Texas Primary Care Provider Fee-For-Service Rate Increase Delayed

Texas will be increasing Medicaid primary care fee–for-service rates, those for certain physician visits and vaccine administration, as quickly as possible. However the state did not receive final federal regulations on the increase until November 1, 2012. This was too late to allow the state to meet the January 1, 2013 date authorized in the Affordable care Act. Once the state increases primary care rates, the Medicaid Managed Care Organizations (MCOs) should be making retroactive payments for increase for fee-for-service providers and services that qualify under the federal regulations. This fee increase does not apply to the RHC encounter rate. RHCs are reimbursed on a facility cost basis and this fee-for-service increase does not apply to RHC encounter rates. However, the Medicaid RHC encounter rate will increase in the beginning months of 2013 due to the annual adjustment that is done every year. When you receive your TMHP Medicaid RHC encounter 2013 rate increase letter, don’t forget to send a copy to the MCOs that you are contracted with in order to be paid correctly.

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