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March 3, 2016
The Honorable Andrew Slavitt
Acting Administrator
Centers for Medicare and Medicaid Services
200 Independence Ave, S.W.
Washington, DC, 20201

Dear Mr. Slavitt:

We write regarding our concerns with the Increased Medicaid Payments for Primary Care Physicians
program created in Section 1202 of the Health Care and Education Reconciliation Act of 20 I 0. As we
continue to hear from physicians in Tennessee, we fear the intent of the program to encourage more
providers to accept Medicaid patients will not be realized, and the program as currently implemented will
have the opposite effect of its goals and will instead limit access and discourage physicians from
participating in the Medicaid program, especially now that the President has proposed extending the
program through 2017 in his budget. We ask that the Centers for Medicare and Medicaid Services (CMS)
evaluate its interpretation of the 60 percent threshold used to determine eligibility for the increased
payments and delay recoupments until all states have finished auditing to ensure the program does not
have these unintended consequences.

The Increased Medicaid Payments for Primary Care Physicians program required participating state
Medicaid programs to pay for primary care services provided in 2013 and 2014 at the same level as
Medicare rates. To determine program participation, CMS required physicians either be board-celti?ed or
report that 60 percent of Medicaid services provided were for evaluation and management services or
vaccine administration, including ancillary services as part oftotal services billed. Due to confusion
related to this 60 percent threshold, about 140 physicians in Tennessee are facing recoupments totaling
more than $7.5 nrilliorr.

Additionally, we believe other states may not have completed their audits of the enhanced payments and
may experience similar findings of physicians being out of compliance with the threshold. We ask that
CMS not recoup any incentive payments for participation in the program until all other states have
completed their audits. This will allow for a complete assessment of the program and its holistic impacts
on providers and Medicaid beneficiaries.

CMS has indicated that it is not considering alternate interpretations of the regulation and guidance
related to the program in correspondence with the Tennessee Medical Association. We are concerned
about the formula used for validating participation in the program and ask that you examine the regulation
and guidance, considering the potential for discouraging physicians from caring for Medicaid
bene?ciaries,

As both Medicare and Medicaid take steps toward rewarding quality and incentivizing certain types of
care, it is critical that we monitor and evaluate these changes to ensure their intended outcomes are
realized and that bene?ciaries are not compromised as a result of new programs or policies. We ask that
you review participation requirements for the Medicaid Payments for Primary Physicians and
delay recoupments until all states have ?nished auditing to ensure the program does not have the

unintended consequences of discouraging provider participation in Medicaid and limiting access to

 

 

bene?ciaries.
Lamar Alexander Bob Corker
United States Senator United States Senator

Diane Black WEI/Blackburn

 

 

 

 

 

 

Member of Congress Member of Congress
 
 
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Member of Congress Member of Congress
  

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Member of Congress Member of Congress
Stephen?Fincher Chuck Fleisl??ann
Member of Congress Member of Congress
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Member of Congress