Affordable Care Act Initiatives
South Carolina Department of Health and Human Services (SCDHHS) received final State Plan Amendment approval for the payment methodology for enhanced payments to Primary Care providers. All qualified providers who self-attested began receiving payments July 17, 2013. If you have not self-attested, you may at https://msp.scdhhs.gov/pc/.
If you are a Fee for Service (FFS) provider, as of July 17 all processed claims will include the enhanced payment. All FFS providers that attested on or before April 19, 2013, will receive enhanced reimbursement by retroactive gross adjustment for qualifying claims processed with a date of service between January 1, 2013 and July 16, 2013 on the remittance advice dated August 16, 2013.
Managed Care providers will receive their enhanced payment through the Managed Care Organization (MCO) by the first week of September. SCDHHS made the first quarter enhanced payment to MCO's on July 19th and will continue this process on a quarterly payment schedule for the duration of the initiative. The July 19th payments made by SCDHHS to the MCOs for the Affordable Care Act (ACA) enhanced primary care rate increase are based on:
- the physicians that appropriately attested based on prior bulletins, and
- the encounter data submitted by the MCO's for the first quarter of 2013
During the implementation of the enhanced payments for Primary Care providers several bulletins were issued. A copy of the bulletins can be found on https://www.scdhhs.gov/Medicaid-Bulletins.
Fee For Service Providers
- First payment July 26th
- Gross adjustment payment August 16th (retro for claims with DOS on or after 1/1/13)
Managed Care Providers
- First SCDHHS payment to the MCO's July 19th for 1st quarter encounters
If you need assistance or have questions please contact the Provider Service Center.
On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act. The law expands health coverage and puts in place comprehensive health insurance reforms. The South Carolina Department of Health and Human Services is actively working on the following Enhanced Payment for Primary Care Services initiatives:
Increasing Access to Affordable Care: Increasing Medicaid Payments for Primary Care Physicians-Effective January 1, 2013-December 31, 2014
As Medicaid programs and providers prepare to cover more patients in 2013, the Affordable Care Act requires states to pay primary care physicians no less than 100 percent of Medicare payment rates in 2013 and 2014 for primary care services. The increase above current payment levels is fully funded by the federal government.
Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status Transactions-Effective January 1, 2013
By implementing these requirements, States will improve the automation of health care administrative processes and benefit from reduced transaction costs (e.g. reduced time and effort related to contacting physicians and health plans for resolution of claims, denial of claims and additional postage and paperwork costs).
The following links provide additional information:
- CMS Letter Concerning Allergy Providers
- Council for Affordable Quality Healthcare CAQH
- Centers for Medicare & Medicaid Services
- SCDHHS Companion Guides
- PCP Final Rule
- Operating Rule Final Rule
- Fees for Primary Care Physicians under the Affordable Care Act Bulletin
- Primary Care Physician Pricing (ACA Enhanced Payment Fee Schedule)
- Enhanced Physician Payment Reimbursement July 22, 2013 Bulletin
Primary Care Physician Attestation
Qs & As on the Increased Medicaid Payment for Primary Care
- CMS 2370-F - MANAGED CARE
- CMS 2370-F
- SC Q&A Managed Care
- Q and A on Increased Medicaid Payments for PCPs (managed care Set II)
- Q and A on Increased Medicaid Payments for PCPs (FFS Set IV)
- Q and A on Increased Medicaid Payments for PCPs (FFS Set III)
- Q and A on Increased Medicaid Payments for PCPs (FFS Set II)