Committee approves 5% physician E&M raise now, asks DHS to return with additional plan

The Senate panel reviewed a DHS proposal to raise physician evaluation-and-management (E&M) reimbursement codes by 5% and debated whether to adopt a larger increase recommended by providers.

Janet Mann, director of medical services at DHS, told the committee the administration used a contracted actuary (Milliman) and internal staff analysis to develop the recommendations. "We proposed splitting it between the evaluation and management codes before you today," Mann said; she confirmed the 5% increase is scheduled to be effective July 1, with an additional 3% being considered for Jan. 1 as part of PCCM/PCMH program changes.

Committee members challenged DHS on the underlying survey and data. Representative Bentley pointed to a fiscal-impact figure in the exhibit showing a $4.5 million total cost with $3.2 million federal and $1.3 million state general-revenue impact and urged a larger increase. "This is where the rubber meets the road," Bentley said, pushing for an 8% increase.

Representative Bentley moved to defer review — effectively withholding approval — seeking a larger adjustment; Representative Wardlaw offered a substitute motion to review the rule as presented by DHS with the expectation DHS would return to the committee before year-end to pursue the additional recommended percentage. The substitute motion carried on a committee vote and the rule was recorded as reviewed; DHS said the 5% would take effect July 1 if the process proceeds toward adoption.

Lawmakers repeatedly asked DHS to provide more granular survey and cost data, access figures for rural areas, and breakdowns showing how much of E&M payments flow directly to independent physicians versus employed providers.