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2013-2014 primary care reimbursement changes under the Affordable Care Act
Enrolled providers:
Submit your self-attestation (new providers must wait until the effective date of their Oregon Medicaid enrollment)
 
Providers, plans and partners:
Read our fact sheet and questions and answers
​​These federal changes were effective January 1, 2013, through December 31, 2014, for primary care practitioners who serve OHP members.

Learn the basics about the federal primary rate increase, which ended December 31, 2014.

Select the topic you want to view using the dropdown box below, or select “All” to view all questions and answers. You can also use the search field to do a text search of the questions and answers.​

  
Answer
When will DMAP apply the 2013-2014 primary care rate increase?

DMAP will apply the FFS federal primary care rates based on the dates qualified providers submit their attestations. Only services rendered in calendar years 2013 and 2014 qualify for the new rates:

Attestation submitted
Increased FFS rate will apply to
qualifying services rendered on or after:
Jan. 1 to Mar. 31
Jan. 1
Apr. 1 to June 30
Apr. 1
July 1 to Sep. 30
July 1
Oct. 1 to Dec. 31
Oct. 1

Note: DMAP began paying the FFS federal primary care rates in July 2013. We reprocessing additional eligible claims to retroactively pay the federal rate increase (details to be determined). 
Which provider types are eligible for the 2013-2014 primary care rate increase?

Physicians with a specialty designation of family medicine, general internal medicine, or pediatric medicine; or

Nurse practitioners and physician assistants billed through, and working under the supervision of, a qualified physician.

Where can OHP health plans learn more about the 2013-2014 primary care rate increase?
Where can health care providers learn more about the 2013-2014 primary care rate increase?
Does this change Oregon's definition of a primary care provider?

No. Oregon did not change its definition of Medicaid primary care provider. Instead, Oregon added the federal definition alongside Oregon's definition in order to identify primary care providers who qualify for the 2013-2014 rate increase.

The CMS definition only determines which providers may qualify for the increase; it does not reduce or change reimbursement for other providers or programs. Oregon's primary care providers who meet CMS's definition receive an enhanced rate for 2013-2014; those who do not receive their existing Oregon primary care rate.​
Why did Oregon have a 2013-2014 primary care rate increase?

In November 2013, the Centers for Medicare and Medicaid Services (CMS) announced that practitioners who meet their new definition of primary care provider would see an increased Medicaid reimbursement rate for two years under section 1202 of the federal Affordable Care Act (ACA).

CMS revised sections 1902(a)(13), 1902(jj), 1905(dd) and 1932(f) of the Social Security Act to require increased payment for certain Medicaid primary care services provided in calendar years 2013 and 2014.
 
The final rule also updated the interim regional maximum fees that providers may charge for vaccine administration under the Vaccines for Children (VFC) program.
 
What services are eligible for the 2013-2014 primary care rate increase?

The increase applies to evaluation and management (E/M) and vacc​ine administration services​​ and the administration fee for Vaccines for Children serum​, when delivered to Oregon Medicaid clients by eligible providers.


For more information about the federal primary care rate increase

 

 

Rates

2013 federal primary care codes and rates
2014 federal primary care codes and rates
Oregon Medicaid Vaccines for Children administration codes and rates
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Other Resources

Federal Primary Care Reimbursement Fact Sheet
Federal Primary Care Reimbursement webinar slides for plans
Federal Primary Care Reimbursement webinar slides for providers
Questions and answers about federal primary care reimbursement
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