Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 211 - Federally Qualified Health Centers › Chapter 1 - General › Rule 23-211-1.5 - Reimbursement

Current through June 25, 2024
The Division of Medicaid reimburses Federally Qualified
				  Health Center (FQHC) providers at a prospective payment system (PPS) rate per
				  encounter and/or an alternative payment methodology (APM).
A. The Division of Medicaid uses the PPS
				methodology for reimbursement to FQHC providers per encounter as described
				below:
1. For services provided on and after
				January 1, 2001, during calendar year 2001, payment for services shall be
				calculated, on a per visit basis, in an amount equal to one hundred percent
				(100¢) of the average of the FQHC's reasonable costs of providing Medicaid
				covered services during fiscal years 1999 and 2000. The average rate will be
				computed from the FQHC Medicaid cost reports by applying a forty percent
				(40¢) weight to fiscal year 1999 and a sixty percent (60¢) weight to
				fiscal year 2000 and adding those rates together. If an FQHC first qualifies
				during fiscal year 2000, the rate will only be computed from the fiscal year
				2000 Medicaid cost report. The PPS baseline calculation shall include the cost
				of all Medicaid covered services including other ambulatory services that were
				previously paid under a fee-for-service basis. This rate will be adjusted to
				take into account any increase or decrease in the scope of services furnished
				by the FQHC during fiscal year 2001.
2. Payment rates may be adjusted by the
				Division of Medicaid pursuant to changes in federal and/or state laws or
				regulations.
3. Beginning in
				calendar year 2002, and for each calendar year thereafter, the FQHC is entitled
				to the payment amount, on a per visit basis, to which the FQHC was entitled to
				in the previous year, increased by the percentage increase in the Medicare
				Economic Index (MEI) for primary care services for that calendar year, and
				adjusted to take into account any increase or decrease in the scope of services
				furnished by the FQHC during that calendar year. The rate will be retroactively
				adjusted to reflect the MEI.
4. New
				centers that qualify for the FQHC program after January 1, 2001, will be
				reimbursed the initial PPS rate which will be based on the rates established
				for other FQHCs located in the same or adjacent area with a similar caseload.
				In the absence of a comparable FQHC, the rate for the new provider will be
				based on projected costs. After the FQHC's initial year, a Medicaid cost report
				must be filed in accordance with the State Plan. The cost report will be desk
				reviewed and a rate will be calculated in an amount equal to one hundred
				percent (100¢) of the FQHC's reasonable costs of providing Medicaid
				covered services. The FQHC may be subject to a retroactive adjustment based on
				the difference between projected and actual allowable costs. Claims payments
				will be adjusted retroactive to the effective date of the original rate. For
				each subsequent calendar year, the payment rate will be equal to the rate
				established in the preceding calendar year, increased by the percentage
				increase in the MEI for primary care services that is published in the Federal
				Register in the fourth (4 
				th) quarter of the preceding calendar
				year.