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Enhanced PCP Payment Information

The Patient Protection and Affordable Care Act (PPACA) mandates states to reimburse eligible providers for certain primary care services at the Medicare rate for services provided between 1/1/2013 and 12/31/2014. Read the Provider Bulletin or the Frequently Asked Questions to learn more about how this program is being implemented in South Dakota.

Program Eligibility

In order for a physician to receive enhanced payments, the department must receive a signed Attestation Form, attesting to his/her eligibility for this program. Per federal rule, physicians must self-attest each year to be eligible for the enhanced payment.  Therefore, those physicians who attested in 2013 must re-attest to their continued eligibility. To learn more about the eligibility requirements for participation, please consult the Frequently Asked Questions.

Provider Attestation

Providers who attested in 2013 and who are eligible to continue enhanced payments in 2014 must re-attest by December 15, 2013 to ensure no break in enhanced payment. South Dakota Medicaid will not issue retroactive payments in 2014.  Physicians who meet the eligibility criteria but have not submitted an attestation can attest at any time up to December 31, 2014 to receive enhanced payment effective the date the attestation is received by South Dakota Medicaid.

2014 Attestation Form
2013 Attestation Form

South Dakota Medicaid prefers to receive attestations scanned and sent via email to Forms can also be faxed to 605-773-5246. Mailed forms must be postmarked before December 15, 2013 to be processed by December 31, 2013.  Forms not received or postmarked by December 15, 2013 will be processed in the order they are received.

Enhanced Payments

The services eligible for enhanced payments include evaluation and management codes 99201 through 99499 and vaccine administration codes 90460, 90461, 90471, 90472, 90473, and 90474. A separate fee schedule of the enhanced rates is available:

View the Fee Schedule

Additional Information

South Dakota submitted a State Plan Amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) to implement this program. The SPA was approved on June 1, 2013.

View the State Plan

To learn more about federal requirements mandating this program, read the federal regulations: