Traditionally, Federally Qualified Health Centers (FQHCs) were reimbursed based on their costs. That changed in 2000, with passage of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act (BIPA).
It put in place what is called the Prospective Payment System (PPS). It also allowed states to use an alternative payment methodology (APM), but only if the health centers agreed to it and only if the state payment method didn’t pay health centers less than what they would have gotten under the federal PPS.
Implementation of Medicaid PPS
The following publications provide information on trends and best practices related to Medicaid PPS implementation.
- Medicaid Prospective Payment System Checklist
- Emerging Issues in the FQHC Prospective Payment System
- 2015 Update on the Implementation of the FQHC PPS in the States
- 2014 Update on Implementation of the FQHC PPS in the States
- Q & A’s on FQHC Prospective Payment System (2001)
- Powerpoint: The Medicaid FQHC Prospective Payment System (2010)
Change in FQHC Scope
- Diabetes Prevention: New Pathways for Prevention (Webinar)
- FQHC Reimbursement for Vision Services in Medicaid
- FQHC Reimbursement for Telemedicine Services in Medicaid
- Health Center Reimbursement for Behavioral Health Services in Medicaid
- Securing Adequate Payments for Obstetrical Services
- BPHC Program Information Notice 2004-05: Medicaid Reimbursement for Behavioral Health Services
Children’s Health Insurance Program (CHIP) and PPS
The following publications provide information on trends and best practices related to CHIP PPS implementation.
- Status of PPS Implementation in the Children’s Health Insurance Program – State Policy Report #42 (NACHC, 2012)
- Status of CHIP Prospective Payer System Implementation: An Assessment of State CHIP Directors (ASTHO, 2011)
- Issue Brief: Summary of CHIP FQHC PPS Reimbursement Guidance (NACHC, 2010)