• NY State DOH Extends Attestation Deadline
  • January 31, 2014
  • Law Firm: Dentons Canada LLP - Toronto Office
  • On January 14, 2014, the New York State Department of Health (DOH) announced that it would reverse its position and extend its deadline to allow NY primary care providers seeking eligibility for retroactive Medicaid Primary Care Rate Increase (PCRI) payments under the Affordable Care Act (ACA).

    The ACA’s “Medicaid bump,” funded in full by the federal government, authorized states to allow a PCRI for specific primary care services furnished by certain qualified primary care providers.  The increase will result in payment of primary care services at the Medicare rate to qualified Medicaid providers from January 1, 2013 through December 31, 2014.  The PCRI is intended to enhance access to care for Medicaid beneficiaries by encouraging physician and provider participation in the Medicaid program and/or acceptance of new Medicaid patients.

    On November 6, 2012, the federal Centers for Medicare and Medicaid Services (CMS) published a Final Rule implementing the PCRI (the Final Rule). The Final Rule required primary care physicians who participate in Medicaid to self-attest that they qualify for the PCRI prior to receiving the increased payments.  CMS gave states great flexibility on how they choose to provide the increased payments retroactively but required states to submit a State Plan Amendment (SPA) by March 31, 2013.  Neither the statute nor the Final Rule mentioned cut-off dates for required attestations.

    DOH, the state agency responsible for implementing the federal increase in New York, set a deadline of August 1, 2013 for self-attestations.  If physicians submitted their attestation before August 1, the payment increase would be retroactive to January 1, 2013.  If not, the payment increase would be only prospective.

    On behalf of a physician group with over 1,000 physician members, some of which had missed the August deadline, Dentons worked with both DOH and CMS to successfully convince DOH to remove the August 1, 2013 attestation deadline and allow retroactive payments back to January 1, 2013 for all qualified physicians that attest before the end of December 2014.  This allowed our physician group client to receive an estimated $10 million in additional Medicaid reimbursement.

    New York's decision to extend its Medicaid primary care rate increase attestation deadline has a substantial impact on eligible physicians throughout New York State.  In addition, physicians and other interested parties in other states may view the New York process as a model for similarly modifying attestation deadlines imposed by other state Medicaid agencies with respect to the Medicaid primary care rate increase.