Centers for Medicare and Medicaid Services: Final Rule on Medicaid Payments for Certain Primary Care Providers

This final rule from the Centers for Medicare and Medicaid Services (CMS) implements section 1202 of the Health Care and Education Reconciliation Act (HCERA), which authorizes increased payments during calendar years 2013 and 2014 to Medicaid primary care providers at rates equivalent to payments to Medicare primary care providers.

Primary care providers are defined as family physicians, internists, and pediatricians that attest that they are board-certified and that at least 60% of their Medicaid billings are for primary care evaluation and management services. Federally Qualified Health Centers, who already receive enhanced Medicaid payment rates, are not eligible for these increases.

CMS estimated the cost of implementation of the two-year HCERA section 1202 to be $11.89 billion

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