1st Quarter 2013 ACA Primary Care Physician Supplemental Payment

1st Quarter 2013 ACA Primary Care Physician Supplemental Payment

As communicated in BT201247, BT201255, and BT201302, for qualifying primary care services furnished by self-attested qualifying providers, the ACA implements temporary Medicaid payments at rates which are the lesser of (1) the Medicare rates in effect for CY 2013 and CY 2014, or, if greater, the rates that would be applicable in those CYs using the CY 2009 Medicare physician fee schedule conversion factor or (2) the provider's actual billed charge for the service.  Under the Vaccines for Children (VFC) program, the ACA implements vaccine administration rates at the lesser of (1) the CY 2013 or CY 2014 Medicare rate or (2) the maximum regional VFC rate in those years.  The rate differential between the ACA-implemented rate and the current Indiana Medicaid State Plan rate,  will be distributed to self-attested qualifying providers for qualifying services provided to FFS members, including those dually eligible for both Medicare and Medicaid, in a quarterly supplemental payment.

The Indiana Health Coverage Programs (IHCP) has completed the first quarter 2013 ACA Primary Care Physician supplemental payment for qualifying services provided to fee-for-service members.  Self-attested, qualifying providers will see the supplemental payment in their remittance advice dated August 6, 2013.

Supplemental payments for services provided to managed care members will be forthcoming following CMS approval.