Nebraska Medicaid Enhanced Primary Care Payments
1-1-2013 to 12-31-2014
****CMS has approved Nebraska Medicaid’s State Plan Amendment regarding paying primary care physicians an enhanced fee.*****
See new Frequently Asked Questions
Notifications to Providers
Attestation Form (updated 06-04-13)
Enhanced Primary Care Provider fee schedule
Information about the Enhanced Primary Care Payments
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 (PA) 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.”
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:
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
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.
Any provider who is attesting for the first time in 2015 or in subsequent years will not receive primary care enhanced payment for years 2013 or 2014.
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.
Acknowledgement of Attested Providers
Attested Providers (updated 9/09/2016)
Board Certification Lists
Medicaid Managed Care Contractors for Physical Health
Provider Service line for information about general questions about the PCP reimbursement
United Healthcare Provider Service line for more specific contracting questions
CMS Final Rule:
Correction to final rule:
Q and A on Increased Medicaid Payments for PCPs
Q and A on Set II INcreased Payments for PCPs
Q and A on Increased Medicaid Payments for managed care
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