Provider Rate Changes Under the Affordable Care Act

Providers

Providers should watch this page for additional developments on pending rate increases. If you have questions, please email them to prvrates@hca.wa.gov.​​​

Providers eligible for the rate increase whose attestation form is received by HCA before or on August 31st will receive payments at higher rates for qualifying services rendered on or after January 1, 2013.

Providers eligible for the rate increase whose attestation form is received by the HCA after August 31st will receive higher rates for qualifying services rendered on or after the date the form is received at HCA.

Background

Section 1202 of the Affordable Care Act amends sections 1902(a)(13), 1902(jj), 1905(dd) and 1932(f) of the Social Security Act to require payment of the Medicare rate for certain Medicaid primary care services provided in calendar years 2013 and 2014. This provision applies to evaluation and management (E&M) and vaccine administration services when delivered by a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine.

States will be eligible to receive 100 percent FMAP (federal match) for the increased expenditures equal to the difference between the Medicare rate and the State Plan rate as of July 1, 2009, for these same services. This applies to both fee-for-service claims and managed care payments. The final rule also will update the interim regional maximum fees that providers may charge for vaccine administration under the Vaccines for Children (VFC) program.

Physician Attestation Form

Each eligible physician must submit the attestation form to qualify for enhanced payments. If you have questions regarding your eligibility, please review the FAQ document (below) and other information provided on this site. Forms can be submitted by fax at (360) 586-7498 or email at prvrates@hca.wa.gov

Provider attestation form

We have updated the Attestation Form to include information about advanced non-physician practitioners (ARNPs and PA-Cs). These individuals may qualify for enhanced payment if supervised by eligible physicians. Please note that the Attestation Form must be filled out by the supervising physician, not the ARNP/PA-C.

Instructions: the form consists of two pages. Physicians who do not supervise ARNPs or PA-Cs will fill out and submit page one only. Physicians who supervise ARNPs or PA-Cs will fill out and submit both pages of the form. Please review the FAQ document (below) for additional information.

Related links for providers

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Health Care Reform

Resources​​​