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PA Bulletin, Doc. No. 24-358



Federally Qualified Health Center Alternative Payment Methodology

[54 Pa.B. 1430]
[Saturday, March 16, 2024]

 This notice announces an extension of an alternative payment methodology (APM) for services provided by qualified public Federally Qualified Health Centers (FQHC) and FQHC look-alikes operated by a city of the first class through March 31, 2029, subject to the approval of the Centers for Medicare & Medicaid Services (CMS). The APM will continue to provide additional funds to qualified FQHCs that provide a high volume of services to Medical Assistance (MA) beneficiaries to enable the FQHCs to maintain and expand access to health care services.


 Section 1902(bb)(1) of the Social Security Act (42 U.S.C. § 1396a(bb)(1)) provides for payment to FQHCs using a Prospective Payment System (PPS) methodology. For services provided to beneficiaries receiving services in a managed care delivery system, states must make supplemental payments equal to the amount the FQHC would have been paid under the PPS. See 42 U.S.C. § 1396a(bb)(5). States can also pay providers using an APM. See 42 U.S.C. § 1396a(bb)(6).

APM for FQHCs Operated by a City of the First Class

 On July 24, 2019, CMS approved the Department of Human Services' (Department) request to implement an APM to pay qualifying FQHCs, located in and operated by a city of the first class and that agreed to the APM in writing, a Medical Assistance Encounter Rate (MAER) for medical services provided to MA beneficiaries for dates of service April 1, 2019, through March 31, 2022. On January 18, 2022, CMS approved the Department's request to continue this APM for dates of service April 1, 2022, through March 31, 2024.

 Subject to the approval of CMS, the Department will continue to pay qualifying FQHCs, located in and operated by a city of the first class and that agree to the APM in writing, the FQHC's MAER as supplemental payments, effective on March 31, 2024, as applied to the number of medical services provided to MA beneficiaries for dates of service April 1, 2024, through March 31, 2029.

Fiscal Impact

 The estimated annual fiscal impact, as a result of the continued funding allocation for these payments, is $38.971 million in total funds.

Public Comment

 Interested persons are invited to submit written comments regarding this APM to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, P.O. Box 2675, Harrisburg, PA 17120, Comments received within 30 days will be reviewed and considered.

 Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).


Fiscal Note: 14-NOT-1615. Under section 612 of The Administrative Code of 1929 (71 P.S. § 232), (1) General Fund; (2) Implementing Year 2023-24 is $0; (3) 1st Succeeding Year 2024-25 is $13,126,000; 2nd Succeeding Year 2025-26 through 5th Succeeding Year 2028-29 are $17,502,000; (4) 2022-23 Program—$589,137,000; 2021-22 Program—$644,059,000; 2020-21 Program—$808,350,000; (7) MA—Fee-for-Service; (8) recommends adoption. The executive budget proposal included funds to cover this increase.

[Pa.B. Doc. No. 24-358. Filed for public inspection March 15, 2024, 9:00 a.m.]

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