Medicaid is an extremely important program for many kids, but access to quality health care through Medicaid can be difficult because of its low payment rates for physicians. Unfortunately, those low rates mean that in some communities, few physicians (including pediatric specialists) will accept Medicaid patients. Fixing Medicaid payment rates is more complicated than its partner, Medicare. Medicare fees are established nationally while Medicaid fees are established by each state. In most – but not all – states, Medicaid providers are paid significantly less than they are paid under Medicare.
Recognizing this discrepancy, Section 1202 of the Affordable Care Act contained language to ensure that physicians who accept Medicaid patients in family medicine, general internal medicine, and pediatric medicine will receive the same pay rates that they would get for Medicare patients. This Medicaid payment “bump up” would last for two years beginning in 2013, and the federal government will pay the full cost of the increase.
Today, the Centers for Medicare and Medicaid Services (CMS) released its proposed rule to implement the two-year Medicaid payment increase to Medicare levels. Under the proposal, the federal government will send states $11 billion to increase the pay of physicians who provide primary care services to kids. The good news for kids’ health is that CMS has included pediatric subspecialists as eligible providers for this payment increase. It is great that the agency recognizes that specialists also provide primary care services, especially to children with serious or chronic medical conditions.
Specifically, CMS proposes “that all subspecialists within the specialty designations of family medicine, general internal medicine, and pediatric medicine as recognized by the American Board of Medical Specialties be eligible for increased payment…For example, a pediatric cardiologist would qualify for payment if he or she rendered one of the specified primary care services by virtue of that physician’s subspecialty within the qualifying specialty of internal medicine.”
That’s a longwinded way of saying that pediatric specialists qualify for the Medicaid payment “bump up.” In addition to being great news, it's also historical - it marks the first time Medicaid payments have been tied to Medicare rates in the program’s history.
However, the rule is not yet final – there is a 30-day comment period on this proposed regulation. After CMS receives public comments, it might make changes to the regulation. We will be doing everything we can, including submitting our own comments to CMS, to make sure that pediatric subspecialists stay in the final regulation so they can receive the increased Medicaid payments. We will also be working with our children’s hospital partners and other organizations that care about kids’ access to care to encourage them to express their support to CMS for the inclusion of pediatric subspecialists in the Medicaid payment increase.
We are extremely pleased that CMS recognized the role that pediatric subspecialists play in primary care and the importance of adequate Medicaid payment in ensuring kids’ access to care. We are going to make sure that they don’t lose sight of that during this next step of the regulatory process.
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