Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 212 - Rural Health Clinics › Chapter 1 - General › Rule 23-212-1.5 - Reimbursement

Current through June 25, 2024
The Division of Medicaid reimburses Rural Health Clinic (RHC)
				  providers at a prospective payment system (PPS) rate per encounter and/or
				  alternative payment methodology (APM).
A. The Division of Medicaid uses the PPS
				methodology for reimbursement to RHC 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 RHC's reasonable costs of providing the Division
				of Medicaid covered services during fiscal years 1999 and 2000. If a RHC first
				enrolls 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 RHC 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 RHC is entitled
				to the payment amount, on a per visit basis, to which the RHC 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 RHC during that calendar year. The rate will be retroactively
				adjusted to reflect the MEI.
4. New
				clinics that qualify for the RHC program after January 1, 2001, will be
				reimbursed the initial PPS rate which will be based on the rates established
				for other RHCs located in the same or adjacent area with a similar caseload. In
				the absence of comparable RHCs, the rate for the new provider will be based on
				projected costs. The RHC's Medicare final or Amended final settlement cost
				report for the initial cost report period year will be used to calculate a PPS
				base rate that is equal to one hundred percent (100%) of the RHC's reasonable
				costs of providing Medicaid covered services. If the initial cost report period
				represents a full year of RHC services, this final settlement rate will be
				considered the base rate. If the initial RHC cost report period does not
				represent a full year, then the rate from the first full year cost report will
				be used as the clinic's base 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) quarter of the
				preceding calendar year.