Section 1202 Rates for Physicians Who Provide Primary Care Services

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

If you participate as a network provider for a MassHealth-contracted managed care entity (such as an MCO) and would like to be eligible for Section 1202 rates, please complete the MassHealth Physician Certification and Attestation Form and send it to CST if you are attesting to eligibility based on your paid claims (see Section IV of the form). If you are attesting based on board certification (see Section IV of the Form), please contact the managed care entity with which you participate for more information about your eligibility for Section 1202 rates.

If you need to self-attest based on billing history, you can do so by submitting the Physician Certification and Attestation Form.