Last week the Department of Health and Human Services (HHS) made headlines with the announcement of a proposed rule that would increase payment rates for primary care physicians serving Medicaid patients. The rule would bring Medicaid primary care service fees in line with those paid by Medicare for the duration of 2013 and 2014. According to a Centers for Medicare and Medicaid Services (CMS) release, states would receive more than $11 billion to facilitate this boost in payments.
Expanding access to primary care doctors is at the very foundation of the Affordable Care Act (ACA) and the proposed rule reflects the ACA’s requirement that Medicaid payments for primary care services provided by primary care doctors, including pediatricians and pediatric subspecialists, be raised to the level of Medicare payment rates for 2013 and 2014. Federal funding will cover 100 percent of the increased payments, with no matching funds required of the states. In addition the payments will be based on the difference between the Medicaid rates used by states in 2009 and current Medicare rates. That means that states that have increased their Medicaid rates since 2009 will realize significant savings, although those that have decreased them will need to return to 2009 levels to benefit.
Last week’s announcement holds important implications for children’s health. Medicaid is the largest source of health care for children, covering roughly 1 in 3 kids according to data from the Kaiser Family Foundation. The proposed rule would qualify physicians with a specialty designation of pediatric medicine as primary care providers for purposes of increased payment. In addition, the rule mandates that services provided by pediatric subspecialists also qualify for increased payments. This is very welcome news for children and families, as the American Board of Medical Specialties lists some 20 subspecialties within Pediatrics, such as neonatal-perinatal medicine, pediatric cardiology and pediatric emergency medicine. Requiring that primary care providers are more adequately compensated will ensure that the 30 million children enrolled in Medicaid have access to these essential services.
Preventive care provided by primary care practitioners offers the best hope of improving health outcomes and curbing national health spending. Yet, despite their importance, these doctors are paid far less than specialists and may soon be in short supply due to the aging of the US population, the retirement of physicians and the 30 million additional Americans expected to gain insurance through the ACA. The proposed rule is an important tool states can use to encourage primary care networks to continue to provide checkups, screenings, vaccines and other care to Medicaid beneficiaries and to prepare to expand these efforts to the expected 17 million additional Medicaid enrollees after 2014.
The proposed rule is another benefit from the ACA that supports the primary care workforce and helps ensure every American has high quality, affordable care, including preventive services. Though the boost in reimbursement will only last two years, it represents an investment in Medicaid’s relationship with providers at a time when that relationship is more important than ever.
This rule reminds us of how important the ACA is for children. What this regulation means for families is that more children will have access to doctors, and that’s a good thing.
Nicole Tambouret, Project Director and
Jake Mogan, Intern, New England Alliance for Children’s Health