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PA Bulletin, Doc. No. 14-2643

NOTICES

Medical Assistance Program Fees for Primary Care Services

[44 Pa.B. 7974]
[Saturday, December 20, 2014]

 The Department of Human Services (Department) is announcing that it will pay the current Medical Assistance (MA) Program Fee Schedule rates for primary care services to all MA Program enrolled physicians, effective with dates of service on and after January 1, 2015.

Background

 Section 1202 of the Patient Protection and Affordable Care Act (Pub. L. No. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. No. 111-152) (collectively ACA), required state Medicaid programs to pay qualifying physicians increased fees for specified primary care services that were no less than the Medicare rates in effect in calendar years (CY) 2013 and 2014, or if greater, the rates that were applicable in those CYs using the CY 2009 Medicare physician fee schedule conversion factor. The Centers for Medicare and Medicaid Services (CMS) provided for an enhanced Federal Medical Assistance Percentage (FMAP) of 100% of the rate in excess of the MA Program rate for CYs 2013 and 2014.

 Qualifying physicians who rendered primary care services to Medicaid beneficiaries in the MA Program's fee-for-service and managed care delivery systems received the increased fees in CYs 2013 and 2014.

Discussion

 Effective January 1, 2015, CMS will no longer provide an enhanced FMAP. Accordingly, and as set forth in the notices published by the Department at 43 Pa.B. 105 (January 5, 2013) and 44 Pa.B. 1949 (March 29, 2014), the Department will revert to paying all MA enrolled physicians the current MA Program Fee Schedule rates for primary care services.

 The Department will issue an MA Bulletin to provide further information to physicians and will post the MA Bulletin on the Department's designated ACA Physician Fee Increases for Primary Care Services webpage.

Fiscal Impact

 The Department does not anticipate a fiscal impact as a result of paying the current rates listed on the MA Program Fee Schedule for primary care services.

Public Comment

 Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Medical Assistance Programs, c/o Deputy Secretary's Office, Attention: Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent revisions of the MA Program Fee Schedule. Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

BEVERLY D. MACKERETH, 
Secretary

 Fiscal Note: 14-NOT-925. No fiscal impact. (8) recommends adoption.

[Pa.B. Doc. No. 14-2643. Filed for public inspection December 19, 2014, 9:00 a.m.]


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