Primary Care Cut Restored; Physicians Must Re-Attest to Qualify

In a press conference Thursday, Sept. 22, Gov. Robert Bentley and Alabama Medicaid Commissioner Stephanie Azar announced that the primary care cut, which became effective Aug. 1, will be restored on Oct. 1. However, Medicaid-enrolled primary care physicians who qualify for the Primary Care Enhanced Physicians Rates must self-attest in order to continue to receive the payments. No dates have been set by Medicaid for the attestation process. Medicaid will be sending a notice out to providers shortly on how to re-attest.

To qualify for the reinstated bump beginning Oct. 1, physicians will need to re-attest and meet one of the following requirements:

1. A physician must have a specialty or subspecialty designation in family medicine, general internal medicine, or pediatrics that is recognized by the American Board of Medical Specialties (ABMS), the American Board of Physician Specialties (ABPS), or the American Osteopathic Association (AOA), and they actually practice in their specialty.
2. A NON-board certified physician who practices in the field of family medicine, general internal medicine, or pediatrics or a subspecialty under one of these specialties, is eligible if he/she can attest that 60 percent of their paid Medicaid procedures billed are for certain specified procedure codes for evaluation and management (E&M) services and certain Vaccines for Children (VFC) vaccine administration codes.

Alabama Medicaid: Primary Care Enhanced Physician Rates “Bump” Certification and Attestation Form

*Note: Practitioners (physician assistants or certified registered nurse practitioners) providing services under the personal supervision of eligible physicians may qualify.

When the cuts originally took effect on Aug. 1, they amounted to 30 to 40 percent of medical practice revenue, according to Executive Director Mark Jackson.

“Regardless of what kind of business you’re in, if you’re seeing cuts of 30 and 40 percent, it’s going to make a major impact on your bottom line,” Jackson said.

The restoration of the bump will also allow the state to continue to implement RCOs. This renewed funding should put the rollout of the RCOs on track by next July, according to Azar.