Medicaid Prospective Payment System

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.

Change in FQHC Scope

Wraparound Payments

Same-Day Visits

Services

Children’s Health Insurance Program (CHIP) and PPS

The following publications provide information on trends and best practices related to CHIP PPS implementation.