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).
The regulations implementing Section 1202 can be found here file size 5MB .
Pursuant to regulations promulgated by EOHHS, Section 1202 rates for calendar year 2014 are in Administrative Bulletin 14-04 .
Section 1202 rates for calendar year 2013 are in Administrative Bulletin 13-06 .
Acute Inpatient Hospital Bulletin 151, Acute Outpatient Hospital Bulletin 31
Physician Bulletin 98
In February 2015, MassHealth issued Physician Bulletin 98 , 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 , 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 that addresses Section 1202’s implementation.
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 . A fillable version of the form is available here .
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.
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 .