Notice of Retroactive Self-Attestation for the Increased Payment for Qualifying Primary Care Services
The Affordable Care Act (ACA) requires that Medicaid reimburse eligible primary care practitioners at parity with Medicare rates in 2013 and 2014 for certain evaluation and management (E&M) codes, as well as reimburse eligible practitioners at a higher rate for qualifying vaccine administration codes (42 CFR 447.400(a)). Prior to receiving the increased rate, eligible providers must self-attest to a specialty designation of family medicine, general internal medicine, pediatric medicine or a qualifying subspecialty defined by the following recognized boards: the American Board of Physician Specialties (ABPS), the American Osteopathic Association (AOA), or the American Board of Medical Specialties (ABMS).
Providers who fall under these specialties or subspecialties must also self-attest that:
- They are Board-certified in the specialty or subspecialty to which they attest; and/or
- At least 60 percent of all the provider’s billed codes, in the most recently completed calendar year, were billed for qualifying E&M and/or vaccine administration codes.
The new rates go into effect January 1, 2013, however providers will not be able to self-attest until later in the year. BMS is developing the self-attestation form and will release details on specific requirements regarding retroactive self-attestation, including limits on self-attestation submittals. Providers will be permitted to retroactively self-attest after January 1, 2013, and receive the payment retroactively, beginning with the January 1, 2013 start-date.
For additional information on the Affordable Care Act’s provision for increased payments to certain primary care practitioners for specified Medicaid primary care services, see the November 1, 2012, CMS Press Release “ HEALTH CARE LAW DELIVERS HIGHER PAYMENTS TO PRIMARY CARE PHYSICIANS” and CMS Fact Sheet, “Increased Medicaid Payment for Primary Care.” BMS will release additional details on this matter in future communications on this website and in provider newsletters.