Rates for Primary Care Services

The web-based Provider attestation form is available. The link can be found under Provider Attestation Information below.

Overview

Section 1202 of the Affordable Care Act requires that Medicaid reimburse designated primary care providers who provide primary care services and vaccine administration services at rates that are not less than the Medicare fee schedule in effect for 2013 and 2014, or, if greater, at the payment rates that would result from applying the 2009 Medicare physician fee schedule conversion factor to the 2013 or 2014 Medicare payment rates. These reimbursement requirements apply to payments made between January 1, 2013 to December 31, 2014.

Federal Interface

Almost 6 months after issuing proposed rules, on November 6, 2012, the Centers for Medicare and Medicaid Services (CMS) published final rules effective January 1, 2013 that set forth the requirements for State Medicaid Agencies mandated by Section 1202 of the ACA. In response to the many comments to the proposed rules that outlined unaddressed operational questions, burdensome requirements, and the limited time period to comply with the federal provisions prior to the January 1, 2013 implementation date, CMS has authorized States until March 31, 2013 to submit their methodologies to CMS for approval. The final rules clarify that approvals of timely State submissions will be retroactive to January 1, 2013. AHCCCS is in the process of developing its methodologies and will issue further guidance in the near future.

The payment of the enhanced rate is predicated upon CMS approval of the AHCCCS proposed methodologies. Based on information provided by CMS, AHCCCS does not expect approval until July 1, 2013 or later. Therefore AHCCCS anticipates that enhanced payments for qualifying claims by qualifying providers with dates of service on or after January 1, 2013 will not begin until after July 1, 2013, but will be made retroactively to January 1, 2013 once CMS approval is received.

AHCCCS recognizes the significant impact and burden that the federal delay and new federal requirements will place on providers in order to obtain the new funding. AHCCCS and its contracted health plans will follow the procedures, processes and policies that are being developed by the federal government. Although these requirements are mandated by the federal government, AHCCCS apologizes for the increased burden this will place on providers and requests that providers be patient as the agency works through the many challenging issues that result from these new requirements. Please continue to check the webpage for updates on this issue.

Provider Attestation Information

• Primary Care Provider Enhanced Fee Attestation page
• Primary Care Provider Enhanced Fee Attestation memo 2/19/13

Provider General FAQs

• General FAQs Set II 5/21/13 
• General FAQs 4/4/13

Provider Vaccine FAQs

Updated Vaccine FAQs supersede the Vaccine Memo to Providers

• Vaccine FAQs 3/29/13 
• Vaccine Memo to Providers 2/11/13  

CMS FAQs

• CMS FAQ Managed Care 2/28/2013
• CMS FAQ Set IV 2/28/13
• CMS FAQ Set III 1/30/13
• CMS FAQs Set II 1/29/13
• CMS FAQs 12/21/12

Additional Information for Providers

• Provider Forums
• Provider Forum Powerpoint Presentation Tucson 3/13/2013
• Provider Forum Powerpoint Presentation Phoenix 2/28/2013
• PCP Info Memo 12/21/12

Regulatory Updates

• SPA 13-002 Primary Care Service Payments 3/18/2013
• AHCCCS Notice of Public Information 11/30/12

CMS Rule

• CMS Final Rule Correction 12/14/12
• CMS Final Rule 11/6/12
• AHCCCS Comments to Proposed Rule 6/7/12
• CMS Proposed Rule 5/11/2012

Additional questions may be directed to the following e-mail address:
PrimaryCareRates@azahcccs.gov