The Affordable Care Act (ACA), Section 1202 of the Health Care and Education Reconciliation Act of 2010, allows increased payment for certain Medicaid primary care services provided by certain qualified primary care providers. Additional information about the increased payments is available on the department’s website at ACA PCP Rate Increase Provider Notice (PDF) (html).
In order to receive the enhanced payments, the physician must attest to providing the primary care services within a specialty designation of family medicine, general internal medicine or pediatric medicine. Specialists and subspecialists providing primary care services within these designations as recognized by the American Board of Medical Specialties (ABMS), the American Osteopathic Association (AOA) or the American Board of Physician Specialties (ABPS) also qualify for the enhanced payments. In addition, the physician must attest that they meet at least one of the following criteria:
- Hold board certification from the American Board of Medical Specialties, the American Board of Physician Specialties or the American Osteopathic Association in pediatric medicine, internal medicine or family medicine or an associated subspecialty, or
- 60% of the Medicaid codes paid during the most recently completed calendar year or for newly eligible providers, the prior month, were for eligible procedure codes specified in the regulation.
To apply for the Primary Care Provider Incentive Payment Program (PCP), applicants may utilize the Medical Electronic Data Interchange (MEDI) website. Once logged onto the MEDI System, please select the Primary Care Attestation link and complete the application and submit.
After submitting the application, physicians must check the listing of NPIs below to verify the application has been approved. This listing will be updated weekly.
Processing of the Enhanced Payments for Primary Care
The department has begun processing the enhanced payments for primary care services as established under the Affordable Care Act (ACA).
Services eligible for the enhanced payments will initially be paid at the department’s fee schedule rate. The incremental increases, or the difference between the department’s fee schedule rate and the rate allowed under the ACA, will be paid as adjustments.
The department is currently processing adjustments for dates of service January 1, 2013 through June 30, 2013. After the initial adjustments are completed, they will be processed on a monthly basis.
Providers will begin receiving remittance advices over the next several days. These adjustments can be identified by the following:
Bureau Code: “D – Bureau of Comprehensive Health Services NIPS/ Pharmacy”
Process type/Reason codes:
22D/ 3313-ACA PCP Payment (Use for ACA payment add on only)
22C/ 3314-ACA PCP Payment Void (Use for void of ACA payment add on only)
Please note: During the first three weeks of adjustment processing, the adjustment amounts for vaccine administration were inadvertently reduced by $6.40 each. That problem has been corrected. The department will make an additional payment adjustment of $6.40 per occurrence for the affected claims.