Medicare Incentive Payments for Physician Care
The Health Resources and Services Administration
(HRSA) designates several types of Health Professional Shortage Areas (HPSAs). Some
HPSAs are areas with shortages of primary care physicians, dentists or psychiatrists.
These shortage designations are referred to as geographic-based HPSAs. Also, there are
HPSA designations based on underserved populations within an area, which are referred
to as population-based HPSAs.
Section 1833(m) of the Social Security Act (the Act) provides incentive payments for
physicians who furnish services in areas designated as HPSAs under section 332
(a)(1)(A) of the Public Health Service (PHS) Act. This section of the PHS Act pertains
to geographic-based HPSAs. The Medicare Claims Processing Manual (Chapter 12,
section 90.4) provides basic implementing instructions to Medicare contractors and
physicians regarding eligibility and claims processing for incentive payments. This
section of the Medicare manual states that only geographic-based HPSAs are eligible
areas for the bonus payments.
With regard to the various types of HPSAs (primary medical care, dental and mental
health) and their applicability to the Medicare Bonus Payment program, section 1833(m)
of the Act provides CMS with the authority to recognize all three types of geographicbased HPSAs.
In light of recent provider inquiries, CMS is clarifying which types of geographic HPSA
(primary medical care, dental and mental health) are applicable to the Medicare Bonus
Payment program. As stated above, the statute recognizes geographic-based, primary
medical care and mental health HPSAs as eligible areas for receiving bonus payments.
Consequently, physicians, including psychiatrists, furnishing services in a primary
medical care HPSA are eligible to receive bonus payments. In addition, psychiatrists
furnishing services in mental health HPSAs are eligible to receive bonus payments. CMS
will furnish you quarterly lists of mental health HPSAs to implement this change, which
is effective for claims with dates of service on or after July 1, 2004. Dental HPSAs
remain ineligible for the bonus payment program due to the fact that Medicare does not
cover dental services for its beneficiaries.
This change would only affect psychiatrists furnishing services in mental health HPSAs
that do not overlap with primary care HPSAs. In other words, these stand-alone mental
health HPSAs are now eligible areas, as of July 1, 2004, for psychiatrists to receive bonus
payments.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 06, 2004
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.