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District Implements Enhanced Payments for Primary Care Services

Tuesday, July 30, 2013

District Implements Enhanced Payments for Primary Care Services

Qualifying fee-for-service claims to be processed at the enhanced payment rate
(Washington, DC) The DC Department of Health Care Finance (DHCF) today announced that it has received all necessary federal approvals to begin processing enhanced payments for eligible primary care services furnished by qualified providers as required by the Affordable Care Act (ACA).
 
“Primary care providers are the lynchpin to good health for the District’s Medicaid beneficiaries,” stated Linda Elam, the District’s Medicaid Director and Senior Deputy Director for DHCF. “We are pleased that the Centers for Medicare and Medicaid Services (CMS) has approved our State Plan and Managed Care Methodology allowing us to begin processing these enhanced payments.”
 
Qualifying fee-for-service claims submitted after Friday, July 5, 2013 will be processed at the enhanced payment rate. Fee-for-service claims will be paid on the same timetable as other fee-for-service claims. Under the District’s federally-approved methodology, DHCF will make enhanced payments to each Medicaid managed care organization (MCO). The health plans will be responsible for passing 100% of the payment owed to each eligible primary care provider.
 
Eligible primary care providers must complete and submit a Physician Self-Attestation Form to DHCF to qualify for enhanced payments. Providers who submitted their Physician Self-Attestation Forms on or before July 1, 2013 are eligible for retroactive payments from January 1, 2013. Providers who submit their Self-Attestation Form after July 1 are eligible for prospective enhanced payments.
 
For more information, including the applicable fee schedule, the Provider Self-Attestation Form and Frequently Asked Questions (FAQ), please go to:  http://dhcf.dc.gov/release/important-notice-primary-care-providers.