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    Medicaid Reimbursement

    The ACA makes changes to payments for some Medicaid-covered services that can affect Medicaid beneficiaries’ access to providers and services.


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    The ACA makes changes to payments for some Medicaid-covered services that can affect Medicaid beneficiaries’ access to providers and services.

    *Milestone details:

    *Full name: Update Medicaid payment levels as required by the ACA.

    *Relevance to the ACA:

    The ACA requires some specific changes to Medicaid payment levels, including the following:

    HCERA §1202 – Requires Medicaid agencies to pay at least the same amount that Medicare would pay for primary care services delivered by primary care providers, and provides 100% FMAP for the increased cost from 2013 until 2015.

    HCERA §1203 – Sets a formula for reductions in State Medicaid DSH allotments based in part on how states target DSH payments to hospitals. The largest reductions are imposed on states that do not target their DSH payments to hospitals with high volumes of Medicaid inpatients or high levels of uncompensated care.

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    Kevin Davis
    New York
    Mary Land Medicaid Wavier program
    I need information regarding Mary Land Medicaid Waiver program and Reimbursement method followed by Mary Land Medicaid for out patient and Inpatient claims. Where can I get complete information regarding Mary Land Medicaid Waiver and Reimbursement... read more

    I need information regarding Mary Land Medicaid Waiver program and Reimbursement method followed by Mary Land Medicaid for out patient and Inpatient claims. Where can I get complete information regarding Mary Land Medicaid Waiver and Reimbursement Methodology.

    replyJuly 12th, '13
    Jade Christie-Maples
    District of Columbia
    Medicaid primary care reimbursement increase
    Last week, CMS published this final rule for increased Medicaid reimbursement for primary care providers. The rule takes effect in January 2013 and pays these providers at Medicare rates for calendar years 2013 and 2014. Increased reimbursement will... read more

    Last week, CMS published this final rule for increased Medicaid reimbursement for primary care providers. The rule takes effect in January 2013 and pays these providers at Medicare rates for calendar years 2013 and 2014. Increased reimbursement will apply to services provided to Medicaid enrollees by physicians practicing family medicine, general internal medicine, pediatric medicine, and related subspecialties.

    replyNov 7th, '12
    Kaitlin Sheedy
    District of Columbia
    Re: Medicaid primary care reimbursement increase

    The Center for Health Care Strategies (CHCS) has put together a summary of the regulation, highlighting select provisions for states to consider when planning implementation.

    Nov 9th, '12
    Overview: Proposed Federal Rules for Increased Medicaid Payment for Primary Care Providers
    On May 9, 2012, CMS released proposed regulations for implementing the Medicaid primary care rate increase under Section 1902(a)(13) of the Affordable Care Act (ACA).... read more

    On May 9, 2012, CMS released proposed regulations for implementing the Medicaid primary care rate increase under Section 1902(a)(13) of the Affordable Care Act (ACA).
    This fact sheet from the Center for Health Care Strategies provides an initial overview of the planned regulatory approach and briefly outlines next steps for states.

    replyMay 16th, '12
    State Refor(u)m
    District of Columbia
    This brief from the Center for Health Care Strategies provides sample performance measures states can use to assess the impact of the Medicaid primary care provider pay increase on access, utilization and quality. Curious about the size of the "bump" in... read more

    This brief from the Center for Health Care Strategies provides sample performance measures states can use to assess the impact of the Medicaid primary care provider pay increase on access, utilization and quality. Curious about the size of the "bump" in your state? See Table 1.

    Katharine Witgert
    District of Columbia
    CMS recently issued a proposed rule that outlines steps states can take in assessing access to care for Medicaid beneficiaries prior to changing provider reimbursements. The rule includes possible data sources states could use to assess access.... read more

    CMS recently issued a proposed rule that outlines steps states can take in assessing access to care for Medicaid beneficiaries prior to changing provider reimbursements. The rule includes possible data sources states could use to assess access. Comments on the rule will be accepted until July 5.

    Related topics:
    replyMay 16th, '11
    Katharine Witgert
    District of Columbia
    New York - Medicaid Reimbursement
    This report by the New York State Health Foundation details the challenges and opportunities NY faces in implementing reform, including Exchange, benefit design and payment issues. Access the report here: http://www.statereforum.org/sites/default/files... read more

    This report by the New York State Health Foundation details the challenges and opportunities NY faces in implementing reform, including Exchange, benefit design and payment issues. Access the report here: http://www.statereforum.org/sites/default/files/nyroadmappaper_aug2010.pdf

    Katharine Witgert
    District of Columbia
    Maryland - Medicaid Reimbursement
    This report discusses progress made by Maryland’s Health Care Workforce Workgroup and options for strengthening workforce capacity and the delivery system. Highlights include discussions on licensing, education, and provider recruitment.... read more

    This report discusses progress made by Maryland’s Health Care Workforce Workgroup and options for strengthening workforce capacity and the delivery system. Highlights include discussions on licensing, education, and provider recruitment.

    Access the report here:
    http://www.statereforum.org/sites/default/files/md_finalreportdeliverysy...