Rates for Primary Care Services

The web-based Provider attestation form is available. The link can be found under Provider Attestation Information below.

 

Overview

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.

 

Federal Interface

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.

On July 18, 2013 those providers who received a request to submit a copy of their board certification, the deadline for submission has been extended to July 31, 2013. Refer to the PCP page for more information.

On July 2, 2013, CMS approved AHCCCS’ financial methodologies. 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 August 1, 2013, but will be made retroactively to January 1, 2013 or the individual provider attestation date if attestation was made on or after 5/1/2013.

  • AHCCCS' Financial Methodologies [PDF]
  • CMS Letter Approving Methodologies 7/2/13 [PDF]

  • On June 27, 2013, AHCCCS submitted Managed Care Organization (MCO) contract amendments to CMS. As noted in the CMS approval letter dated 7/2/13, this requirement is the final step for Federal approval to implement the primary care increase. AHCCCS anticipates written approval of these amendments by July 31, 2013, and further anticipates implementation of the rate increases on August 1, 2013.

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.

 

Provider Attestation Information

 

Provider Reimbursement Rates

 

Provider General FAQs

 

Provider Vaccine FAQs

Updated Vaccine FAQs supersede the Vaccine Memo to Providers

 

CMS FAQs

 

Additional Information for Providers

 

Regulatory Updates

 

CMS Rule

 

Additional questions may be directed to the following e-mail address:
PrimaryCareRates@azahcccs.gov

 

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