DHHS Preparing to Implement Announced Medicaid Payment Increase

NC DHHS is moving forward with paying primary care at 2018 Medicare rates for Medicaid. As soon as the official State Plan Amendment is approved by CMS (expected to be later this spring or early summer), all payments will be retroactive to January 1st. For over a year, the NCAFP advocacy team, along with its counterparts from the NC Pediatric Society, have advocated for a rate increase for primary care physicians. It secured the victory in late 2018, and as a result, the increase is expected to put over $100 million additional dollars into primary care during each state fiscal year; will raise payments for Evaluation and Management codes for primary care (including family physicians, pediatricians, Ob/Gyns, nurse practitioners and physician assistants, as defined in the Affordable Care Act) to rates at 2018 Medicare rates for the same services; and establish a crucial rate floor just prior to the state’s conversion to Medicaid Managed Care. A copy of the State Plan Amendment can be found online at–Physician-Svcs-.pdf. Stay tuned!