Health Professional Shortage Area (HPSA) Bonus Payments - 2014 Update

MLN Matters®Number: MM8463
Related Change Request (CR) #: CR 8463
Related CR Release Date: September 27, 2013
Effective Date: January 1, 2014
Related CR Transmittal #: R2794CP
Implementation Date: January 6, 2014
Provider Types Affected

 This MLN Matters® Article is intended for physicians, providers, and suppliers submitting claims to Medicare contractors (Fiscal Intermediaries (FIs), carriers and A/B Medicare Administrative Contractors (A/B MACs)) for services to Medicare beneficiaries.

Provider Action Needed
Change Request (CR) 8463, from which this article is taken, alerts you that the annual HPSA bonus payment file for 2014 will be made available by the Centers for Medicare & Medicaid Services (CMS) to your Medicare contractor and will be used for HPSA bonus payments on applicable claims with dates of service on or after January 1, 2014, through December 31, 2014. These files will be posted to the internet on or about December 1, 2013. You should review http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HPSAPSAPhysicianBonuses/index.html   on the CMS website each year to determine whether you need to add the AQ modifier to your claim in order to receive the bonus payment, or to see if the ZIP code area in which you rendered services will automatically receive the HPSA bonus payment. Note that Medicare contractors will continue to accept the AQ modifier for partially designated HPSA claims. Please be sure that your staffs are aware of this update.

Background
Section 413(b) of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 mandated an annual update to the automated HPSA bonus payment file. CMS automated HPSA ZIP code file is populated using the latest designations as close as possible to November 1 of each year. The HPSA ZIP code file will be made available to CMS contractors in early December of each year. CMS contractors shall implement the HPSA ZIP code file and for claims with dates of service January 1 to December 31 of the following year, shall make automatic HPSA bonus payments to physicians providing eligible services in a ZIP code contained on the file.

Additional Information
The official instruction, CR8463, issued to your MAC regarding this change may be viewed at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2794CP.pdf  on the CMS website.

Last Updated Oct 21, 2013

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DHCS announces Healthy Families transition to Medi-Cal Managed Care in rural counties (California)

The Department of Health Care Services (DHCS) announced Medi-Cal fee-for-service transition to Medi-Cal managed care is set to begin for 28 rural counties on September 1, 2013. The transition is to be implemented in phases in order to ensure the readiness of DHCS contracted health plans and to minimize any disruption in services to beneficiaries.
Phase 4 of the Healthy Families Program transition will begin on September 1, 2013, for the eight County Organized Health System (COHS) counties that include Del Norte, Humboldt, Lake, Lassen, Modoc, Shasta, Siskiyou and Trinity. DHCS is evaluating health plan readiness to minimize disruption of services and ensure continuity of care. Approximately 8,000 Healthy Families’ patients will be transitioned.
On November 1 2013, Phase 4b of the 27,000 Healthy Families Program beneficiaries will transition in Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Imperial, Inyo, Mariposa, Mono, Nevada, Placer, Plumas, Sierra, San Benito, Sutter, Tehama, Tuolumne and Yuba counties.
Additional details are available on the expansion of Medi-Cal managed care here.
Details for the Healthy Families transition are available here.
Questions or comments for DHCS can be sent via email to DHCSHealthyFamiliesTransition@dhcs.ca.gov.

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