Want to receive enhanced Medicaid fees under ACA? You must complete the Texas Medicaid attestation form

posted 07.24.13

Updated 10.02.13

The state’s Health and Human Services Commission recently released a letter explaining that the federal Centers for Medicare and Medicaid Services already approved Texas’ higher primary care fee-for-service rates, but we are still waiting on federal approval for increased rates for Medicaid. While HHSC hopes to implement the rate increase as soon as possible, March 1, 2014, is the anticipated beginning date for this pay. Providers who have completed the attestation form before the first payment is issued will be eligible for retroactive payments back to Jan. 1, 2013.

> Read the HHSC letter in its entirety, including details on the self-attestation process

Original story

Under the Patient Protection and Affordable Care Act, primary care physicians are supposed to be receiving Medicaid fees for evaluation and management services and vaccinations at Medicare payment rates as of Jan. 1, 2013. The state’s Medicaid contractor, Texas Medicaid Healthcare Partnership, hopes to implement the rate increases in early fall, but is waiting on the Centers for Medicare and Medicaid Services to approve the proposed payment methodology.  Once that approval is given, qualified physicians should receive a lump-sum payment to cover the fee adjustment for eligible claims already made in 2013.

According to the Kaiser Family Foundation, Texas Medicaid fees for E/M services and vaccine administration should increase by approximately 66 percent because of the change.

To be eligible for the increased fees, physicians must attest that they are board certified in a primary care specialty or that at least 60 percent of their total billings are for evaluation and management services and vaccine administration. The attestation form has been available since March 8 on the TMHP website. To complete the form, you will need your National Provider Identifier, your Texas Provider Identifier, and a copy of your board certification if available.

Texas Medicaid hasn’t set a deadline yet on the attestation process, but it will before the rate increases are implemented. Physicians who do not complete the attestation will not receive the higher payments, so if you haven’t done it yet, now is the time.

> Read the March 8, 2013 TMHP article announcing the opening of the attestation process

> Access the attestation form, Texas Medicaid Attestation for ACA Primary Care Services Rate Increases