Q: I work for a primary care physician’s office and we see a lot of Medicaid patients. I’ve heard that the Affordable Care Act requires an increase in Medicaid payments to primary care physicians to 100% Medicare rates. When will we see these increases take place? Can you provide any guidance for us?
On March 4, 2013, the Illinois Department of Health & Family Services (HFS) published this notice
about the increase in fees for primary care physicians. It says, "For dates of service January 1, 2013 through December 31, 2014, the department will apply an increased payment rate to enrolled practitioners for primary care services delivered by a primary care physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine. The increased payments will apply to services reimbursed by Medicaid fee-for-service, Voluntary Managed Care Organizations and Integrated Care Program Health Plans." In order to receive the increased payments, physicians must self attest that they meet certain criteria. Interested primary care providers should read the notice for more information.
Under the Affordable Care Act, will licensed acupuncture be covered by private insurance plans?
The covered benefits and services for small group and individual group plans under the Affordable Care Act have not been fully defined yet; however, the Illinois Health Reform Implementation Council (IHRIC) is meeting this month (see info on our events page here
) to discuss what the benchmark Essential Health Benefits (EHB) package will be in Illinois.
If the Illinois’ EHB benchmark includes acupuncture then a licensed acupuncturist will be able to submit to insurance for her/his services. California just chose their benchmark EHB which does include acupuncture; see their scope of benefits here
: Acupuncture Services (typically provided only for the treatment of nausea or as part of a comprehensive pain management program for the treatment of chronic pain).
Public comment on the Illinois EHB is welcomed by IHRIC by 9/19/12 and can be submitted on their website here
I am a hospital administrator in Illinois. I understand the Governor's Health Care Reform Implementation Council is considering various ways to pay for the costs associated with administering the Health Benefits Exchange including assessments on insurance carriers, consumers and providers. How much will it cost Illinois to run its Exchange?
The Affordable Care Act will provide the initial funding necessary for a state to build and maintain an Exchange through federal grants. These federal funds are available to support the costs of the Exchange through the end of 2014. Beginning January 1, 2015, federal law requires that state exchanges must be financially self-sustaining. In order to do this, states need to determine the method by which the Exchange’s operations will be financed. According to the Illinois Department of Insurance (DOI), the costs associated with the Illinois Exchange are still unknown. Illinois is currently requesting an independent analysis of estimated operational costs. Very few states have run their own exchange and the experience of those that have done so is varied: Utah's exchange was estimated to cost $600,000/year and Oregon's estimate is $48-49 million/year. The estimate for administering the Massachusetts Connector is between $10-$20 million/year. The reason for the cost difference is due to a wide variation in the responsibilities delegated to the Exchange. Information from DOI about the Illinois Exchange will be released once the independent analysis has been completed. When the information is released it will be posted at www.illinoishealthmatters.org
I am a state legislator in Illinois and I am concerned that my constituents don't know how health care reform can help them right now. How can I help constituents who call my office and are uninsured?