CMS has issued a final rule establishing a prospective payment system for federally qualified health centers under the Patient Protection and Affordable Care Act.
CMS estimates the reformed system could increase payments to FQHCs by as much as 32 percent for services delivered to beneficiaries in medically underserved areas. FQHCs are generally required to treat all patients regardless of their ability to pay (hospitals that receive reimbursement from HHS and CMS must do the same regarding emergency care).
Medicare currently pays FQHCs based on reasonable costs, subject to established Medicare coverage pay limits. Under the new payment system, Medicare will pay the centers a single encounter rate per beneficiary per day for all services provided. CMS would adjust the rate for geographic variation in costs and the higher cost of providing care to a patient who is new to the health center or who is there for a comprehensive initial Medicare visit.
The new system will take effect starting Oct. 1, and FQHCs will be transitioned to the new reimbursement method throughout 2015, according to CMS.
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