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 pdf format of 101 CMR 317 Medicine
doc format of                             101 CMR 317 Medicine                file size 5MB .

1202 Rates

Pursuant to regulations promulgated by EOHHS, Section 1202 rates for calendar year 2014 are in Administrative Bulletin 14-04 pdf format of Administrative Bulletin 14-04
doc format of                             Administrative Bulletin 14-04                .

Section 1202 rates for calendar year 2013 are in Administrative Bulletin 13-06 pdf format of Administrative Bulletin 13-06
doc format of                             Administrative Bulletin 13-06                .

Acute Inpatient Hospital Bulletin 151, Acute Outpatient Hospital Bulletin 31

In February 2015, MassHealth issued Acute Inpatient Hospital Bulletin 151 pdf format of Section 1202 Rates for Hospital-Based Physicians
doc format of                             Section 1202 Rates for Hospital-Based Physicians                 and Acute Outpatient Hospital Bulletin 31 pdf format of Section 1202 Rates for Hospital-Based Physicians
doc format of                             Section 1202 Rates for Hospital-Based Physicians                , which provide guidance to acute hospitals regarding Section 1202 implementation.

Physician Bulletin 98

In February 2015, MassHealth issued Physician Bulletin 98 pdf format of Section 1202 Rates for Hospital-Based Physicians
doc format of                             Section 1202 Rates for Hospital-Based Physicians                , which provides guidance to hospital-based physicians who provide primary care services regarding Section 1202 implementation.

All Provider Bulletin 235

In August 2013, MassHealth issued All Provider Bulletin 235 pdf format of Section 1202 Rates for Physicians
txt format of                             Section 1202 Rates for Physicians                , which includes some updated guidance to physicians in the implementation of Section 1202.

All Provider Bulletin 230

In December 2012, MassHealth issued an All Provider Bulletin pdf format of All Provider Bulletin 230
txt format of                             All Provider Bulletin 230                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 pdf format of aca-1202
doc format of                             Physician Certification and Attestation Form                . A fillable version of the form is available here pdf format of 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 Billing MassHealth Managed Care Entities

Physicians billing MassHealth managed care entities (such as a managed care organization or senior care organization) may wish to contact their managed care entities for additional information.

Additional Resources

Questions and Answers about Section 1202 from the federal agency CMS (The Centers for Medicare and Medicaid Services) can be found under Provider Payments here: http://www.medicaid.gov/AffordableCareAct/Provisions/Provider-Payments.html. Note that in Set I, CMS provides a list of which subspecialty certifications are eligible for Section 1202 Rates.

 


This information is provided by MassHealth .