IHCP Announces 1st Quarter ACA Supplemental Payment for Primary Care Physicians

In previous bulletins the Indiana Health Coverage Program (“IHCP”)  explained that under the Affordable Care Act (“ACA”), Indiana will temporarily increase Medicaid payments to self-attested qualifying providers for qualifying primary care services, at rates that are the lesser of: (1) the calendar year (CY) 2013 and CY 2014 Medicare rates, or if greater, the rates that would be applicable in CY 2013 and CY 2014 using the CY 2009 Medicare physician fee schedule conversion factor; or (2) the provider’s actual billed charge for the service provided (“ACA increased rate”).  In addition, under the Vaccines for Children (“VFC”) program, vaccine administration rates will be increased to the lesser of (1) the CY 2013 or CY 2014 Medicare rate or (2) the maximum regional VFC rate in CY 2013 and CY 2014.  These original bulletins, BT201247, BT201255, and BT201302 described how providers can qualify for the ACA increased rate and explained that the difference between the current Indiana Medicaid State  Plan rate and the ACA increased rate would be distributed to self-attested qualifying providers, in a quarterly supplemental payment.

On August 2, 2013, the IHCP  published notice that IHCP had completed the first quarter ACA Primary Care Physician supplemental payment for qualifying services provided to fee-for-service members, including members that are dually eligible for Medicaid and Medicare.  Qualifying providers that have self-attested should expect to see these supplemental payments in their August 6, 2013 remittance advice.    IHCP is waiting on CMS’ approval of supplemental payments for services provided to managed care members, after which such supplemental payments will be paid. If you have any further questions on supplemental payments for primary care physicians, please contact Meghan Linvill McNab at mmcnab@kdlegal.com.