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website. This survey will take approximately two minutes. Your responses will help
us ensure that you have a high quality experience.
Section 1202 of the Affordable Care Act requires that Medicaid reimburse designated
primary care providers who provide primary care services and vaccine administration
services at rates that are not less than the Medicare fee schedule in effect for
2013 and 2014, or, if greater, at the payment rates that would result from applying
the 2009 Medicare physician fee schedule conversion factor to the 2013 or 2014 Medicare
payment rates. These reimbursement requirements apply to payments made between January
1, 2013 to December 31, 2014.
Almost 6 months after issuing proposed rules, on November 6, 2012, the Centers for
Medicare and Medicaid Services (CMS) published final rules effective January 1,
2013 that set forth the requirements for State Medicaid Agencies mandated by Section
1202 of the ACA. In response to the many comments to the proposed rules that outlined
unaddressed operational questions, burdensome requirements, and the limited time
period to comply with the federal provisions prior to the January 1, 2013 implementation
date, CMS has authorized States until March 31, 2013 to submit their methodologies
to CMS for approval. The final rules clarify that approvals of timely State submissions
will be retroactive to January 1, 2013. AHCCCS is in the process of developing its
methodologies and will issue further guidance in the near future.
The payment of the enhanced rate is predicated upon CMS approval of the AHCCCS proposed
methodologies. Based on information provided by CMS, AHCCCS does not expect approval
until July 1, 2013 or later. Therefore AHCCCS anticipates that enhanced payments
for qualifying claims by qualifying providers with dates of service on or after
January 1, 2013 will not begin until after July 1, 2013, but will be made retroactively
to January 1, 2013 once CMS approval is received.
AHCCCS recognizes the significant impact and burden that the federal delay and new
federal requirements will place on providers in order to obtain the new funding.
AHCCCS and its contracted health plans will follow the procedures, processes and
policies that are being developed by the federal government. Although these requirements
are mandated by the federal government, AHCCCS apologizes for the increased burden
this will place on providers and requests that providers be patient as the agency
works through the many challenging issues that result from these new requirements.
Please continue to check the webpage for updates on this issue.
Updated Vaccine FAQs supersede the Vaccine Memo to Providers
Additional questions may be directed to the following e-mail address: