Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-548 - Federally qualified health centers › Section 182-548-1100 - Federally qualified health centers-Definitions

Current through Register Vol. 24-14, July 15, 2024
This section contains definitions of words or phrases that
				  apply to this chapter. Unless defined in this chapter, the definitions found in
				  chapter 182-500 WAC apply.
"APM index"
- The agency uses the alternative
				  payment methodology (APM) to update APM encounter payment rates on an annual
				  basis. The APM index is a measure of input price changes experienced by
				  Washington's federally qualified health center (FQHC) and rural health clinic
				  (RHC) providers. The index is derived from the federal medicare economic index
				  (MEI) and Washington-specific variable measures.
"Base year"
- The year that is used as the
				  benchmark in measuring an FQHC's total reasonable costs for establishing base
				  encounter rates.
"Cost center"
- A category of service approved
				  to be provided by the FQHC under WAC
				  182-548-1200
				  and reported in the medicaid cost report. The categories of services provided
				  by the FQHC may include medical, mental health, dental, maternity support
				  services, and substance use disorder.
"Cost report"
- A statement of costs and
				  provider utilization that occurred during the time period covered by the cost
				  report. FQHCs complete a cost report when there is a request for a change in
				  scope rate adjustment, there is a rebasing of the encounter rate, or the agency
				  sets a base rate.
"Encounter"
- A face-to-face or telemedicine
				  (including audio-only telemedicine) visit between an encounter-eligible client
				  and an FQHC provider who exercises independent judgment when providing services
				  that qualify for encounter rate reimbursement.
"Encounter-eligible client"
- A client who
				  receives benefits under Title XIX (medicaid) or Title XXI (CHIP).
"Encounter rate"
- A cost-based,
				  facility-specific rate for covered FQHC services.
"Enhancements (also called managed care
				  enhancements)"
- A monthly amount the agency pays to FQHCs for each
				  client enrolled with a managed care organization (MCO). FQHCs may contract with
				  MCOs to provide services under managed care programs. FQHCs receive
				  enhancements from the agency in addition to the negotiated payments they
				  receive from the MCOs for services provided to enrollees.
"Federally qualified health center (FQHC)"
- An
				  entity that has entered into an agreement with the Centers for Medicare and
				  Medicaid Services (CMS) to meet medicare program requirements under
				  42 C.F.R.
				  405.2434 and:
(a) Is receiving a grant under section 329, 330, or 340 of
				  the federal Public Health Service (PHS) Act, or is receiving funding from such
				  a grant under a contract with the recipient of such a grant and meets the
				  requirements to receive a grant under section 330 of the PHS Act;
(b) Based on the recommendation of the PHS, is determined by
				  CMS to meet the requirements for receiving such a grant;
(c) Was treated by CMS, for purposes of medicare part B, as a
				  comprehensive federally funded health center (FFHC) as of January 1, 1990;
				  or
(d) Is an outpatient health program or facility operated by a
				  tribe or tribal organization under the federal Indian Self-Determination and
				  Education Assistance Act of 1975 or an Urban Indian organization receiving
				  funding under Title V of the federal Indian Health Care Improvement Act of
				  1976.
"Fee-for-service"
- A payment method the agency
				  uses to pay providers for covered medical services provided to Washington apple
				  health clients, which excludes services provided by the agency's contracted
				  managed care organizations and services that qualify for an encounter
				  rate.
"Interim rate"
- The rate the agency establishes
				  to pay an FQHC for covered FQHC services prior to the establishment of a
				  permanent rate for that FQHC.
"Medicare economic index (MEI)"
- An index
				  published in the Federal Register used in the calculation of changes to
				  determine allowed charges for physician services. The agency adjusts FQHC
				  encounter rates and enhancement rates by the MEI each year on January
				  1st.
"Rebasing"
- The process of recalculating
				  encounter rates using actual cost report data.
11-14-075, recodified as §
											182-548-1100, filed 6/30/11,
					 effective 7/1/11. Statutory Authority:
					 RCW
					 74.08.090, BIPA of 2000 Section 702, sections
					 201 and 209 of 2009-2011 budget bill, and
					 42 U.S.C.
					 1396 a(bb). 10-09-002, § 388-548-1100,
					 filed 4/7/10, effective 5/8/10.