In tandem with the Patient Protection and Affordable Care Act's Medicaid expansion was a provision to temporarily boost Medicaid payment rates for primary-care physicians. Implementation has been slow on the fee-for-service side and even slower for Medicaid managed-care services.
The increase is supposed to apply to services rendered between Jan. 1, 2013, and Dec. 31, 2014. The CMS has promised to pay make retroactive payments going back to the first of this year. Texas physicians recently received some clarity on when to expect their payments.
In a letter last week to the state's physicians, the Texas Health and Human Services Commission said the CMS asked it in May for more information on the proposed methodology for increasing the Medicaid managed-care rate. Then, in September, it asked for more.
“Because of the time needed for system changes to calculate and process payments, we anticipate beginning to pay the rate increase by March 1, 2014, in the form of quarterly supplemental payments to eligible providers,” Kay Ghahremani, the Texas Medicaid director, wrote in the letter. “We will expedite this timeline if at all possible.”
Not only has the CMS been slow in processing the payment increases, but doctors have not been responding quickly to meet requirements associated with the increases. In an “Action Special Report” to its members, the Texas Medical Association stated that, out of the estimated 25,000 Texas doctors eligible to receive the Medicaid payment increase, only about 15,300 have completed the attestation process certifying that they meet the eligibility requirements for increased pay.
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