Working for you toward Medicaid funding parity with Medicare

Friday, May 20, 2016 10:39 AM
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HB16-1405/HB16-1408, the budget bill, passed the House and the Senate with numerous amendments but maintained critical funding for Medicaid for which CMS advocated. Limits from the Taxpayer Bill of Rights (TABOR) threatened the ability of the state General Assembly to fund Colorado infrastructure, including health care, and the Medicaid evaluation and management (E&M) code parity with Medicare was on the chopping block.

“Cash Fund Transfers for Health Care Programs” addresses part of the proposed decrease in funding for physician services within Medicaid. It creates a Primary Care Provider Sustainability Fund and transfers $20 million in cash funds for the continuation of Medicaid rate enhancements in specific areas including primary care office visits, preventative medicine visits, counseling and health risk assessments, immunization administration, health screening services and newborn care (including neonatal critical care).

Maintaining Medicaid parity with Medicare rates for E&M codes has been a top legislative priority for Colorado Medical Society this year. Colorado is one of the few states that extended parity once the federal Affordable Care Act funds expired. A full rollback of these codes would have likely decreased timely access to care for patients, reduced resources for care coordination and triggered a negative backlash on the state’s highly successful Regional Care Collaborative Organization (RCCO) program.

Colorado has made great gains in the reform of its Medicaid program, namely through the Accountable Care Collaborative (ACC). For three years in a row, the ACC has produced savings and increased patient satisfaction. The program relies on a solid primary care base using the patient-centered medical home (PCMH) model, along with practice analytics and support. The enhanced fees through E&M code parity with Medicare has helped strengthen PCMHs, save taxpayer dollars and improve care; repeal of the enhanced fees threatened these gains.

CMS thanks all physician members, specialty society partners and others who joined advocacy efforts to fight for this critical funding to help ensure access to care for Medicaid patients. It is a hard fought victory.

CMS also recognizes that this achievement is only a partial success. With only $20 million to fill a $49 million hole, some code enhancements were removed from the formula, most notably care in emergency settings. Additionally, these funds are available one time only and not built into the Medicaid rate base.

CMS legislative staff will continue to work to find funding solutions for next year and beyond to ensure physicians are appropriately paid for their care of Medicaid patients.



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