Enhanced Primary Care Payments

 
2
Medicaid Related Assistance
Medicaid & Long-Term Care
 
No
No

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What you need to know

​On December 31, 2014, the enhanced federal funding to certain eligible physicians for the enhanced primary care payment for Medicaid services ended. However, Nebraska Medicaid has chosen to continue primary care enhanced payment to attested providers in the calendar year 2015 and beyond. The enhanced rate is available for providers who are fee-for-service providers with Nebraska Medicaid, as well as eligible providers who are enrolled in the Nebraska physical health managed care program. 

The increased payments pertain to primary care services delivered by a physician (MD or DO) with a specialty designation of family medicine, general internal medicine, or pediatrics. Physician Assistants who are supervised by a physician that is eligible for the enhanced rate are also eligible to receive the enhanced rate. The increase applies to a specific set of services and procedures that Centers for Medicare & Medicaid Services (CMS) designates as “primary care services."

Attested Providers:

Attested Providers (updated June 4, 2020)

Attestation:

In order to qualify for the enhanced rates, eligible enrolled Nebraska Medicaid providers must attest to being a primary care physician by one of the following:

  1. Board certification as a primary care physician by the American Board of Medical Specialties (ABMS), the American Board of Physician Specialties (ABPS), or the American Osteopathic Association (AOA) or
  2. Have furnished evaluation & management (E&M) and vaccines services (codes specified by federal regulation) ​that equal at least 60% of the Medicaid codes billed during the most recently completed fiscal year.

Eligible providers who may qualify for the enhanced rate must complete an Attestation Form to be submitted with the identified documentation to the Medicaid central office. Providers must attest for each new provider number or any time the provider's status of eligibility changes.

Attestation Form

Providers should send forms and documentation to the following address:
DHHS Medicaid and Long-Term Care
Enhanced PCP Rates
P.O. Box 95026
Lincoln, NE  68509-5026 
Or Fax to: (402) 471-9092   Attention: Enhanced PCP Rates

To assist in delivery of information, a dedicated email address has been created for questions and answers specific to this program change.  We will gather the questions and responses and place them on our website.  The email address is:  DHHS.EnhancedPCPRates@nebraska.gov.

Questions

Questions regarding enhanced primary care payments may be sent to:   DHHS.EnhancedPCPRates@nebraska.gov.