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PA Bulletin, Doc. No. 24-1834

NOTICES

DEPARTMENT OF
HUMAN SERVICES

Federally Qualified Health Center and Rural Health Clinic Alternative Payment Methodology

[54 Pa.B. 8354]
[Saturday, December 21, 2024]

 This notice announces the implementation of an alternative payment methodology (APM) for Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) for a supplemental payment at the Medical Assistance (MA) Program Fee Schedule rate for a Long-Acting Reversible Contraceptive (LARC) device and its insertion, or the removal of a LARC device, in addition to payment for an encounter. The effective date of this APM will be the date that the Centers for Medicare & Medicaid Services approves the Department of Human Services' (Department) State Plan Amendment.

Background

 Section 1902(bb)(1) of the Social Security Act (42 U.S.C. § 1396a(bb)(1)) provides for payment to FQHCs and RHCs using a Prospective Payment System (PPS) methodology. States can pay providers using an APM. See 42 U.S.C. § 1396a(bb)(6).

 The supplemental payment provided by this APM will offset the high cost of LARC devices, allowing FQHCs and RHCs to keep an inventory of LARC devices on-hand and improving access to reproductive health for MA beneficiaries.

Insertion or removal of a LARC device in the FQHC and RHC settings

 For FQHCs and RHCs that agree to accept this APM, the Department will pay for the LARC device and its insertion, or the removal of a LARC device, at the MA Program Fee Schedule rate in addition to payment for an encounter. FQHCs and RHCs are to bill procedure code T1015 to be paid their provider-specific PPS rate. FQHCs and RHCs are to bill the appropriate procedure codes, either for a LARC device and its insertion on two separate claim lines or the removal of a LARC device on a separate claim line, from the MA Program Fee Schedule.

Fiscal Impact

 The estimated fiscal impact for Fiscal Year 2025-2026 is $1.000 million in total funds (State and Federal) for this APM.

Public Comment

 Interested persons are invited to submit written comments regarding this APM to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, P.O. Box 2675, Harrisburg, PA 17120 or to RA-PWMAProgComments@pa.gov. 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 Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

VALERIE A. ARKOOSH, 
Secretary

 Fiscal Note: 14-NOT-1667. Under section 612 of The Administrative Code of 1929 (71 P.S. § 232), (1) General Fund; (2) Implementing Year 2024-25 is $0; (3) 1st Succeeding Year 2025-26 through 5th Succeeding Year 2029-30 are $330,000; (4) 2023-24 Program—$3,594,000,000; 2022-23 Program—$3,418,000,000; 2021-22 Program—$4,557,000,000; (7) MA—Capitation; (8) recommends adoption. No costs will be incurred in the current fiscal year.

[Pa.B. Doc. No. 24-1834. Filed for public inspection December 20, 2024, 9:00 a.m.]


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