Start the New Year with Some Good News

The NC Department of Health and Human Services (NCDHHS), Division of Health Benefits recently announced that they have submitted a state plan amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) to increase the Medicaid reimbursement rate for Evaluation and Management procedure codes for primary care physicians (including Ob/Gyns), nurse practitioners and physician assistants, as defined in the ACA. Once accepted, the new rates would most likely be retroactive to Jan. 1, 2019. While the exact rates are not known, based on the public notice, which reveals the state’s budgeted share, the increase will bring the rates closer to Medicare. Currently, the reimbursement for E&M codes is about 75 percent of Medicare rates.

“This change is recognition of how important primary care providers are to ensuring Medicaid beneficiaries receive the best care possible,” said NC DHHS Deputy Secretary Dave Richard. “As we are in the process of Medicaid transformation, we want to make sure we have a healthy primary care base.”

Read the public notice.

 
 

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