Nearly a year after it was supposed to take effect, the physician pay hike for Medicaid services still hasn’t been fully implemented in Georgia and other states.
The delays have come in states, including Georgia, that use managed care in their Medicaid programs, a physicians organization says.
The Affordable Care Act created the pay hike with the goal of reimbursing family physicians, internists and pediatricians the same for Medicaid services as they receive under Medicare.
The ACA required the raise to be paid for two years, 2013 and 2014.
Once implemented, the raise will be paid retroactively to eligible doctors back to Jan. 1, 2013.
Doctors currently are getting the pay increase for care rendered under the traditional fee-for-service model. But the majority of Medicaid patients in Georgia are in managed care plans called CMOs.
“There’s a lot of blame to go around,” Dr. Bob Wiskind, an Atlanta pediatrician, told GHN on Monday. “It’s been a very frustrating process.”
The delay has increased the financial pressure on primary care physicians who serve a heavy load of Medicaid patients, said Wiskind, who’s the current president of the Georgia chapter of the American Academy of Pediatrics.
The pay hike was designed to increase patients’ access to care, he said. “We’re almost at the end of Year One, and we’ve seen only a small amount.”
The state Medicaid agency said it has not yet received federal approval of a “contract amendment” that will allow the payments to the CMOs.
Once these organizations get the payments, they would be able to pay physicians the reimbursement increase, said a Department of Community Health spokeswoman in an email.
The federal Centers for Medicare and Medicaid Services referred questions on the managed care snag to the state Medicaid agency.
Physician groups in Georgia raised alarms about the delay in July, calling it, among other things, “inexcusable.”
The Medical Association of Georgia (MAG) said Monday that it has been pressing Community Health “to take whatever steps are necessary” to start the payment process.
“The affected physicians have been more than patient and reasonable, but the ongoing delay is growing increasingly unreasonable and unacceptable — and it undermines Georgia’s failing and unsustainable Medicaid program,” Donald J. Palmisano Jr., executive director of MAG, said in a statement.
It’s not clear how many states are still experiencing a delay in payments.
The American Academy of Pediatrics said it has data showing that about 40 states are paying the increase in Medicaid fee-for-service, but that there are persistent problems with Medicaid managed care.
Pediatricians want to make sure their practices receive the full payment hike so patients’ access to care can increase, said Dr. Anne Edwards, chair of the American Academy of Pediatrics’ committee on state government affairs.
Edwards, a Minneapolis pediatrician, noted the pay raise had a tight timeline, with the federal rules not being released until November 2012. “Medicaid managed care has increased complexity, with many companies still reviewing their payment methodologies to get the increased payments to qualified clinicians,” she added.
This pay hike represents the first Medicaid raise for Georgia doctors in more than a decade.
Wiskind, the pediatrician, adds, “There have been plenty of roadblocks put up.’’
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