Jackie Selby Quoted in “Temporary Medicaid Fee Hike Could Come Back to Haunt Plans”

Managed Healthcare Executive

Jackie Selby, a Member of the Firm in the Health Care and Life Sciences practice in the New York office, was quoted in an article titled “Temporary Medicaid Fee Hike Could Come Back to Haunt Plans.”

Following is an excerpt:

Fewer physicians are willing to accept Medicaid patients today, as the reimbursement rates continue to decline. State and federal policies are attempting to remedy the problem with additional funding, particularly for primary care. ...

For most states, the rule proposed in the Patient Protection and Affordable Care Act (PPACA), which increases Medicaid rates up to Medicare levels, and the $11 billion in new federal funds to improve Medicaid primary care, were good news. ...

Medicaid managed care plans are also likely to lace some contract issues with their physicians. Legal language might need to change to reflect the temporary fee increases, according to Jackie Selby, a Member of the law fìrm Epstein Becker & Green in New York. She says that contracts with individual physicians tend to be one-year evergreen contracts that are automatically renewed unless either the physician or the plan does not want to do so.

However, group contracts often remain in effect for multiple years, and it is rare to see providers agreeing in advance to a lower rate for the future. "I would be shocked if a physician group that has some leverage would agree to multiple year contract in which they would agree to take a fee cut in 2015," she says. A more likely scenario is for physician groups to agree to a two-year contract to cover the fee increase period. Then a few months before the contract expires, the plan and the physician group could negotiate fees for the next contract starting in 2015.