On November 6, 2012, CMS published a final rule implementing an ACA provision requiring states to reimburse certain primary care physicians in CYs 2013 and 2014 at rates not less than the applicable Medicare rates. This minimum payment level applies to specified primary care services furnished by a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine, and it also applies to services rendered by these providers under Medicaid managed care plans. CMS will provide 100% federal matching funds for the difference in payment between the applicable Medicare payment and the Medicaid rate in effect as of July 1, 2009. The final rule specifies which services and types of physicians qualify for the minimum payment level, and the method for calculating the payment amount and any increase for which increased federal funding is due. The final rule also updates the interim regional maximum fees that providers may charge for the administration of pediatric vaccines to federally vaccine-eligible children under the Vaccines for Children program. CMS estimates that in CY 2013, the federal cost of the rule will be approximately $5.835 billion with $235 million in state savings, while in CY 2014, the federal cost will be approximately $6.055 billion with $310 million in state savings.