Health Care Authority prepares website to answer Medicaid providers’ questions

Washington State’s Medicaid program, like all other states, is waiting for information from the federal government in order to finalize the rate increases for primary care providers promised under the Affordable Care Act.


Under the health care reform law, certain primary care providers, pediatricians, family medicine practitioners and general internal medicine physicians will receive rate increases to raise Medicaid reimbursements to the same rates Medicare pays as of January 1, 2013, through the end of 2014. (Medicaid is traditionally the lowest payer in health care.)

However, the federal government is still finalizing the rule changes necessary to reach that objective, so states cannot immediately implement the new rates.

“Our hope is that all these questions can be resolved soon. In the meantime, we are putting up a website that will answer doctors’ questions about how it will work, which physicians qualify for the new rates and what billing codes will receive the enhanced rates,” said MaryAnne Lindeblad, director of the Health Care Authority.

She stressed that no provider will miss out on the bigger payments, because providers who qualify for the higher rates will be able to file those claims retroactively.

The address of the new website is The site includes an explanation of the current situation, a list of all the eligible codes involved in the rate changes and a Question and Answer document to address other concerns.

The site will be updated regularly so it will be important for providers to continue to check it.

The website also will include a copy of a provider attestation form that must be completed in order to qualify for the new rates. That form also is undergoing final review and approval.

Basically, Section 1202 of the Affordable Care Act provides federal dollars to pay Medicaid providers at Medicare rates for two years. It amends sections 1902(a)(13), 1902(jj), 1905(dd) and 1932(f) of the Social Security Act to require payment of the Medicare rate for certain Medicaid primary care services provided in calendar years 2013 and 2014.

The provision applies to evaluation and management (E&M) and vaccine administration services when delivered by a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine



Medicaid Expansion 2014 website:

The Health Benefits Exchange website:

The Provider Rates Change website:




We encourage an open exchange of ideas on this story's topic, but we ask you to follow our guidelines for respecting community standards. Personal attacks, inappropriate language, and off-topic comments may be removed, and comment privileges revoked, per our Terms of Use. Please see our FAQ if you have questions or concerns about using Facebook to comment.

Read the Oct 26
Green Edition

Browse the print edition page by page, including stories and ads.

Browse the archives.

Friends to Follow

View All Updates