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PA Bulletin, Doc. No. 21-1813



Federally Qualified Health Center Alternative Payment Methodology

[51 Pa.B. 6849]
[Saturday, October 30, 2021]

 This notice announces an extension of an alternative payment methodology (APM) for services provided by qualified public Federally Qualified Health Centers (FQHC) and FQHC look-alikes operated by a city of the first class through March 31, 2024, subject to the approval of the Centers for Medicare & Medicaid Services (CMS). The APM will continue to provide additional funds to qualified FQHCs that provide a high volume of services to Medical Assistance (MA) beneficiaries to allow the FQHCs to develop and offer additional services.


 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 beneficiaries receiving services in a managed care delivery system, states must make supplemental payments equal to the amount the FQHC 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.

APM for FQHCs Operated by a City of the First Class

 On July 24, 2019, CMS approved the Department of Human Services' (Department) request to implement an APM to pay qualifying FQHCs, located in and operated by a city of the first class and that agreed to the APM in writing, a Medical Assistance Encounter Rate (MAER) for medical services provided to MA beneficiaries for dates of service April 1, 2019, through March 31, 2022.

 Subject to the approval of CMS, the Department will continue to pay qualifying FQHCs, located in and operated by a city of the first class and that agree to the APM in writing, the FQHC's MAER as supplemental payments, effective on March 31, 2022, as applied to the number of medical services provided to MA beneficiaries for dates of service April 1, 2022, through March 31, 2024.

Fiscal Impact

 The estimated annual fiscal impact, as a result of the continued funding allocation for these payments, is $42.089 million.

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, 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 Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

Acting Secretary

Fiscal Note: 14-NOT-1465. (1) General Fund; (2) Implementing Year 2021-22 is $0; (3) 1st Succeeding Year 2022-23 is $7,088,000; 2nd Succeeding Year 2023-24 is $14,176,000; 3rd Succeeding Year 2024-25 is $7,088,000; 4th Succeeding Year 2025-26 and 5th Succeeding Year 2026-27 are $0; (4) 2020-21 Program—$808,350,000; 2019-20 Program—$344,107,000; 2018-19 Program—$342,544,000; (7) MA—Fee-for-Service; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 21-1813. Filed for public inspection October 29, 2021, 9:00 a.m.]

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