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Skip Navigation LinksHome > News and Events > Medicaid Enhanced Primary Care Rates to Continue

Medicaid Enhanced Primary Care Rates to Continue

July 14, 2016

PHO previously shared that Governor Branstad line-item vetoed a provision of the Health and Human Services budget bill that would remove the enhanced primary care physician rate and cap dual- eligible Medicaid coverage if the Medicare primary payment exceeds the Medicaid fee schedule for that procedure. These changes were intended to become effective 7/1/2016.

Yesterday, IMS received a letter from DHS advising that while DHS would be allowed to pursue this cost-containment strategy, at this time DHS has no plans to pursue these changes. IME and the MCOs should continue to pay the enhanced primary care physician rates and Medicare dual-eligible claims for now. Click here to read the letter from DHS to IMS explaining these changes.

IME also announced yesterday that the MCOs have successfully completed testing for Medicare crossover claims. As of 7/25/2016, crossover claims will be sent automatically by Medicare to the MCO. However, prior to managed care, there were a limited number of claims which did not automatically crossover (Medicare Advantage claims). This will continue, and will be the provider's responsibility to submit the crossover claim to the appropriate MCO for reimbursement. Click here to read the Informational Letter advising of this update.