NOTICES
DEPARTMENT OF PUBLIC WELFARE
Notice of Intent to Amend the Medicaid State Plan for Payments to Federally Qualified Health Centers and Rural Health Clinics
[31 Pa.B. 1809] The Department of Public Welfare (Department) is announcing its intent to amend the Medicaid State Plan for payments to Federally qualified health centers (FQHCs) and rural health clinics (RHCs).
The Department intends to change the Medicaid State Plan to reflect the Department's implementation of section 702 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000. We also intend to clarify the treatment of case management fees.
Section 702 of BIPA repeals the reasonable cost-based reimbursement requirements for FQHC/RHC services, and institutes a new prospective payment system (PPS) to pay for FQHC/RHC services effective January 1, 2001. In accordance with BIPA requirements, for the period January 1, 2001, through September 30, 2001, the Department will pay FQHCs/RHCs 100 % of the average of their audited reasonable costs of providing Medicaid-covered services during Fiscal Years (FY) 1999-2000, adjusted to account for any increase or decrease in the scope of services furnished by the FQHCs/RHCs during FY 2001. The payment amount will be calculated on a per visit basis. Beginning in FY 2002, and for each FY thereafter, each FQHC/RHC is entitled to a payment amount, on a per visit basis, equal to that of the previous FY, adjusted by the percentage increase in the Medicare Economic Index (MEI) for primary care services for that FY and adjusted to account for any increase or decrease in the scope of services furnished by the FQHCs/RHCs during that FY.
For FQHCs/RHCs that are newly qualified as an FQHC or RHC after FY 2000, the Department will pay for the initial year, on a per visit basis, 100 % of the reasonable costs related to the provision of Medicaid covered services of other centers/clinics located in the same or adjacent areas with a similar caseload. In the absence of such other centers/clinics, cost reporting methods will be used to establish the initial rate.
For the next FY, the Department will pay, on a per visit basis, the amount paid for the initial year, adjusted to reflect the actual audited reasonable costs of the FQHC/RHC, increased by the percentage increase in the MEI applicable to primary care services for the current FY and adjusted to account for any increase or decrease in the scope of services furnished by the FQHC/RHC during that FY. For subsequent FYs, payment shall be set by using the MEI method used for other centers/clinics.
The Department will pay FQHCs and RHCs directly, on a quarterly basis, an amount which represents the difference, if any, between the amounts paid by managed care organizations (MCOs) to FQHCs and RHCs for services provided to MCO enrolled Medical Assistance recipients and the payment to which the FQHC/RHC would be entitled for these services under the PPS payment method. The Department will use the FQHC's and RHC's audited cost reports to reconcile the amount of these supplemental payments, and for FQHCs only, to reconcile the amount paid for dental services.
The Department will pay case management fees during the first year of an FQHC's or RHC's participation in a primary care case management (PCCM) system. Thereafter, the Department will use the FQHC's/RHC's audited cost report to adjust the payment, on a per visit basis, to take into account the FQHC's/RHC's costs for participation in the PCCM system. Any PCCM fees paid after the initial year will offset the FQHC's/RHC's overall costs.
Fiscal Impact
There is no fiscal impact anticipated to result from the implementation of the new PPS system.
Contact Person
A copy of this notice is available for review at local County Assistance Offices. Interested persons are invited to submit written comments to the notice within 30 days of this publication. These comments should be sent to the Department of Public Welfare, Office of Medical Assistance Programs, Attention: Suzanne Love, Room 515 Health and Welfare Building, Harrisburg, PA 17105-2675.
Persons with a disability may use the AT&T Relay Service by calling (800) 654-5984 (TDD users) or (800) 654-5988 (voice users). Persons who require an alternate format should contact Thomas Vracarich at (717) 783-2209.
FEATHER O. HOUSTOUN,
Secretary
[Pa.B. Doc. No. 01-556. Filed for public inspection March 30, 2001, 9:00 a.m.]
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