Skip all navigation Skip to page navigation

DHHS Home | A-Z Site Map | Get Updates | Divisions | About Us | Contacts | En Español

NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

Affordable Care Act - Primary Care Rate Increase

 

IMPORTANT NOTICE

DMA has restarted processing attestations for enhanced payments under the Affordable Care Act as of October 22, 2013. Click here for more information.

According to Section 1202 of the Affordable Care Act (ACA) – which amends Section 1902(a)(13(c) of the Social Security Act – the Medicaid program is federally required to pay at the Medicare rate for certain primary care services and to reimburse 100% Medicare Cost Share for services paid in calendar years 2013 and 2014.

Section 1902(a)(13)(C) now specifies that physicians with a primary specialty designation of family medicine, general internal medicine or pediatric medicine are primary care providers. Those who render evaluation and management codes and services related to immunization administration for vaccines and toxoids for specified codes would be eligible for reimbursement.

In order to qualify for the reimbursement, the following requirements must be met:

  • Be a physician defined in 42 CFR 440.50, or under the personal supervision of a physician with special designation in family practice, general internal medicine and pediatrics or a subspecialty recognized by the American Board of Medical Specialties (ABMS), the American Osteopathic Association (AOA), or the American Board of Physician Specialties(ABPS);

  • Be board certified in the specialty or subspecialty, or;

  • Have furnished Evaluation and Management (E&M) and vaccines services that equal at least 60% of the Medicaid codes billed during the most recently completed Calendar Year*

Note: The 60% threshold will be validated by DMA’s Fiscal Agent

PROVIDERS NEED TO CLICK HERE to SELF ATTEST

Question? Visit our Frequently Asked Questions (FAQ) page (updated 03/14) or view this ACA Enhanced Payments webinar presented by DMA on March 5, 2014. If you still have questions, please contact the Webmaster

Important Note: The features on the ACA attestation page require the use of Internet Explorer