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PA Bulletin, Doc. No. 17-894

NOTICES

Discontinuance of Federally Qualified Health Center Alternative Payment Methodology

[47 Pa.B. 3049]
[Saturday, May 27, 2017]

 This notice announces that the Department of Human Services (Department) is discontinuing the alternative payment methodology (APM) for delivery services provided in the Federally Qualified Health Center (FQHC) setting.

Background

 Section 1902(bb)(1) of the Social Security Act (42 U.S.C.A. § 1396a(bb)(1)) provides for payment to FQHCs using a Prospective Payment System (PPS) methodology. For services provided to managed care beneficiaries, states pay supplemental payments equal to the amount the FQHC or Rural Health Clinic (RHC) would have been paid under the PPS. See section 1902(bb)(5) of the Social Security Act. States can also pay providers using an APM. See section 1902(bb)(6) of the Social Security Act.

 The Department issued a notice at 46 Pa.B. 7485 (November 26, 2016), announcing implementation of APMs for delivery services provided in the FQHC setting, FQHC personnel performing delivery services in a hospital inpatient setting and Medical Assistance (MA) managed care organizations paying the PPS rate to FQHCs/RHCs. The Department submitted a corresponding State Plan Amendment to the Centers for Medicare & Medicaid Services (CMS) on December 2, 2016.

 On March 1, 2017, CMS informed the Department that delivery services rendered in the FQHC setting are included in the FQHC's provider specific PPS rate when such services are included in the FQHC's scope of project as approved by Health Resources and Services Administration (HRSA). Therefore, delivery services rendered in the FQHC setting cannot be paid under an APM.

APM for Delivery Services Performed in the FQHC Setting

 Effective with dates of service on and after June 1, 2017, the Department is discontinuing the APM for delivery services provided in the FQHC setting, and end-dating the U4 pricing modifier associated with the Healthcare Common Procedure Coding System procedure code T1015 that was added to the MA Fee Schedule for deliveries in the FQHC setting. The Department will pay FQHCs that have intrapartum services included in their HRSA approved scope of project and render delivery services in the FQHC setting their provider specific PPS rate. FQHCs with changes to their HRSA approved scope of project are subject to MA Bulletin 08-12-31, ''FQHC Change in Scope of Service,'' that was issued and effective June 20, 2012.

Fiscal Impact

 The Department anticipates no fiscal impact to the MA Program as a result of these changes.

Public Comment

 Interested persons are invited to submit written comments regarding this change to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered.

 Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

THEODORE DALLAS, 
Secretary

 Fiscal Note: 14-NOT-1136. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 17-894. Filed for public inspection May 26, 2017, 9:00 a.m.]


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