Background

For calendar years 2013 and 2014, Section 1202 of the federal Affordable Care Act requires Medicaid agencies to provide payment for certain primary care services delivered by eligible physicians, consistent with federal rules set forth in 42 CFR Part 447, Subpart G (Payments for Primary Care Services Furnished by Physicians). 

1202 Regulations

The regulations implementing Section 1202 can be found here.   

1202 Rates

Section 1202 rates are effective January 1, 2013, pursuant to regulations promulgated by EOHHS. You can find the rates in Administrative Bulletin 13-06.

All Provider Bulletin 230

In December 2012, MassHealth issued an All Provider Bulletin that addresses Section 1202’s implementation. 

Self-Attestation Information

If you need to self-attest to an eligible specialty designation or paid claims history, you can do so by submitting the Physician Certification and Attestation Form.

You may check your eligibility status for Section 1202 rates in your physician profile online at the MassHealth Provider Online Service Center (POSC).

Physicians Participating in MassHealth-Contracted Managed Care Entities

MassHealth is currently determining the implementation process for physicians participating in MassHealth-contracted managed care entities (such as an MCO or SCO). MassHealth will issue a follow-up provider bulletin containing additional information on the Section 1202 attestation process and any other relevant information for such physicians at a later date. Managed care entities may also issue additional information to assist their providers.

 

This information is provided by MassHealth .