August 29, 2025

Idaho cuts doctor pay rates for Medicaid. More cuts could come, Health and Welfare says.

August 27, 2025

By: Kyle Pfannenstiel, Idaho Capital Sun

Idaho will cut reimbursement rates for providers who treat Medicaid patients by 4%.

The cuts — coupled with another Medicaid program set to end soon — could push some doctors' offices to stop accepting Medicaid, one health leader says. State health officials say the cuts are meant to reduce rapidly rising Medicaid costs, but more cuts could come.

In a letter announcing the Medicaid cuts, Idaho Medicaid Deputy Director Juliet Charron said Medicaid's budget is projected to grow by 19% — more than twice as sharp as state lawmakers on the budget committee anticipated when they set the budget.

Health and Welfare "must take action to reduce the (trustee and benefit) trendline, which is driving the budget growth," she wrote. Over the coming months, Health and Welfare "will continue to evaluate the need for additional actions" and "will keep providers and stakeholders apprised of any next steps."

The cuts could push Idaho Medicaid patients into an "access to care crisis," said Idaho Medical Association CEO Susie Keller.

"This additional 4% payment cut on top of an already major funding cut will likely push many physician practices over the edge," she told the Sun in a written statement. "And if this happens, Idaho Medicaid patients will face an access to care crisis, especially in rural and underserved areas of the state." READ MORE

How to Submit Public Comment on 4% Medicaid Reimbursement Cuts

On August 22, the Idaho Department of Health and Welfare (DHW) sent a memo to doctors who treat Medicaid patients stating that 4% reimbursement rate cuts will start on Sept. 1st. The proposed cuts still require a public comment period and final approval from the Centers for Medicare & Medicaid Services before they can be permanently implemented.

Public comments must be received by the Department of Health and Welfare by September 26 and must be sent using one of the following methods:

• Email comments to: MCPT@dhw.idaho.gov
• Call and leave recorded comments at: (208) 364-1887
• Fax comments to: (208) 287-1170
• Mail comments to: Division of Medicaid; PO Box 83720; Boise, ID 83720-0009; Attn: Policy Team
• Hand deliver comments during regular business hours (M-F from 8AM to 5PM, except holidays) to: Division of Medicaid; 450 West State Street, 6th Floor; Boise, ID 83720; Attn: Policy Team

Time and Location Set for Sept. 3 Twin Falls Regional DHW Medicaid Review Panel Meeting

On September 3, in the Allen Room in the Herrett Center at College of Southern Idaho in Twin Falls the Idaho Department of Health and Welfare will be hosting the first of several provider regional meetings.

IMA encourages you to attend. It is critical that the Department of Health and Welfare and members of the Medicaid Review Panel hear your recommendations and past experiences with managed care while also sharing the impact of the December 31 Healthy Connections program sunset. Your perspective will help shape the direction of Idaho's transition.

10:00 a.m. - 12:00 p.m. - Medicaid Participant and Stakeholder Listening Session for Comprehensive Managed Care

2:30 p.m. - 5:00 p.m. - Medicaid Review Panel

6:00 p.m. - 7:00 p.m. - Medicaid Provider Listening Session for Comprehensive Managed Care

As a reminder, the Medicaid Review Panel, made up by 11 legislators and co-chaired by Rep. John Vander Woude (R-Meridian) and Sen. Julie VanOrden (R-Pingree), was established in 2024 to review existing Medicaid contracts and make recommendations on key performance measures to be included in any future Medicaid contract. During the 2025 interim, the Panel is particularly focused on Idaho's transition to comprehensive managed care and has committeed to several regional meetings to hear from providers.

Please email the IMA advocacy team if you have questions or are interested in attending: cunnington@idmed.org.

Five IMA Board of Trustee Positions Up for Election at Annual Meeting

IMA delegates will have the opportunity to vote for candidates for the offices of Speaker of the House, Vice Speaker of the House, AMA Alternate Delegate, Young Physician Section Representative, and Secretary/Treasurer at the Annual Meeting in Sun Valley. Please note that current AMA Alternate Delegate, Zachary Warnock, MD, of Pocatello has indicated his intent to seek re-election, and outgoing Vice Speaker April Dillion, DO of Boise has indicated her intent to run for the open Speaker position.

Election to the IMA Board of Trustees allows you to provide policy input and guidance to the organization. The Board meets four times per year, and the expertise of IMA professional staff ensures that your workload will be minimal. All travel, meals, and lodging expenses are reimbursed by IMA.

All open positions have a two-year term. These elections will be held at the AMA House of Delegates, October 10-12, in Sun Valley. It is recommended (but not required) that candidates attend. Any IMA active member may seek election to these open positions.

If interested, please complete the Nomination Form and return to rebecca@idmed.org by September 3, 2025.

AAP Releases Evidence-Based Immunization Schedule; Calls on Payors to Cover Recommendations

August 19, 2025

By: Melissa Jenco, AAP Publications

The American Academy of Pediatrics (AAP) has published an independent evidence-based immunization schedule for children and adolescents in the wake of federal officials undermining the rigorous scientific process of making recommendations.

The schedule published in the AAP Red Book Online includes guidance on COVID-19 vaccination that differs from federal policy. It also includes updates to recommendations on respiratory syncytial virus (RSV) and flu.

"The AAP will continue to provide recommendations for immunizations that are rooted in science and are in the best interest of the health of infants, children and adolescents," said AAP President Susan J. Kressly, M.D., FAAP. "Pediatricians know how important routine childhood immunizations are in keeping children, families and their communities healthy and thriving."

The AAP has a long history of providing evidence-based guidance on vaccines and worked with the Centers for Disease Control and Prevention (CDC) and others in recent decades to harmonize recommendations when possible. However, Health and Human Services secretary Robert F. Kennedy Jr. unilaterally removed COVID-19 vaccines from the routine recommendations for healthy children and pregnant people, sparking a lawsuit from the AAP and other medical groups. READ MORE

Advanced Primary Care Management (APCM):

A Refined Look at Cost Sharing and Preventive Designation in the CY 2026 Proposed Rule

In the CY 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule, CMS introduces a significant update to support the integration of behavioral health services within advanced primary care models. Specifically, the proposal outlines a new suite of G-codes, GPCM1, GPCM2, and GPCM3, intended to function as optional add-on services when billed in conjunction with APCM base codes (HCPCS G0556, G0557, or G0448) by the same practitioner during the same calendar month.

• GPCM 1 is modeled after CPT 99492, capturing initial psychiatric collaborative care management.
• GPCM2 aligns with CPT 99493, supporting subsequent month CoCM services.
• GPCM3 reflects CPT 99484, which accounts for general behavioral health integration (BHI).

These add-on codes are designed to support team-based, integrated care and delivery without the traditional burden of time-based documentation. Notably, CMS is not proposing a companion code to CPT 99494, which reflects the additional time, due to the non-time-based nature of the APCM framework.

A key policy innovation in the proposed rule is CMS's consideration of removing beneficiary cost sharing, which is currently required under traditional Part B rules. This would be a huge win for providers as recent IMA feedback has suggested deep reluctance of patients consenting to these services due to the cost sharing component. Historically, services like Chronic Care Management (CCM) and Behavioral Health Integration (BHI) have faced underutilization, in part because of the 20% co-pay owed by patients. Recognizing this, CMS is explicitly requesting comment on whether these new codes should be treated as preventive services, a designation that would authorize the elimination of cost sharing altogether under the Social Security Act.

CMS points out that the structure and intent of the new APCM codes align closely with existing preventive service models. This approach signals a broader conceptual shift in CMS policy, redefining prevention not just as one-time screenings, but as ongoing, team-based care aimed at mitigating long-term risks and managing complex needs proactively.

Why It Matters for Primary Care Providers

The proposal represents a two-pronged strategy to enhance and reduce administrative burden:

• Introducing monthly, predictable billing codes that are not time-based and reflect the intensity of managing chronic conditions.
• Exploring statutory pathways to remove cost sharing through preventive services designation, effectively increasing uptake and long-term patient engagement.

Unlike traditional care management codes, the APCM series allows for stratification based on the number of chronic conditions, making it both flexible and scalable for diverse practice type. We strongly encourage primary care providers and practice administrators to review and comment on these proposed changes.

CMS is seeking feedback on the following issues:

• Should cost sharing be waived when APCM bundles include both preventive and treatment services?
• Which preventive services (e.g., Annual Wellness Visit, depression screening) should be embedded within the APCM framework?
• Should CMS introduce new coding structures ot more accurately capture primary care's role in prevention and chronic care management?
• Would monthly prospective APCM payments be appropriate for Shared Savings Program ACOs, and how should these payments be reconciled?
• What patient consent protocols or safeguards should be built into APCM billing within ACO settings?
• What other policies would increase primary care participation in ACOs through APCM?

Comments are due by September 12, 2025.

Public Comment Link: https://www.regulations/gov/commenton/CMS-2025-0304-0009