Reimbursement

Resources and Related Events

Reimbursement

Resources to strengthen and support health centers’ ongoing financial health through various reimbursement models and contracting arrangements, including value-based payment.

Reimbursement

Resources to strengthen and support health centers’ ongoing financial health through various reimbursement models and contracting arrangements, including value-based payment. CHCANYS develops financial analysis, recommendations, and strategies to be used and shared with partner advocacy organizations, policymakers, and other stakeholders with a goal of affecting positive policy change on behalf of New York State’s community health centers.  

Events
Committee

The reimbursement committee meets the fourth Thursday of every other month from 11am-12:30pm EST. The CHCANYS staff lead is Bethany Wolfe, Director of Health Center Reimbursement.


To join the reimbursement committee, email Bethany, bwolfe@chcanys.org.
The reimbursement committee is a CHCANYS Association Committee and only available to CHCANYS members.

Alternative Payment Methodology

Federal law mandates that state Medicaid programs reimburse FQHCs using a visit-based bundled payment methodology, known as the prospective payment system (PPS), regardless of contractual agreements between FQHCs and Medicaid managed care plans. However, Federal law also permits an FQHC to be paid under an Alternative Payment Methodology (APM), as long as a) the APM reimbursement is not less than what the FQHC would have received under a “traditional” visit-based PPS methodology and b) each health center individually agrees to participate in the APM.

The traditional PPS incentivizes volume over value, as the payment methodology itself is visit-based. However, an FQHC APM allows State Medicaid programs to adopt a different methodology that can support integrated care, incentivize high-quality comprehensive primary care services, allow flexibility to address patients’ social determinants of health, and promote increased access to care. Some states with health center APMs, i.e. Oregon and Washington, have shown that the model ultimately improves health outcomes among health center patients.

To sign up for the APM Newsletter, email hwoodman@chcanys.org.