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Enhanced Payment Provider Self-Attestation - Department of Social

Enhanced Payment Provider Self-Attestation - Department of Social 2025

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The document outlines the eligibility criteria and procedures for enhanced payments to certain primary care physicians under South Dakota Medicaid, as mandated by the Patient Protection and Affordable Care Act. It specifies that eligible physicians must be board certified in Family Practice, Pediatrics, or Internal Medicine, or can self-attest if they meet specific billing requirements. Enhanced payments apply to designated evaluation and management codes and vaccine administration codes for services rendered between January 1, 2013, and December 31, 2014. The document also includes details on how to self-attest, frequently asked questions regarding eligibility, and payment processes.

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How do Medicaid payments work?

Medicaid, the public health insurance program covering more than 72 million people with low income, is jointly funded by states and the federal government. Medicaid spending totaled around $890 billion in the 2023 federal fiscal year, with the federal government paying 69 percent and states paying 31 percent.

What is a direct payment plan?

Direct payment is a method of transferring funds directly from one account to another without the need for intermediaries.

What is the Medicaid directed assistance program?

Medicaid Consumer-Directed Personal Assistance Programs provide an alternative way of receiving home care services in which consumers have more control over who provides their care and how it is provided.

Who are Medicaid payments made to?

State Medicaid programs (or the states contracted Medicaid managed care organizations (MCOs)) pay hospitals through a combination of base payments for services and supplemental payments.

What is a Medicaid directed payment program?

Although MCOs generally have the flexibility to negotiate payments with providers, the directed payment option provides states with more control over the rates and methods used by MCOs to pay network providers and can direct MCOs to use methods that advance specific state goals.

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When dealing with managed care in Medicaid, the payment is made to providers through?

The two main delivery system models are fee-for-service, where the Medicaid agency directly pays providers or groups of providers, and capitated managed care, where the Medicaid agency pays an external managed care organization, who then pays providers for covered services.

What are directed payments in Medicaid?

These types of payment arrangements permit states under 42 CFR 438.6(c) to direct specific payments made by managed care plans to healthcare providers and can assist states in furthering the goals and priorities of their Medicaid programs.

Enhanced Payment Provider Self-Attestation - Department of Social 2025

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How do Medicaid payments work?

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What is a Medicaid directed payment program?

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When dealing with managed care in Medicaid, the payment is made to providers through?

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