Frequently Asked Questions are used to provide additional information and/or statutory guidance not found in State Medicaid Director Letters, State Health Official Letters, or CMCS Informational Bulletins. The different sets of FAQs as originally released can be accessed below.
Frequently Asked Questions
How are case management fees in Primary Care Case Management (PCCM) programs affected by CMS 2370-F?
PCCM payments are not eligible for higher payment under this rule.
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FAQ ID:91326
SHARE URLDo physicians practicing in Federally Qualified Health Center (FQHCs) or Rural Health Clinic (RHCs) qualify for higher payments under CMS 2370-F?
Higher payment does not apply to services provided under another Medicaid benefit category such as clinic or FQHC or RHC.
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FAQ ID:91331
SHARE URLWill the new payment rate under CMS 2370-F for each of the billing codes affected by this regulation be made publicly available?
Yes. This information will be made available on Medicaid.gov. States will be asked to verify the payment amount in effect for each of the billing codes affected by the final rule as of July 1, 2009.
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FAQ ID:91336
SHARE URLWill the Center for Medicare & Medicaid Services (CMS) issue a preprint for the increased physician payment under CMS 2370-F?
Yes. CMS has provided a preprint for the reimbursement section of the Medicaid state plan that will describe payment for evaluation and management services and vaccine administration. The preprint is available on Medicaid.gov.
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FAQ ID:91341
SHARE URLIs a state required to cover all of the primary care service billing codes specified in the CMS 2370-F regulation and then reimburse all qualified providers at the Medicare rate in calendar years (CYs) 2013 and 2014?
A state is not required to cover all of the primary care service billing codes if it did not previously do so. Rather, to the extent that it reimburses physicians using any of the billing codes specified in the final rule, the state must pay at the Medicare rate in the calendar years (CYs) 2013 and 2014.
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FAQ ID:91346
SHARE URLWill a state receive 100 percent federal matching funds for new codes added to the fee schedule in CYs 2013 and 2014 under CMS 2370-F?
A state may not add any of the eligible service codes solely for the purpose of obtaining enhanced federal matching funds. For example, a state may not eliminate a code currently in use and attempt to substitute it with another Evaluation and Management (E&M) code. However, we recognize that a handful of codes have been added to the E&M code set since 2009. States which added those codes to their fee schedules will receive higher match for those services.
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FAQ ID:91351
SHARE URLThe notice of proposed rulemaking (NPRM) provided that states were required to pay the lesser of the provider's charges or the applicable Medicare rate. The final rule under CMS 2370-F no longer specifies this. Can a state continue to pay at the lower of the two amounts?
Under Medicare and Medicaid principles, payment is to be made at the lower of provider charges or the rate, which in this case is the applicable Medicare rate. This language was inadvertently omitted from the final rule. The Center for Medicare & Medicaid Services (CMS) is processing a technical correction to the regulatory text at 42 CFR 447.405 to restore this language.
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FAQ ID:91356
SHARE URLDoes higher payment apply to CHIP under CMS 2370-F?
The primary care provider rate increase does apply to the Children's Health Insurance Program (CHIP) Medicaid expansions but not separate (stand-alone) CHIPs. Qualified physicians who render the primary care services and vaccine administration services specified in the regulation will receive the benefit of higher payment for services provided to these Medicaid beneficiaries.
The State will receive 100 percent federal matching funds for the difference between the rate in effect 7/1/09 and the rate in calendar years (CYs) 2013 and 2014. The remainder of the payment will be funded at the CHIP matching rate, through the CHIP allotment. Services provided under separate (standalone) CHIPs are not eligible for higher payment.
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FAQ ID:91361
SHARE URLThe rule under CMS 2370-F indicates that all limitations, conditions and policies that applied to the code prior to January 1, 2013 can be applied to the code after that date. If a state sets a reduced rate for a Level III emergency service (99283) if it is a triage service (based on criteria described in the state plan) can it continue to do so or must it pay 100 percent of the Medicare rate? If it can continue to reduce the rate, must it develop a "Medicare triage rate", or can it continue to use the Medicaid triage fee?
This rule does not affect the state's ability to define and operate its coding system, and a state could distinguish claims submitted from those otherwise identified with code 99283. For those claims, the state should develop a rate that it believes Medicare would pay if Medicare made a similar distinction for emergency services limited to triage services, and would then pay that rate. For claims that were not limited to triage services, the state would pay based on the established Medicare rate for code 99283.
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FAQ ID:91366
SHARE URLWhat federal matching rate will apply for services for which a higher payment is made under CMS 2370-F if the services also qualify for a higher FMAP under the provisions of section 4106 of the Affordable Care Act?
In qualifying states, certain United States Preventive Services Task Force (USPSTF) grade A or B preventive services and vaccine administration codes are eligible for a one percent FMAP increase under section 4106 of the Affordable Care Act (which amended sections 1902(a)(13) and 1905(b) of the Act). Some of these services may also qualify as a primary care services eligible for an increase in the payment rates under section 1202 of the Affordable Care Act. For these services the federal matching rate is 100 percent for the difference between the Medicaid rate as of July 1, 2009 and the payment made pursuant to section 1202 (the increase). The federal matching payment for the portion of the rate related to the July 1, 2009 base payment would be the regular Federal Medical Assistance Percentage (FMAP) rate, except that this rate would be increased by one percent if the provisions of section 4106 of the Affordable Care Act are applicable.
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FAQ ID:91376
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