FQHC Payment

Health centers are responsible for providing their patients with comprehensive services – from primary care, to mental and behavioral health and dental care, as well as enabling services that include transportation, translation and case management services. In recognition of the critical role health centers play and the value they deliver for Medicare, Medicaid and CHIP patients and state programs, Congress, on a bipartisan basis, created a specific payment methodology for health centers, the FQHC Prospective Payment System (PPS). This payment system is central to the successful relationship between health centers, Medicaid, and Medicare and to health centers’ continued viability.

Quick References

NACHC Fact Sheet: Medicaid’s FQHC Prospective Payment System (PPS)

NACHC Summary: Medicare FQHC PPS Final Rule

Helpful Resources

Each of the below resources can serve as reference tools on the specifics of Medicaid PPS, key messaging, and the nuances, particulars, and finer points of PPS policy.

Medicaid PPS – a national overview

CMS Guidance on Medicaid FQHC PPS Implementation

NACHC Issue Brief: Overview of the Medicaid FQHC PPS

NACHC Issue Brief: Understanding the Medicaid PPS System for FQHCs

NACHC Checklist: Medicaid FQHC PPS Implementation

The finer points of Medicaid PPS

NACHC Issue Brief: Legal Requirements and Issues Concerning Wraparound Payments to FQHCs

NACHC Issue Brief: Medicaid Change in Scope

NACHC State Policy Report: Implementation of the FQHC PPS in the States (2015)

Medicaid PPS and emerging health center services

NACHC State Policy Report: Medicaid and Telemedicine

NACHC State Policy Report: Medicaid and Vision Services

NACHC Issue Brief: Medicaid Reimbursement for Same Day Visits, the Florida Experience

NACHC Issue Brief: Health Center Reimbursement for Behavioral Health Services in Medicaid

Medicare Payment & Health Center Reimbursement

NACHC Fact Sheet: MACRA and Health Centers

NACHC Fact Sheet: Chronic Care Management and Health Centers

NACHC Fact Sheet: How to Enroll in Medicare as an FQHC

CHIP Payment & Health Center Reimbursement

Status of CHIP PPS Implementation, An Assessment of State CHIP Directors

NACHC Issue Brief: Summary of CHIP FQHC PPS Reimbursement Guidance

State Policy Report CHIP Implementation

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