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HHS finalizes higher payments to primary care physicians

By Jennifer Bresnick

Health and Human Services (HHS) secretary Kathleen Sebelius has announced the final rule implementing higher payments to primary care physicians treating Medicare and Medicaid patients. The new rule raises reimbursement rates to ensure physicians are paid the same for treating Medicare and Medicaid patients, without raising costs for the state.

Secretary Sebelius states that “by improving payments for primary care services, we are helping Medicaid patients get the care they need to stay healthy and treat small health problems before they become big ones.”

The payment increase allows physicians to receive the newly established Medicare rates instead of their state-established rates, which may be lower, and applies to primary care physicians operating in the areas of family medicine, internal medicine, or pediatric medicine and its related subspecialties. States will receive 100% federal financial participation (FFP) for the difference between the Medicaid state plan payment amount of July 1, 2009 and the applicable Medicare rate.

The CMS fact sheet on the final rule states that the rule permits states to lock in rates at the level of the Medicare physician fee schedule in effect at the beginning of 2013 and 2014 or modify the rates in alignment with all updates by Medicare. It also provides for payment of vaccine administration for pediatric patients under the VFC program at the lesser of the VFC regional maximum administration fee (the VFC “ceiling”) or the Medicare rates in 2013 and 2014. Because the VFC ceiling rates were issued in 1994 and have never been updated, the rule also updates these rates using the Medicare Economic Index, which is a measure of medical practice cost inflation.

The complete rule can be accessed from the Federal Registrar.

 

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