Analysis of the “Medicaid Parity” Final Rule

Proposed Rule Comments by ACP 

This proposed rule recognizes that ready access to primary care services is a core goal of the Medicaid program, and attempts to ensure through increased payments that a sufficient number of primary care physicians and related specialists /subspecialists participate in the program to meet the needs of this expanded population. More specifically this proposed rule would implement Medicaid payment for primary care services furnished by primary care and related physicians in calendar years 2013 and 2014 at rates not less than the Medicare rates in effect in those years. The federal government would be responsible for the total cost of these added payments during this time period The College is very supportive of the overall goal of this proposed rule and generally supports the specific regulations the rule defines.

Final Rule with Details 

This final rule implements Medicaid payment for primary care services furnished by certain physicians in calendar years (CYs) 2013 and 2014 at rates not less than the Medicare rates in effect in those CYs or, if greater, the payment rates that would be applicable in those CYs using the CY 2009 Medicare physician fee schedule conversion factor. The increased payment is available to eligible physicians participating in a state Medicaid program or a Children’s Health Insurance Program (CHIP) structured as an expansion of the state’s Medicaid program. The increased payment is not available to physicians delivering services within a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) since payment for these programs is made on a facility rather than a services delivered basis. Payment for designated services will be at the rate of 100 percent of the fee as reflected in the Medicare Physician Fee Schedule (PFS). The rate is the full fee---there is no deducted beneficiary co-pay.