Primary Health Care Providers – Do You Feel The Pinch?
It had been nice although it lasted – as a result of provision from the Patient Protection and cost-effective Care Act (“ACA”), services provided by certain primary health care providers (“PCPs”) were susceptible to an improved payment rate for Calendar Years 2013 and 2014. These PCPs needed (a) been Board certified within the niche designation of family medicine, general internal medicine or pediatric medicine and have a subspecialty designation identified by specific boards or associations, or (b) furnished greater than 60% of claims in specific evaluation and management or vaccine administration services under certain codes to possess been qualified of these enhanced payments. The instalments elevated to the stage from the Medicare Medicare Part B fee schedule rate (unless of course the particular billed charge for that service was lower), and providers had until April 1, 2013 to self-verify being qualified. The rise put on both fee-for-service and managed care State medicaid programs plans.
Essentially, the us government supplemented the condition State medicaid programs payment rate, raising it towards the Medicare rate for 2 years, being an inducement for additional primary health care providers to supply choose to State medicaid programs recipients because the provisions from the Affordable Care Act required full effect. Services supplied by non-physician practitioners qualified with this enhanced rate when delivered underneath the supervision of the qualifying physician.
Sadly, the time for enhanced payment has become over. A six-month claim run-out period was permitted for claims for services in CY 2013-2014 and then any adjustments or corrections, and also the Kentucky Department for State medicaid programs Services published an update for their website in mid-September, proclaiming that “[t]he final cycle for that adjusted primary care payment rate, including the claim run-out period along with the reconciliation, will process October 1, 2015.”
For providers who trusted these enhanced payments, the finish of the program only brings into sharp relief the crisis in low reimbursement rates underneath the State medicaid programs program. The failure of Congress to increase what is called the “Medicaid Primary Care Pay Parity” program could eventually cause providers to start to decrease State medicaid programs patients to be able to stay afloat. Based on the Kaiser Family Foundation, 15 states have selected to carry on the improved payment program from condition coffers, but Kentucky isn’t included in this. Time will inform when the finish of enhanced payment rates will affect the amount of care open to Kentucky State medicaid programs recipients, but providers in Kentucky are most likely already feeling the pinch.
 42 CFR 447.400
 42 CFR 447.405
 Kentucky Department for Medicaid Services, http://chfs.ky.gov/dms (Last Accessed September 29, 2015)
 Kaiser Family Foundation, “The ACA Primary Care Increase: State Plans for SFY 2015” http://kff.org/medicaid/perspective/the-aca-primary-care-increase-state-plans-for-sfy-2015/ (Oct. 28, 2014, Last Accessed September 29, 2015)