Department of Human Services

The Department of Human Services (DHS) Med-QUEST Division (MQD) is extending its enhanced reimbursement rate through June 30, 2015 for certain primary care services provided by eligible primary care physicians (PCP).  The initial two year provision ended December 31, 2014.

The MQD will use the same reimbursement methodology that has been in place for the past two years under Section 1202 of the Affordable Care Act.  Under this provision, Medicaid programs were required to increase reimbursement to Medicare rates for certain primary care services provided by eligible PCPs.  In Hawaii during this period, 1,039 eligible PCPs received an aggregate increased payment of approximately $44 million for services provided to Medicaid beneficiaries.

In FY 2014, the MQD requested and received an appropriation from the Hawaii State Legislature to maintain the higher reimbursement levels for an additional six months.  Beginning in 2015, the federal matching rate for the increased reimbursement will be approximately 52%, compared to the previous 100% federal funding under Section 1202.  The new State appropriation will make up the funding difference.

To qualify for the increased reimbursement, physicians must attest that they practice family medicine, general internal medicine or pediatric medicine, or sub-specialties recognized by the American Board of Medical Specialties, the American Osteopathic Association, or the American Board of Physician Specialties.  Physicians who have already self-attested and have been receiving the increased payments will continue to be eligible.

The percent of Medicare reimbursement at which Medicaid PCP reimbursement will be made beyond June 30, 2015 is dependent on available funding.  Expansion of eligibility to other important Medicaid providers including psychiatrists, neurologists, obstetrician-gynecologists, and advanced practice registered nurses, to services provided to children covered under the Children’s Health Insurance Program (CHIP), and/or implementation of a monthly PCP care management payment also is dependent on available funding.
For more information about MQD PCP reimbursement enhancement or the self-attestation process, call 808-692-8099 or visit the MQD website at
www.med-quest.us/providers/PrimaryCarePhysician.html.

Media Contact:
Kayla Rosenfeld, DHS Public Information Officer
586-4892; [email protected]