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Provider rate changes under the Affordable Care Act

Background

Section 1202 of the Affordable Care Act amends sections 1902(a)(13), 1902(jj), 1905(dd) and 1932(f) of the Social Security Act to require payment of the Medicare rate for certain Medicaid primary care services provided in calendar years 2013 and 2014. This provision applies to evaluation and management (E&M) and vaccine administration services when delivered by a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine.

States will be eligible to receive 100 percent FMAP (federal match) for the increased expenditures equal to the difference between the Medicare rate and the State Plan rate as of July 1, 2009, for these same services. This applies to both fee-for-service claims and managed care payments. The final rule also will update the interim regional maximum fees that providers may charge for vaccine administration under the Vaccines for Children (VFC) program.

Physician Attestation Form

Each eligible physician must submit the attestation form to qualify for enhanced payments. If you have questions regarding your eligibility, please review the FAQ document (below) and other information provided on this site. Forms can be submitted by fax at (360) 586-7498 or email at prvrates@hca.wa.gov

Provider attestation form

The Attestation Form has been updated to include information about advanced non-physician practitioners (ARNPs and PA-Cs). These individuals may qualify for enhanced payment if supervised by eligible physicians. Please note that the Attestation Form must be filled out by the supervising physician, not the ARNP/PA-C.

Instructions

The form consists of two pages. Physicians who do not supervise ARNPs or PA-Cs will fill out and submit page one only. Physicians who supervise ARNPs or PA-Cs will fill out and submit both pages of the form. Please review the FAQ document (below) for additional information.

Related links for providers

• Frequently Asked Questions - list of frequently asked questions about the rate changes. FAQ has been updated (as of 3/19/2013) Updated information includes the following subjects: FQHC/RHC, billed charges, and modifier usage.
• Eligible codes - list of all eligible codes involved in the rate changes. The 2013 enhanced fees have been added to each code.
• Provider Information - to expedite the processing of the attestation forms, we encourage large clinics/groups to populate this file with their provider information and submit it via email to prvrates@hca.wa.gov. Please note that submitting this file does not replace the individual attestation forms.
• Federal rule on ACA rate changes - final rule posted by the Department of Health and Human Services
• Federal Q&A on provider rates - includes Fee For Service and Managed Care