Enhanced Primary Care Payment materials now available!
The Affordable Care Act (ACA) requires that Medicaid reimburse eligible primary care providers at parity with Medicare rates in 2013 and 2014 for certain evaluation and management (E&M) and vaccination codes beginning with January 1, 2013 dates of service (42 CFR 447.400(a)). Prior to receiving the enhanced rate, eligible physicians and advanced practice registered nurses (APRNs) must self-attest (please see the Self-Attestation Form below). Physician assistants (PAs) are not required to complete a Self-Attestation Form, but instead should be listed in the appropriate section of their supervising physician’s Self-Attestation Form.
The West Virginia Bureau for Medical Services (BMS) is currently undergoing system changes to their Medicaid Management Information System (MMIS) required to implement these enhanced payments to primary care providers. Additionally, BMS is working with the Centers for Medicare & Medicaid Services (CMS) for approval to change West Virginia’s Medicaid State Plan. Payments will not be made until necessary system changes are complete and CMS approves West Virginia’s Medicaid State Plan Amendment. Therefore, there may be lag time between when a Self-Attestation Form is submitted and approved and when the enhanced payments begin. However, because retroactive payments will be made, the lag time will not impact the amount providers are reimbursed each calendar year. This enhanced rate will only be available during the calendar years 2013 and 2014. At the end of this period, the enhanced Federal funding for this program expires and the enhanced rate for Medicaid services will end.
All participating providers should read the Provider’s Guide (above) prior to completing the Self-Attestation Form. The required Self Attestation Forms, and the Self-Attestation Form Cover Letter, are provided below:
If you have additional questions, please contact Molina’s Provider Enrollment Department within the West Virginia Medicaid call center at:
Phone: (888) 483-0793
Fax: (304) 340-2763