cine administration codes. Federal regu- lations clarify that subspecialists also can receive the enhanced rates.
Originally scheduled to begin Jan. 1 and continue through Dec. 31, 2014, Texas and a majority of other states have delayed implementation of the raise, largely because of the Centers for Medi- care & Medicaid Services’ late release of final federal rules. Once the change is in place, the Texas Health and Human Ser- vices Commission will make payments retroactive to Jan. 1, then pay the ad- justed rate on each claim going forward. The fee increase applies to Medicaid
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fee-for-service and managed care, and the federal government will cover the cost regardless of a state’s position on the federal Medicaid expansion. On average, Texas Medicaid physician fees for primary care services will rise by 66 percent in 2013, researchers estimate. Nationally, rates will go up 73 percent on average. According to the study, fees will more than double, on average, for qualified physicians in six states: Florida (105 per- cent increase), New Jersey (109 percent), Michigan (125 percent), California (136 percent), New York (156 percent), and Rhode Island (198 percent). The in- crease does not affect Alaska and North Dakota because Medicaid rates there al- ready exceed Medicare levels. The Kaiser commission, with the Ur- ban Institute, conducted the survey us- ing data from Medicaid physician fees as of July 2012. Researchers also found that to comply with the PPACA requirement, most states will have to increase their 2012 Medic- aid fees. That includes Texas, where Medicaid paid 61 percent of Medicare rates for primary care services and 68 percent for obstetric care last year. The report derived its calculations
from the seven most commonly used primary care services eligible for the in- crease out of 146 services total, finding that to be a representative sample. n
Contact your agent or Diannah Tatum at (806) 792-5564 or email
info@tmgworkcomp.com.
26 TEXAS MEDICINE March 2013
Visit us at
www.texasmedicalgroupwcprogram.com. Dividends are based on performance and are not guaranteed.
Amy Lynn Sorrel is an associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at
amy.sorrel@
texmed.org.
©2013 Texas Mutual Insurance Company
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