov, and may be required to complete additional forms
