July 22, 2013 The ACA Self Attestation Form is now available on the ACA Increased Medicaid Payment for Primary Care Physicians page of the Medi-Cal website. Providers must use this form to self-attest that they are eligible for the increased payment available under the Affordable Care Act (ACA). Providers can reference the Primary Care Physician Self Attestation Form Completion Instructions for step-by-step instructions and additional information about the form. BACKGROUND The Patient Protection and Affordable Care Act (PPACA), as amended by the H.R. 4872-24 Health Care and Education Reconciliation Act of 2010, Section 1202, requires payments to be increased to the Medicare equivalent for certain primary care services. The increased payments are retroactive for dates of service on or after January 1, 2013, for both fee-for-service and managed care programs. According to the final rule, physicians must meet the following criteria to be eligible for increased payments: A physician as defined in 42 Code of Federal Regulations (CFR) 440.50, with a specialty designation of family medicine, general internal medicine, pediatric medicine or a subspecialty within one of the listed specialties. AND Meeting at least one of the following qualifications: o Board certified in a specialty or subspecialty as recognized by the American Board of Medical Specialties, the American Osteopathic Association and the American Board of Physician Specialties. OR o At least 60 percent of the services billed to Medi-Cal for the most recently completed calendar year fall within the Evaluation and Management (E&M) or vaccine administration codes covered by the regulation. Services provided at Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are not eligible and will continue to receive their prospective payment system (PPS) rate. Physicians must attest online to be eligible for the increased payments. The Department of Health Care Services (DHCS) is working with Xerox State Healthcare, LLC, (Xerox) the DHCS Fiscal Intermediary (FI), to make the necessary system changes. Upon complete implementation of the system, DHCS will initiate payment corrections for eligible services provided on or after January 1, 2013. Eligible providers will receive the increased payments for future claims as defined in the Centers for Medicare & Medicaid Services (CMS) Final Rule.