In Touch: News from the Texas Health and Human Services Commission
January/February 2013

Texas to increase Medicaid primary care rates in 2013

HHSC is working to finalize a primary rate increase now that states have received federal guidance on the Affordable Care Act provision.

The higher rates, including those for certain physician visits and vaccine administration, will be retroactive to Jan. 1. Federal regulations for the rate increases came Nov. 1, leaving HHSC inadequate time to develop a state plan for the increases and get federal approval by the Jan. 1 target date. Once the state plan is approved and the rates are increased, HHSC will make retroactive payments to cover the increase for services that qualify under the federal regulations.

Under those federal rules, providers qualify for the rate increase if:

  • They have a specialty designation of family practice, general internal medicine, pediatrics or a subspecialty within those designations that’s recognized by the American Board of Medical Specialties, the American Osteopathic Association, or the American Board of Physician Specialties.
  • More than 60 percent of the services they provide are primary care services eligible for the rate increase, such as physician visits and administration of vaccines or they are board certified in an eligible specialty / subspecialty designation.
  • They complete a self-attestation to meeting the requirements. HHSC is developing a process for the self-attestations and will notify providers once that process is set.

For updates on the development of the state plan, federal approval and the timeline for the rate increases, check the provider section of the TMHP website.

Texas Health and Human Services Commisison

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