The Department of Public Welfare (Department) is implementing Section 1202 of the Patient Protection and Affordable Care Act (ACA). Section 1202 of the ACA requires state Medicaid programs to pay increased fees to qualifying physicians that are no less than the Medicare rates in effect in calendar years (CYs) 2013 and 2014, or if greater, the rates that would be applicable in those CYs using the CY 2009 Medicare Physician Fee Schedule conversion factor (CF). As such, the Department will increase fees for certain Evaluation and Management (E&M) and vaccine administration procedure codes to the extent covered by the Department when furnished by a physician, or under the personal supervision of a physician, in the specialties of family medicine, internal medicine or pediatric medicine, effective January 1, 2013 through December 31, 2014. The fee increase applies to qualified physicians in the above-stated specialties or subspecialties rendering primary care services to MA beneficiaries paid through both the MA Program’s fee-for-service and managed care delivery systems.
Provider Quick Tip(s):
QT #147 was obsoleted by MAB 31-13-11
. See Medical Assistance Bulletin related to "Attestation Form" below.
Medical Assistance Bulletin(s):
Medical Assistance Program Attestation Form:
ACA Primary Care Physician Fee Schedule: (Look for future publication)
Remittance Advice Banner Alert(s):
This virtual classroom training session is designed to provide physicians with information regarding the Department’s implementation of Section 1202 of the ACA relating to MA fee increases for select primary care services.
- Physicians may sign up for virtual classroom training at http://www.dpw.state.pa.us/provider/training/. First, browse to “PROMISe provider education and training” at the bottom right list on the page, then, select “Conference call training”, and from the bottom right list of that page, select “Class offerings on the MA Program’s primary care fee increases.”
Centers for Medicare and Medicaid Services’ (CMS) Final Rule published November 6, 2012:
Medical Assistance Program Fee Increase for Select Primary Care Services Provider Training