Primary Care Provider Self Attestation Form

"Changes to Medicaid primary care reimbursement were enacted as part of the Affordable Care Act. Eligible physicians will receive supplemental payments for services rendered between January 1, 2013, and December 31, 2014, that raise the Medicaid reimbursement to Medicare rates. Medicare rates have not been confirmed at this time.

To be eligible, physicians must personally attest as practicing in family medicine, general internal medicine and/or pediatric medicine and be board certified or meet thresholds for providing recent primary care services.  Advanced practice professionals practicing under the personal supervision of a qualified physician are eligible to receive the supplemental payment...Providers must fill out the short Self-Attestation Form in order to be eligible for the supplemental payments.

If self-attested before March 31, 2013, payments will be retroactive to January 1, 2013. If attested after March 31, 2013, the supplemental payments will be for eligible services provided after the date of self-attestation."  Click here to read more.

• Self-Attestation Form
• FAQs
• Fact Sheet

[Source: Colorado Department of Health Care Policy and Financing]