Date: April 24, May 8, May 22, June 5, June 17

Time: All sessions are at 2pm-3:30pm ET via Zoom

Deadline to Apply: April 15, 2024, at 11:59PM ET

Overview

Achieving adequate Medicaid reimbursement is critical to Federally Qualified Health Centers’ (FQHC) financial and operational stability. The National Association of Community Health Centers (NACHC) is hosting this learning collaborative to build capacity and awareness among FQHC leaders about the various federal and state policy gaps impacting reimbursement through Medicaid Prospective Payment System (PPS) and/or other Alternative Payment Methodologies (APMs). NACHC hopes to convene FQHC Director-level staff overseeing key components of their FQHC’s reimbursement system (e.g., health center finance, population health initiatives, care coordination, value-based care contracts, denial management, etc.) to increase awareness of the policy challenges and administrative mechanisms impacting reimbursement, and identify the systemic barriers to FQHC reimbursement and strategize on how to overcome them.

Furthermore, this learning collaborative will highlight the innovative strategies FQHC leaders have leveraged to maximize reimbursement for their health center and identify advocacy opportunities/strategies for expanding the types of billable FQHCs providers, petitioning for change in scope of services offered, advocating for more equitable reimbursement methodologies, and more. Submissions will be reviewed on a rolling basis with priority given to the first 20 submissions from each state.

Target Audience:

• FQHCs
• FQHC Look-Alike Health Centers

FQHC objectives:

• Clear understanding of the history of FQHC reimbursement and how it has evolved
• Increased understanding of PPS and various APM models, including how to successfully petition for an increase in reimbursement rates (e.g., change in scope, APM development, etc.)
• Improved understanding of MCO contracts and rates, and determine whether FQHCs are being reimbursed at the appropriate levels

NACHC objectives

• Identify 3-5 systemic challenges among FQHCs to maximizing their reimbursement rates
• Identify technical issues with FQHC reimbursement (e.g., misaligned billing codes, loopholes in MCO contracts)
• Determine specific roles that NACHC, PCAs, and FQHCs can play in expanding awareness and overall fluency in the various FQHC reimbursement components

Schedule and Session Information:

• Wednesday, April 24: Reimbursement History: How FQHC reimbursement evolved into PPS and how it is continuing to evolve today
  • Statutory history of FQHC reimbursement (BIPA, ACA, etc.)
    • Federal requirements, challenges, and opportunities
    • State-by-state reimbursement requirements, challenges, and opportunities
• Wednesday, May 8: Administrative gaps in FQHC reimbursement
  • MCO contracts – are FQHCs getting paid the correct rate?
  • Advocating for more timely wraparound payments from state Medicaid agencies
  • Ensuring state compliance with federal disclosure requirements (e.g., clear and publicly available change in scope process, FQHC manual, etc.)
• Wednesday, May 22: Strategies to increase FQHC reimbursement
  • Petitioning for change in scope
  • Alternative sources of funding
  • Addressing persistent operational challenges to FQHC reimbursement (e.g., incorrect billing codes, incorrect and/or delayed payments, etc.)
• Wednesday, June 5: Successfully Negotiating Alternative Payment Methodologies
  • Highlight successful APMs negotiated by PCA leaders
  • Discuss advantages/disadvantages of various payment models – what do FQHCs need?
• Monday, June 17: What does the health center movement need to achieve more equitable reimbursement across the board?
  • FQHC and PCA discussion about leveraging the health center movement to coordinate reimbursement strategies
  • How to build FQHC and PCA institutional memory and capacity to improve FQHC reimbursement

Questions? Contact state@nachc.org.

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This program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $6,625,000 with 0 percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.