Policy and Issues

Medicaid Prospective Payment System

 
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Traditionally, Federally Qualified Health Centers (FQHC) were reimbursed based on their costs. That changed in 2000, with passage of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act (BIPA).

It put in place what is called the Prospective Payment System (PPS). It also allowed states to use an alternative payment method (APM), but only if the health centers agreed to it and only if the state payment method didn’t pay health centers less than what they would have gotten under the federal PPS.

The following documents explore provisions of the PPS as it has evolved since inception.

View PPS Clearinghouse
 
 
12-01-2007   CMS Q & As (512kb)

09-01-2007   State Policy Report #17 (309kb)
2007 Update on the Status of the Medicaid Prospective Payment System in the States

01-01-2001   Issue Brief #69 (769kb)
Understanding the Medicaid Prospective Payment System for Federally Qualified Health Centers (FQHCs)

ARCHIVES

09-01-2006   State Policy Report #11 (279kb)
Update on the Status of the Medicaid Prospective Payment System in the States

08-01-2004   State Policy Report#4 (472kb)
A Closer Look: Surverys of Primary Care Associations and State Medicaid Agencies Provide Insight on the Implementation of Medicaid Prospective Payment System for Health Centers



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