ACA Provision Increasing State Medicaid Coverage for Primary Services Now in Effect

January 11, 2013

A provision included in the Affordable Care Act requiring state Medicaid programs to begin paying for primary care services and vaccine administration at rates no lower than Medicare is now in effect as of January 1. The payment increases apply to states’ Medicaid fee schedules, Medicaid managed care plans, and state Children’s Health Insurance Program Medicaid expansion plans. Oncologists may qualify for these increased payments, but they must self-attest that they are either Board-certified in an eligible specialty or sub-specialty (medical oncology and hematology are both included as eligible), and/or that 60 percent of their Medicaid claims for the prior year were for the evaluation and management codes specified in the regulation.

The regulations will remain in effect through the end of 2014. Please see the Center for Medicare and Medicaid Services Frequently Asked Questions for additional information.