On April 29, the Centers for Medicare & Medicaid Services (CMS) issued a final rule establishing a Medicare prospective payment system (PPS) for FQHCs.
Under this new rule, Medicare will pay health centers a single encounter rate per beneficiary per day for all services provided, with some exceptions. The rate will be adjusted according to the geographic variation in costs. The rate will also be adjusted for the higher costs associated with providing care to new patients and when a health center furnishes an initial preventive physical examination or an annual wellness visit to a Medicare patient. The same services that have been paid for by Medicare in the past will continue to be covered under the new system.
The new payment system could increase Medicare payments to FQHCs by as much as 32%.The National Association of Community Health Centers (NACHC), while still in the process of reviewing the details of the final rule, has issued a preliminary statement on the rule, accessible here.
To access the official press release by CMS, click here.
To access a fact sheet issued by CMS that outlines key aspects of the new PPS, click here.