Final Medicaid rules in 7/24 DCR

The Department of Health Care Finance (DHCF) issued final rules in the July 24, 2009 DC Register regarding Medicaid reimbursement rates.   The rules create a new section of the DC Municipal Regulations (DCMR) entitled "Medicaid Physician and Specialty Services Rate Methodology."   This rule will establish a new rate methodology that will increase Medicaid reimbursement for physician and specialty services.

Low reimbursement rates have kept specialty docs, who might accept Medicaid, out of DC.   The Medicaid program projects total annual expenditures of $11.34 million as a result of the proposed change in the fee schedule for physician and specialty services.

Medicaid is also amending the State Plan for Medicaid Assistance (State Plan) to reflect these changes.   The District’s State Plan Amendment (SPA) has already been approved by the Council of the District of Columbia (August 15, 2008) and the federal Centers for Medicare and Medicaid Services (effective April 25, 2009).