Bundle 3 GenICs - Health Home SPA (#22), Primary Care Payment Increase (#23), and Medicaid Accountability (#24)

---

Overview

Instructions - Overview
Sample Template with Notes
Questions
Primary Care Rate Data

---

Sheet 1: Instructions - Overview

OMB Control Number: 0938‐1148

Expiration date: 10/31/2014

Data Collection Instructions - Medicaid Primary Care Payment Increase

On November 6, 2012 CMS published 2370-F “Payments for Services Furnished by Certain Primary Care Physicians and Vaccines for Children Program.” This final rule implements Medicaid payment for primary care services furnished by certain physicians in calendar years (CYs) 2013 and 2014 at rates not less than the Medicare rates in effect in those CYs or, if greater, the payment rates that would be applicable in those CYs using the CY 2009 Medicare physician fee schedule conversion factor. This minimum payment level applies to specified primary care services furnished by a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine and also applies to services rendered by these provider types paid by Medicaid managed care plans contracted by states to provide the primary care services. It also provides for 100 percent federal financial participation (FFP) for any increase in payment above the amounts that would be due for these services under the provisions of the approved Medicaid state plan as of July 1, 2009. This rule also updates the interim regional maximum fees that providers may charge for the administration of pediatric vaccines to federally vaccine-eligible children under the Pediatric Immunization Distribution Program, more commonly known as the Vaccines for Children (VFC) program.

In Subpart G—Payment for Primary Care Services Furnished by Physicians at 42 CFR 447.400(d)(1) CMS requires that the state “must submit to CMS, in such form and such time as CMS specifies, information relating to participation by physicians described in paragraph (a) of this section and the utilization of E&M codes described in paragraph (c) of this section (whether furnished by or under the supervision of a physician described in paragraph (a)) of the section for the following periods—(i) as of July 1, 2009, and (ii) CY 2013 (2) As soon as practicable CMS will post this information on www.Medicaid.gov.”

About this Data Request

In accordance with the regulatory requirements CMS is formally requesting each state and the District of Columbia to submit data on physician participation and on payment rates in effect as of July 1, 2009, December 31, 2012 and January 1, 2013 and 2014. To minimize the administrative burden of completing this data collection tool we have developed a template in Excel for states to use in submitting their responses. There are four components/worksheets within the template: Instructions - Overview, Sample Template with Notes, Questions, and Primary Care Rate Data to gather information related to physician participation. CMS provided a selection of default answers for certain questions.

How to Submit the State’s Responses

The state should submit its response by the dates indicated in the Data Collection Timeline to: (add dedicated mailbox address here) using this OMB-approved template. Upon receipt of the state’s response CMS will send an automated date-stamped reply by email.

Technical Specifications

The workbook, “Medicaid Primary Care Payment Increase – State Data Collection” was produced in Excel version 97-2003. If a state experiences technical difficulty in using this workbook, please send an email with the subject line “Technical Assistance Requested” to (put mailbox address here). CMS will work with the state to remedy any problem. See below for the Data Collection Timeline and a sample of the Questions.

Data Collection Timeline

September 30, 2013 Provide answers to questions 1 - 8 and rate data

Data/Information:

• The Medicaid rates in effect as of 7/1/09, 12/31/12 and 1/1/13

• The number of physicians, regardless of specialty, who were enrolled in Medicaid as of 12/31/12

• If known, the number of primary care physicians enrolled in Medicaid as of 12/31/12

Notes:

• Provide fee schedule data on “Primary Care Rate Data” tab of the Excel workbook.

• Provide responses using the “Questions” tab of the Excel workbook.

• For questions 1, 2, 3, 5 and 6 respond by using the pull-down tabs.

• The response to question 4 will auto-fill if the answer to question 3 was “Yes.”

• For question 8, report data as of 12/31/12 only if the state is able to distinguish between primary care physicians and other types of physicians. For 2012 data the state may use its own definition of a primary care physician but should adhere to the definition of a PCP as specified in statute and further clarified in the final rule for the periods ending 12/31/13 and 121/31/14.

April 1, 2014 – Provide answers to questions 1 – 10 (except 7) and rate data

Data/Information:

• The Medicaid rate in effect as of 1/1/14

• The number of primary care physicians enrolled in Medicaid as of 12/31/13

• The number of primary care physicians who, during CY 2013, enrolled in Medicaid for the first time

• The number of physicians enrolled prior to 1/1/13 who did not bill during CY 2012 but resumed billing in CY 2013

Notes:

• Report rate data using the “Primary Care Rate Data” tab in the Excel workbook.

• Provide responses using the “Questions” tab of the Excel workbook.

April 1, 2015 – Provide answers to questions 1 – 6, 8, 9 and 11

Data/Information:

• The number of primary care physicians enrolled in Medicaid as of 12/31/14

• The number of primary care physicians who enrolled in Medicaid for the first time during CY 2014

• The number of physicians enrolled prior to 1/1/14 who did not bill during CY 2013 but resumed billing in CY 2014

PRA Disclosure Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0938-1148.  The time required to complete this information collection is estimated to average hours 40 per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.  If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

---

Sheet 2: Sample Template with Notes

SAMPLE Survey Template with Notes
Notes to Respondents on Survey Questions
Name of state – Select your state from the drop-down menu.
Question 1 – 3 This information is available in the state plan.
Question 4 – If the state answered “Yes” to question 3 then the response to question 4 will default to November 16, 2012.
Question 5 – This information is available in the state plan.
Question 6 – The state should indicate whether it intends to extend higher payment beyond CY 2014.
Question 7 -11 – Physician participation data may be derived from provider enrollment and claims data.
Medicaid Enhanced Primary Care Rate Survey
When responding to this survey, please use the drop down arrow-menus whenever possible. Begin with "Name of State" by right clicking on the cell "ENTER HERE" and then use the drop down arrow to choose the response (the State name). Repeat the same action for the questions.
Name of State: ENTER HERE
Questions	CY2012	CY2013	CY2013
1. Which of the four rate methodologies did the state use?
2. Did the state implement the higher primary care Medicaid rate through supplemental payment?
3. Did the state use the Deloitte-developed rates?
4. If the state did not use the Deloitte-developed rate then what is the release date of the Medicare Physician Fee Schedule used by the state to develop its fee schedule?
5. Did the state adjust its Medicaid rate according to periodic adjustments made by Medicare?
6. As of 2013 does the state intend to extend the enhanced primary care payment beyond 12/31/ 2014?
Primary Care Physician Data
	12/31/2012	12/31/2013	12/31/2014
7. The number of physicians, regardless of specialty designation, enrolled as of 12/31/12
8. The number of primary care physicians enrolled in Medicaid as of 12/31/2012, 12/31/13 and 12/31/14
9. The number of primary care physicians enrolled in Medicaid for the first time during CY 2013 or 2014
10. The number of primary care physicians enrolled in Medicaid prior to 1/1/13 who did not bill during CY 2012 but resumed billing in CY 2013
11. The number of primary care physicians enrolled in Medicaid prior to 1/1/13 who did not bill during CY 2012 but resumed billing in CY 2013

---

Sheet 3: Questions

Medicaid Enhanced Primary Care Rate Questions
When responding to this survey, please use the drop down arrow-menus whenever possible. Begin with "Name of State" by right clicking on the cell below that reads "ENTER HERE", and then used the drop down arrow to choose the response (the State name). Then perform the same actions for Quesitons 1, 2, 3, 5 & 6 in CY2013 & CY2014.
Name of state:		ENTER HERE
				CY2013	CY2014
Questions
1. Which of the four rate methodologies did the state use?
2. Did the state implement the higher primary care Medicaid rate through a supplemental payment?
3. Did the state use the Deloitte-developed rates?
4. If the state did not use the Deloitte-developed rate then what is the release date of the Medicare Physician Fee Schedule RVUs used by the state to develop its fee schedule?
5. Did the state adjust its Medicaid rate according to periodic adjustments made by Medicare of its Physician Fee Schedule?
6. As of 2013 does the state intend to extend the enhanced primary care payment behond 2014?
Primary Care Physician Data
			12/31/2012	12/31/2013	12/31/2014
7. The number of physicians, regardless of specialty designation, enrolled as of 12/31/12
8. The number of primary care physicians who were enrolled as of 12/31/2012, 12/31/13 and 12/31/14
9. The number of primary care physicians enrolled in Medicaid for the first time during CYs 2013 and 2014
10. The number of primary care physicians enrolled in Medicaid prior to 1/1/13 who did not bill during CY 2012 but resumed billing in CY 2013
11. The number of primary care physicians enrolled in Medicaid prior to 1/1/14 and did not bill during CY 2013 but resumed billing in CY 2014

---

Sheet 4: Primary Care Rate Data

State

National Procedure Code

Locality

7/01/2009 Medicaid Fee

12/31/2012 Medicaid Fee

2013 Medicare Reference Rate

2014 Medicare Reference Rate

Local code

Non-Facility

Facility

Non-Facility

Facility

Non-Facility

Facility

Non-Facility

Facility

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-