ACA Now

Implementation Status

2013

Prior to January 2013, CMS issued preliminary guidance regarding the development and upcoming implementation of the FQHC PPS.  See here and here.  In addition, MedPAC and the GAO have weighed in on this issue, respectively, here and here.

On July 23, 2013, HHS posted its updated semiannual regulatory agenda.  Per the updated agenda, consistent with the ACA requirement at section 10501 of the law, CMS indicated that it tentatively plans to release in September 2013 a proposed rule (CMS-1443-P) establishing a new Federally Qualified Health Center (FQHC) PPS that would apply to cost reporting periods effective October 1, 2014.

On September 18, 2013, CMS released a proposed rule to establish a PPS methodology and payment rates for FQHC services under Medicare Part B, noting the proposed PPS system is “estimated to have an overall impact of increasing total Medicare payments to FQHCs by approximately 30 percent” compared with the reasonable-cost-based methodology currently employed for reimbursing these facilities. The rule addresses certain preventive services as defined in section 4104 of the ACA.  The FQHC PPS takes effect on October 1, 2014.  Comments on the proposed rule are due by November 18, 2013; CMS anticipates releasing a final rule in 2014. A press release and fact sheet are available.

2014

On April 29, 2014, CMS released a final rule with comment effectuating a new PPS methodology and payment rates for FQHC services under Medicare Part B. CMS estimates that the new FQHC PPS could increase payments to FQHCs by roughly 32% – a slight bump over the agency’s estimation under the proposed rule (of 30%) – compared with the reasonable-cost-based methodology currently employed for reimbursing these facilities. The FQHC PPS will begin on October 1, 2014, as specified in the statute. A CMS fact sheet is available here, as is a press release.

On May 21, 2014, CMS convened a call with stakeholders to review the new Medicare PPS for FQHCs.

On June 25, 2014, CMS convened a national provider call to discuss the operational requirements associated with the new Medicare PPS for FQHCs. Slide presentation is available here.

On July 18, 2014, CMS issued revised guidance, updated to reflect an updated change request implementing the FQHC prospective payment system for cost reporting periods starting on or after Oct. 1, 2014. The notice addresses FQHC-specific payment codes, “basic billing requirements” and claims for Medicare Advantage supplemental payments, among other issues.

On Nov. 19, HRSA announced the availability of three separate grants to support the Health Center Program funding through a “variety of community-based and patient-directed public and private nonprofit organizations that serve an increasing number of the Nation’s underserved.” Various application deadlines are stipulated, though in general, are due Dec. 3, 2014 or Dec. 17, 2014.

On Nov. 24, HRSA announced the availability of roughly $1.1M to fund health centers working to improve the health of underserved communities and vulnerable populations. These grants “support a variety of community-based and patient-directed public and private nonprofit organizations that serve an increasing number of the Nation’s underserved.” Applications are due Jan 7, 2015.

2015

On Feb. 13, CMS issued a transmittal to Medicare contractors updating the Geographic Practice Cost Index (GPCI) for the FQHC Pricer.

On July 8, CMS issued its CY 16 Medicare Physician Fee Schedule proposed rule (for which comments are due Sept. 8) acknowledging this provision in the context of proposed payment policies relative to grandfathered Tribal FQHCs that were provider-based clinics on or before Apr. 7, 2000.

On July 8, CMS issued its CY 16 Medicare Physician Fee Schedule proposed rule (for which comments are due Sept. 8) acknowledging this provision in the context of proposed payment policies relative to grandfathered Tribal FQHCs that were provider-based clinics on or before Apr. 7, 2000.

2016

On May 4, 2016, HHS announced over $260 million in funding to 290 health centers in 45 states, the District of Columbia, and Puerto Rico for facility renovation, expansion, or construction.