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New Medicaid Rates for Primary Care Services Will Mean Approximately $65 Million Statewide

Friday, 03 29, 2013

Gwenda Bond or Jill Midkiff (502) 564-6786,
ext. 3100 or 3465

Primary Care Providers Should Sign Up Now for Enhanced Reimbursement Rates

FRANKFORT, Ky. (March 29, 2013) The Department for Medicaid Services (DMS) is encouraging more than 3,300 eligible primary care providers to sign up now to receive enhanced Medicaid reimbursement rates for primary care services retroactive beginning Jan. 1, 2013. The enhanced payments are estimated to mean an additional $65 million per year statewide and are part of Affordable Health Care Act changes designed to ensure preventive services are easy for Medicaid recipients and others to access. 

“It is our hope that these enhanced reimbursement rates provided under the Affordable Care Act will help ensure that Medicaid recipients have access to primary care services they need and will act as an incentive for primary care providers,” said Lawrence Kissner, commissioner of DMS. “These providers are essential to our overall healthcare system and play a key role in our efforts to improve the health of Kentuckians.” 

Eligible primary care physicians are those who practice in family medicine, general internal medicine or pediatric medicine. The initiative applies to both Medicaid fee-for-service and Medicaid managed care plans. To receive the enhanced rates, the provider – M.D., D.O., PA, or APRN – must log on to his or her KyHealthNet account to complete and submit an attestation. The web address is https://sso.kymmis.com.

APRN and PA providers must be supervised by an eligible M.D. or D.O. to qualify. Providers should sign up as soon as possible to avoid the possibility of missing the first quarter’s enhanced payment. For more information, please visit the Medicaid website at: http://chfs.ky.gov/dms.

“We all know that the best medicine is prevention,” said Audrey Tayse Haynes, Secretary of the Cabinet for Health and Family Services. “We are pleased that the federal government recognizes the importance of primary care services and has provided this increased reimbursement.”

The enhanced rate is equal to at least 100 percent of Medicare reimbursements in calendar years 2013 and 2014. Specific CPT procedure codes are eligible for enhanced reimbursement and the average increase in reimbursement is 40 percent. The increase represents the difference between Medicaid and Medicare rates. 

DMS will conduct a claims analysis of calendar year 2012 to ensure only qualified providers receive the enhanced rate. If no claims history is available for 2012, a prior month claims analysis will be used. The enhanced rates will be effective for dates of service beginning Jan. 1, 2013, through Dec. 31, 2014.

More information about this initiative is available at: http://www.Medicaid.gov

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The Cabinet for Health and Family Services is home to most of the state's human services and health care programs, including Medicaid, the Department for Community Based Services and the Department for Public Health. CHFS is one of the largest agencies in state government, with nearly 8,000 full and part-time employees throughout the Commonwealth focused on improving the lives and health of Kentuckians.