Enhanced Physician Payments for Allergy and Immunology Providers



Effective January 1, 2013, the South Carolina Department of Health and Human Services (SCDHHS) implemented a portion of a final rule under the Affordable Care Act (ACA) that increases Medicaid reimbursements for evaluation, management and immunization services to 100 percent of Medicare reimbursement for 2013 and 2014.  The increase applies to both fee-for-service (FFS) and Managed Care Organization (MCO) plans.                                        

SCDHHS released a bulletin January 8, 2013, on the Affordable Care Act Enhanced Physician Payment program.  This notice advised providers that enhanced physician payments were available to providers with a specialty designation of family medicine, general internal medicine, pediatric medicine or a subspecialty recognized by the American Board of Medical Specialties (ABMS), the American Board of Physician Specialties (ABPS) or the American Osteopathic Association (AOA).

Recently, the Centers for Medicare and Medicaid Services (CMS) communicated a clarification statement that the American Board of Allergy and Immunology (ABAI) is an ABMS recognized sub-discipline of the American Board of Pediatrics (ABP) and the American Board of Internal Medicine (ABIM).  The clarification articulated clearly that allergists should be recognized for higher payment under the Enhanced Physician Payment rule.  The communication from CMS that provides detailed discussion concerning this sub-specialty is posted on the SCDHHS ACA website located at www.scdhhs.gov/resource/affordable-care-act-initiatives under links for additional information.

In response to the communication from CMS, all qualifying allergists will be given the opportunity to enroll and receive reimbursements for services rendered with date of service January 1, 2013 to present.  Allergists who qualify based on their affiliation with the ABP and the ABIM and have not already attested should attestimmediately.  SCDHHS will accept attestations from allergists for 90 days after the date of this bulletin. Retroactive payments for these providers will occur within 90 days after the close of the attestation period. Allergists attesting after this 90 day period will receive ACA enhanced reimbursement from thefirst day of the month in which they attest.  

All allergists participating with Medicaid FFS and those participating with MCOs need to register with SCDHHS and complete the Primary Care Provider Attestation form in order to be eligible to receive the enhanced primary care reimbursement rates.

The registration portal is available at: www.scdhhs.gov/physicianattestation.

For more details on this program, including the bulletins and Questions and Answers, please visit the SCDHHS website at www.scdhhs.gov/resource/affordable-care-act-initiatives

This bulletin applies to FFS, Medical Homes Networks (MHNs) and MCOs.  If you have questions regarding this bulletin, please contact the Provider Service Center at (888) 289-0709.  Thank you for your continued support of the South Carolina Healthy Connections Medicaid Program.

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