Thursday, August 11, 2016
On August 5, 2016, the Department of Health Care Finance (DHCF) published a notice of emergency and proposed rules to amend the Medicaid reimbursement methodology for a Federally Qualified Health Center (FQHC).
On August 22, 2016, DHCF will host a public forum to obtain stakeholder feedback on the pending emergency and proposed rulemaking. The major components of the proposed reimbursement model include:
- Allowance for the election of a prospective payment rate (PPS) or an alternate payment methodology (APM) that includes separates encounter rates for primary care services, behavioral health services, preventive, diagnostic, and comprehensive dental services;
- Allowance for same-day billings for multiple encounters under the APM.
- Definitions of allowable services and reasonable costs.
- Allowance for payment for services delivered outside of the four walls of the clinic.
- Establishes quality reporting and performance based payments.
These emergency and proposed rules set forth the standards for participation in the Medicaid program, the standards used to develop the PPS, APM, cost reporting and auditing processes, and establish the requirements for Medicaid reimbursement of FQHCs for Medicaid-reimbursable services that are outside the scope of core services that qualify for APM rates.
These rules were adopted on July 22, 2016 and will become effective for dates of services rendered beginning September 1, 2016, if the corresponding State Plan amendment has been approved by CMS with an effective date of September 1, 2016 or the effective date established by CMS, whichever is later.
Copies of this notice are on the DHCF website at http://dhcf.dc.gov, and the emergency and proposed rules are available on the DC Municipal Register at http://www.dcregs.dc.gov/Gateway/NoticeHome.aspx?noticeid=6143124 or upon request from Claudia Schlosberg, Medicaid Director, DC Department of Health Care Finance, 441 Fourth Street NW, 9th Floor South, Washington, DC 20001.
There are two opportunities to provide comments on the proposed rulemaking:
1. DHCF will hold a public forum during which written and oral comments on the proposed amendments will be accepted. Interested stakeholders presenting written comments should bring at least two copies and may also submit electronic copies of any comments to [email protected]. The public forum will be held at the DC Department of Health Care Finance, 441 Fourth Street NW, Washington, DC 20001, Main Street Conference Room, 10th Floor on Monday, August 22, 2016, from 11:30 am to 1 pm.
2. In addition, stakeholder wishing to submit comment on this rulemaking may submit comments in writing to Claudia Schlosberg, J.D., Senior Deputy/State Medicaid Director, Department of Health Care Finance, Government of the District of Columbia, 441 4th Street, N.W., Suite 900, Washington, DC 20001, via telephone on (202) 442-8742, via email at [email protected], or online at www.dcregs.dc.gov, within thirty (30) days of the date of publication of this notice in the DC Register (September 6, 2016). Additional copies of these rules are available from the above address.
For further information, please contact Trina Dutta, Special Projects Officer, DC Department of Health Care Finance, (202) 719-6632 or [email protected].