Notice Regarding 2013/2014 Primary Care Payment Increase

May 29, 2013

Included below are important updates related to the 2013/2014 Primary Care payment increase, which was effective January 1, 2013.

The Centers for Medicare and Medicaid Services (CMS) has informed us that the enhanced rates we had set are too high, and we will need to decrease the rates.

Effective Wednesday, May 29, 2013, these claims will pay at these lower, corrected rates. Claims paid from January 1, 2013 through Tuesday, May 28, 2013 will be reprocessed. This reprocessing will begin the first week in June.

Next, CMS has also asked us to update the self-attestation form. Providers who have already attested must re-attest using the new form, which is available online at www.maine.gov/dhhs/oms/pdfsdoc/news/2013-14PCP_Increase.doc, along with instructions. Please complete and submit the revised form by June 30, 2013.

Please note that, although our previous attestation process permitted PAs and APRNs practicing under the supervision of a qualifying physician to attest on their own behalf, CMS has said that the supervising physician must do the attestation on behalf of any PAs and APRNs that they supervise and are responsible for.

Lastly, CMS has informed us that hospitals – specifically provider specialty 062 (Hospital Based Professionals) – are NOT eligible for the increase (due to the fact that MaineCare cost-settles hospital-based physicians), so there is no need for hospital-based providers to attest. The Department will send a separate communication to hospitals informing them of the timing to reprocess claims that were inappropriately paid at the enhanced rate.

Thank you for your patience and we apologize for any inconvenience this has caused. If you have any questions, please contact Provider Services at: 1-866-690-5585.