Reimburses certain providers at the statewide rate which reflects the Medicare mean value over all counties for E&M codes 99201-99499 for dates of services between January 1, 2013 and December 30, 2014.

Prohibits Payments to States for any amounts expended for providing medical assistance for certain hospital outpatient and other PPC health care-acquired conditions for dates of service on or after July 1, 2011.

This amendment was submitted to comply with The Patient Protection and Affordable Care Act of 2010 (Affordable Care Act, Public Law 111-148) enacted March 23, 2010 and further addresses the payment for other provider preventable conditions, to include the three never events.

P more evidenced based practices in service delivery in the community, and removes disease management which is no longer being provided.

Reimburses physicians who self-attest to a primary care designation of internal medicine, family medicine or pediatric or a physician that has a practice history of primary care as represented by a 60% claims history for approved E&M reimbursement codes for services rendered in calendar year 2013 and 2014. In addition, the State will pay the federally calculated VFC vaccine administration charge.

Revises policy related to outpatient hospital reimbursement.

Establishes a five-year "look-back" period for the State's retrospective reviews in order to be consistent with Maine policy.

Increases certain primary care service payments.

Deletes PCMH from the PCCM section of the State plan and also provides details regarding the HH and PCCM programs to ensure that no duplication of payment or services exists.

Revises payment of bed hold for a semi-private room for short-term hospitalizations. Additionally, this SPA reduces reimbursement for a member's leave of absence from an inpatient facility.