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Special Feature: Medicare and Medicaid Updates
Posted on: 6/1/2013

Medicaid Rates to Match Medicare for Primary Docs; Deadline to Apply for Increase is June 30

As physicians know, health care reform directs an increase in Medicaid payments to Medicare rates for primary care services when delivered by certain primary care physicians. Although this increase was to start Jan. 1, 2013, the Illinois Department of Healthcare and Family Services (HFS) has yet to announce a payment release date. However, the deadline to self-attest for the increase is less than a month away

To receive the increase in payments, physicians must "self-attest" by June 30 by either completing and mailing Form HFS 2352, or attesting online. Once eligibility is approved, HFS will mail out a new Provider Information Sheet with a specialty code on the Provider Database. (If you do not receive within 30 days, call 217-782-0538 or send an email.)

Medicare levels will be applied retroactively to services rendered on or after Jan. 1, 2013. (The rate increase is to take effect for dates of service Jan. 1, 2013, through Dec. 31, 2014.)

As a reminder, this initiative is funded by the federal government for only two years (2013 and 2014). Continuation of the increased payment levels beyond these two years hinges on approval by the Illinois General Assembly.

Medicaid expansion

Before the spring 2013 legislative session came to a close, both the Illinois Senate and House passed S.B. 26 to increase the number of Medicaid recipients. Governor Quinn has indicated he supports the measure, so his signature is expected. Once enacted, about 342,000 uninsured, low income Illinoisans currently excluded from Medicaid coverage will become eligible. Medicaid is expected to grow to cover roughly one-third of all Illinoisans.

The federal government will fund this expansion for the first three years. After that, states gradually pick up more and more of the tab. Even with a "cap" of 10 percent, this will be a challenge for financially strapped Illinois.

Questions? Your ISMS Advocacy Team is standing by to help; call 800-782-4767 ext. 1470 or send an email.

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