Rates for primary care services covered by Pennsylvania’s Medical Assistance program will rise upon implementation next year of a new federal regulation recently published in draft form by the Centers for Medicare & Medicaid Services (CMS).
Under the proposed regulation, Pennsylvania must pay Medicare-level rates for Medicaid-covered primary care services in 2013 and 2014.  Medicare rates are higher for such services than Pennsylvania’s Medical Assistance rates, and under the proposed regulation the federal government, not the state, will pay for the difference between Medicare and Medicaid rates.
This new policy was mandated by the Affordable Care Act.  In addition to raising fee-for-service rates, Pennsylvania will be expected to revise agreements with its contracted HealthChoices plans to ensure that they, too, pay the better rates.
The higher rates should be especially beneficial for Pennsylvania safety-net hospitals because of the large numbers of Medicaid patients they serve.
Proponents of the higher rates believe they will improve access to primary care services for the Medicaid population and possibly reduce future Medicaid costs by helping recipients get more timely care and thereby avoid more serious illnesses.
Learn more about the proposed Medicaid rate increase in a Commonwealth Fund blog entry and find the entire proposed regulation here.  Interested parties have until June 11 to submit written comments to CMS.