Primary Care Physicians Get Medicaid Pay Boost; OB/GYNs, ER Physicians Excluded

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CMS has released a final rule (pdf), within the Patient Protection and Affordable Care Act, that will increase Medicaid payments for certain primary care physicians to Medicare rates over the next two years beginning Jan. 1, 2013.

The final rule stated that all primary care physicians in specialties of family medicine, general internal medicine or pediatric medicine (and related subspecialties) will be paid Medicare rates for Medicaid primary care services for calendar years 2013 and 2014. In addition, qualifying physicians will receive higher payments if primary care services are rendered by certain physician extenders — such as nurse practitioners — who work under the qualifying physicians' supervision.

The rates will be based on the difference between applicable Medicare rates and the state's Medicaid plan payments as of July 1, 2009. States will not have to worry about anteing up more Medicaid money to foot the bill, as the federal government will cover 100 percent of the increased payments.

However, CMS denied the increased payments to obstetricians, gynecologists and emergency medicine physicians despite the fact they play a major role in primary care services. "Although we recognize the role that other specialty physicians play in providing primary care services, the authority does not exist to extend the payment to other categories of physicians, including OB/GYNs," CMS officials said in the final rule.

The final rule also said states will have two options when it comes to implementing the increased payments. States can either lock in rates at Medicare levels at the beginning of 2013 and 2014, or they can modify rates that go along with Medicare updates.

Jeffrey Cain, MD, president of the American Academy of Family Physicians, said in a statement that the boost in Medicaid payments for primary care physicians is a "step in the right direction," but Congress must work to "permanently extend and fund this provision" so physicians and patients are not back at square one two years from now.

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