FQHC Payment
Health centers are responsible for providing their patients with comprehensive services ā 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 centersā continued viability.
Quick References
NACHC Fact Sheet: Medicaidās 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 ā 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