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.
Reports
Defining an Effective Change in Scope Process, Emerging Issues #6
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
Status of CHIP Prospective Payer System Implementation: An Assessment of State CHIP Directors
Health Center Reimbursement for Behavioral Health Services in Medicaid - State Policy Report #34
2009 Update on the Status of the Medicaid and CHIP Prospective Payment System in the States - State Policy Report # 30
Click Here for the 2008 Update on the Status of the Medicaid Prospective Payment System in the States - State Policy Report #23
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
The following documents explore provisions of the PPS as it has evolved since inception.
| 03-19-2010 |
|
Issue Brief: Summary of CHIP FQHC PPS Reimbursement Guidance
(70kb)
Effective October 1, 2009, CHIPRA requires that FQHCs be reimbursed based on a Prospective Payment System (PPS). On February 4, 2010, CMS issued guidance to State Health Officials providing them with direction in implementing the CHIP FQHC PPS statutory requirement. |
| 05-28-2009 |
|
Issue Brief #69 Understanding the Medicaid Prospective Payment System for Federally Qualified Health
(1109kb)
|
| 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 |
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 |
