The Government Role in Health Centers National Asociation 健康中心协会中政府的作用.pptVIP

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The Government Role in Health Centers National Asociation 健康中心协会中政府的作用.ppt

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The Government Role in Health Centers National Asociation 健康中心协会中政府的作用

America’s Voice for Community Health Care The NACHC Mission To promote the provision of high quality, comprehensive and affordable health care that is coordinated, culturally and linguistically competent, and community directed for all medically underserved people. Medicaid FQHC Prospective Payment System Roger Schwartz National Association of Community Health Centers Documents Relevant to PPS Implementation Federal Documents Federal Medicaid Statute Medicare FQHC Regulations State Medicaid Manual CMS State Medicaid Directors letters and other Federal Policy Publications State Documents State Medicaid Plan and Plan Amendments State Statutes State Regulations State Manuals and other State Policy Publications Case Law NACHC’s Annual State-by-State PPS Update and other NACHC Publications OBRA 89/90: Establishment of FQHC Omnibus Budget Reconciliation Acts of 1989 and 1990 Establish FQHC and FQHC Services for Medicare/Medicaid Medicare FQHC regulations: 42 CFR 405.2400 et seq. Medicare RHC/FQHC Manual (Pub. 27) Reasonable cost payments intended to protect grant dollars from low Medicare/Medicaid reimbursements Cost-Based Reimbursement (Reusable Cost) Medicare statute and regulations (42 CFR 413) Allowable costs for Medicaid-covered services Allowable costs for Medicaid services divided by number of face to face encounters equals per visit rate Example: $1,000,000 allowable costs $ 10,000.00 visits All inclusive per visit rate=$100 Medicaid-covered Services Establishment of FQHC FQHC Services, as defined in Medicaid Statute: 42 USC §§ 1396a(a)(10)(A) and 1396d(a)(2)(C) and 1396d(l)(2) FQHC services (Medicare rural health clinic services) and any other ambulatory service in the State Medicaid plan provided by the FQHC The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA) [P.L.106-554] Replaces reasonable cost with Prospective Payment System (PPS) The PPS Baseline For services provided between January 1 – September 30, 20