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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

Affordable Care Act - Primary Care Rate Increase

 

IMPORTANT NOTICE

Attestation for the ACA PCP payments ends December 31, 2014. No further attestations will be accepted after that date.
ACA PCP payments will end for ACA PCP services provided on or after January 1, 2015.

This page is for informational purposes only. No one can attest after December 31, 2014.

According to Section 1202 of the Affordable Care Act (ACA) – which amends Section 1902(a)(13(c) of the Social Security Act – the Medicaid program is federally required to pay at the Medicare rate for certain primary care services and to reimburse 100% Medicare Cost Share for services paid in calendar years 2013 and 2014. The ACA payments will stop for all dates of service on or after January 1, 2015. 

Section 1902(a)(13)(C) now specifies that physicians with a primary specialty designation of family medicine, general internal medicine or pediatric medicine are primary care providers. Those who render evaluation and management codes and services related to immunization administration for vaccines and toxoids for specified codes would be eligible for reimbursement.

In order to qualify for the reimbursement, the following requirements must be met:

  • Be a physician defined in 42 CFR 440.50, or under the personal supervision of a physician with special designation in family practice, general internal medicine and pediatrics or a subspecialty recognized by the American Board of Medical Specialties (ABMS), the American Osteopathic Association (AOA), or the American Board of Physician Specialties(ABPS);

  • Be board certified in the specialty or subspecialty, or;

  • Have furnished Evaluation and Management (E&M) and vaccines services that equal at least 60% of the Medicaid codes billed during the most recently completed Calendar Year*

Note: The 60% threshold will be validated by DMA’s Fiscal Agent

 

 

 

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