Policy 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.

Issue Brief: Understanding the Medicaid Prospective Payment System for Federally Qualified Health Centers

Implementation of Medicaid PPS

2013 Update on Implementation of the FQHC Prospective Payment System (PPS) in the States - State Policy Report #51

Medicaid Prospective Payment System Checklist - Promising Practices #12

FQHC Reimbursement for Vision Services in Medicaid - State Policy Report #50

FQHC Reimbursement for Telemedicine Services in Medicaid - State Policy Report #48

2012 Update on Implementation of the FQHC Prospective Payment System (PPS) in the States - State Policy Report #44

2011 Update on the Status of the FQHC Medicaid Prospective Payment System in the States - State Policy Report #40

Emerging Issues in the FQHC Prospective Payment System - State Policy Report #38

Defining an Effective Change in Scope Process, Emerging Issues #6

Medicaid Reimbursement for Multiple Same-Day Encounters: Florida's Experience, Emerging Issues #7

Health Center Reimbursement for Behavioral Health Services in Medicaid - State Policy Report #34

 

PPS and the Children's Health Insurance Program 

Status of PPS Implementation in the Children's Health Insurance Program, State Policy Report #42 (NACHC, 2012)

Status of CHIP Prospective Payer System Implementation: An Assessment of State CHIP Directors (ASTHO, 2011)

Issue Brief: Summary of CHIP FQHC PPS Reimbursement Guidance (NACHC, 2010)

Best Practices

Securing Adequate Payments for Obstetrical Services-Promising Practices #3

Increasing Private Payment Rates to Health Centers in Hawaii-Promising Practices #6

Change of Scope for Electronic Health Records-Promsing Practices #7

Resources

Powerpoint: The Medicaid FQHC Prospective Payment System, March 31, 2010

Q & A's on FQHC Prospective Payment System (2001)

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

 




 
 

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

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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