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 .
All Provider Bulletin 230
In December 2012, MassHealth issued an All Provider Bulletin that addresses Section 1202’s 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.
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 a managed care organization or senior care organization). 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.
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 .