Nurse Practitioners of New York

NPs Raise Concerns on Medicaid Primary Care Pay Incentive

Posted over 6 years ago by Juliette Blount

As states move to implement provisions of the health reform law intended to improve access to Medicaid primary care providers and services, AANP and other nurse practitioner groups are expressing concerns to federal officials regarding  problems with policies related to the implementation of increased Medicaid payments for some primary care services.  In addition to meeting with members of Congress, AANP has contacted the Centers for Medicare and Medicaid Services (CMS) and the Medicare and CHIP Payment and Access Commission (MACPAC) to discuss its concerns about restrictions on the ability of NPs to receive the two-year higher payment incentive.

The Centers for Medicare and Medicaid Services (CMS) have interpreted provisions of the Affordable Care Act to include primary care services provided by nurse practitioners, only if those services are provided “under the personal supervision” of an eligible physician.  Their interpretation of the rule specifically excludes services provided by NPs in autonomous practices from the higher payments.  NP groups submitted comments on proposed regulations last June, convincing the agency to drop a plan to require that NP services be billed under the physician’s enrollment number to qualify for higher payment.

Some members of Congress proposed to completely repeal the incentive provisions last year, expressing concerns about the cost of higher payments and doubts about whether the incentive would actually result in more physicians accepting Medicaid patients.  Concerns about increasing federal spending also face efforts to expand the current incentive policy to directly include services provided by NPs.