Higher Payments And New Eligibility Categories Coming To Indiana Medicaid

Medicare Medicaid Parity Payments for 2013 and 2014

The Centers for Medicare and Medicaid Services (CMS) recently released their final regulation for section 1202 of the Affordable Care Act.  The regulation provides guidance and funding for states to increase Medicaid payments to primary care physicians for two years. From January 1, 2013 to December 31, 2014 when a family physician sees a Medicaid patient the physician will receive payment at Medicare rates for the following codes:

  • E/M codes 99201 through 99499
  • Vaccine administration codes 90460, 90461, 90471, 90473 and 90474

To receive the federal funding, Indiana’s Family and Social Services Agency (FSSA) must submit a state plan amendment to CMS. FSSA has confirmed that they are already drafting the state plan amendment and will have it submitted to CMS in advance of the deadline.

The IAFP has been informed that Medicaid currently plans to pay physicians the increase in lump sum quarterly payments. Claims should be paid normally at the current Medicaid rates, then at the end of every quarter each physician’s claims will be reviewed, the increase due to the physician would be calculated, and then Medicaid will remit the extra payment to the physician.

Qualifying for the additional payment should be easy. Right now Medicaid says that all a physician must do is be enrolled in Medicaid and board certified in family medicine, general internal medicine, or pediatric medicine. Alternatively a physician may qualify if they are enrolled in Medicaid and 60% of the codes billed to Medicaid in 2012 were qualifying E/M and vaccine administration codes.

Physicians who plan to apply to become new Medicaid providers in 2013 or 2014 who are not board certified can also qualify if 60% of the codes they billed to Medicaid in the last month were the qualifying E/M or vaccine administration codes.

Please read the attached November 27th bulletin from Medicaid and look out for more information from Medicaid and the IAFP in December and January.

New Eligibility Category for Indiana Medicaid

Indiana Medicaid is announcing a new benefit package for men and women under 133% of the federal poverty level. This new package provides family planning services for men and women who meet income qualifications and do not qualify for another Medicaid program.

The new program is a result of CMS accepting Indiana’s 1115 waiver request to expand family planning services to this population. Coverage under this program should be available starting January 1, 2013.

For more information please see the bulletin released by Indiana Medicaid November 21st and look out for more information from the IAFP and Medicaid in December.