Nearly a year after the General Assembly directed Medicaid to cut physician rates by 3 percent, medical practices across the state are still bracing for impact. That’s right, the cut originally scheduled for January 1, 2014 has still not been implemented, and NCTracks is again the reason for the delay. And while avoiding a rate reduction for an entire year may sound like good news, it isn’t.
Here’s why: Medicaid and CSC have repeatedly delayed the implementation of this reduction in favor of other projects. Those delays now mean that for Medicaid to comply with the General Assembly’s directive, physicians will have to be cut both retrospectively and prospectively. The retrospective implementation will require a massive claims reprocessing effort in which 3 percent of the Medicaid payments received by many physicians* since January 2014 will be taken back. Physicians also will see payment rates permanently reduced 3 percent going forward. So just because the cuts haven’t been implemented yet – a year later – doesn’t mean they never will be.
* The 3 percent reduction will not affect physicians who received enhanced ACA payments from Medicaid in 2014. The 3 percent cut will apply to those physicians in 2015, however.
When will these cuts take effect?
The only date shared with NCMS so far is February 15, 2015. This is when the prospective part of the rate cut is scheduled to take effect. But this date has been delayed many times already, and it could change again. Given the significant risk of administrative and financial disruption that this presents for medical practices across the state, NCMS will continue to provide updates on the timing of this cut.
Then There’s Another 1 percent
On top of the 3 percent cut, the General Assembly also passed an additional 1 percent cut effective January 1, 2015. Currently there’s no information available from Medicaid or CSC about when that reduction will be implemented, either. NCMS is fairly confident, however, that it will NOT be implemented on January 1, nor before the 3 percent cut is implemented.
Our Focus in the 2015 Session of the NC General Assembly
When the legislature convenes for its long session on January 15, the outright repeal of the 3 percent and 1 percent rate cuts will be an NCMS priority issue. The harm these accumulated reductions will do to our strong network of Medicaid providers must be prevented.
|Description of Payment Rate Reduction||Affected Claims||Effective Date Established by Law||Actual NCTracks Implementation Date||Additional Notes|
|3% cut prospective||All claims with dates of service of Feb. 15, 2015 and later||Jan. 1, 2014||Feb. 15, 2015|
|3% cut retroactive||Jan. 1, 2014 dates of service through implementation date of prospective cut||Jan. 1, 2014||Not yet announced (definitely after Feb. 15, 2015)||Cut will not apply to PCPs receiving special ACA payment rates in 2014|
|1% cut prospective||Jan. 1, 2015||Not yet announced (definitely after Jan. 1, 2015)|
|1% cut retroactive||Jan. 1, 2015 dates of service through date of prospective cut||Jan. 1, 2015||Not yet announced|