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CMS Proposes Medicaid Payment Increase for Primary Care in 2013 and 2014

May 11, 2012—The Centers for Medicare and Medicaid Services (CMS) May 9 released a proposed rule that increases Medicaid payments for primary care services provided by certain primary care physicians for calendar years (CYs) 2013 and 2014. 

The proposal, mandated the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152), provides more than $11 billion in funding to states to reimburse family medicine, general internal medicine, and pediatric physicians at the full CY 2013 and 2014 Medicare rates for Evaluation and Management (E&M) services and other non-Medicare covered primary care services.  All subspecialists within the three eligible specialty designations also will be eligible to receive the enhanced reimbursement in 2013 and 2014. CMS estimates that the average Medicaid primary care payments would increase by 34 percent.

CMS aims to use increased payment promote access to primary care services in the Medicaid program before the implementation of the ACA Medicaid coverage expansion in 2014. The increased payment requires no matching payments by states.  Comments on the proposed rule are due June 11.


Will Dardani
Clinical Policy and Practice Specialist
Telephone: 202-828-0541


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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806