HF2760

Purpose of the Bill

The bill aims to modify reimbursement procedures for Federally Qualified Health Centers (FQHCs) in Minnesota. The focus is on updating and refining the way these health centers report costs and receive payments for services provided under the medical assistance program.

Main Provisions

• Reimbursement Process: FQHCs must submit detailed financial reports to receive payments. New FQHCs submit budget estimates for initial periods, whereas existing ones use actual costs and visit data.
• Essential Community Provider Designation: FQHCs and rural health clinics must apply for this status to continue cost-based payment. Failing to apply results in payments akin to non-FQHC providers after a period.
• Prospective Payment System: Clinics must choose annually between this system and an alternative payment methodology, which includes cost assessment based on Medicare principles.
• Payment Claims: After January 1, 2021, claims for services by FQHCs and rural health clinics will follow this structured annual election system.

Significant Changes to Existing Law

• Change of Scope Requests: The commissioner will consider requests that alter the scope of services provided by FQHCs, factoring in changes that cause a cost fluctuation of 2.5% or more.
• Encounter Payment Rates: Establishes an encounter rate equivalent to that set by the Indian Health Service for FQHCs that are also urban Indian organizations.
• Quality Workgroup: Formation of a workgroup to evaluate clinical and non-clinical quality measures at FQHCs and rural health clinics.
• Tribal FQHC Enrollment: Permits Tribal health centers to enroll as Tribal FQHCs, aligning their payment and procedural requirements with those of non-FQHC tribal facilities, while maintaining necessary federal compliance.

Relevant Terms

• Federally Qualified Health Center (FQHC)
• Rural Health Clinic
• Medical Assistance Program
• Essential Community Provider
• Prospective Payment System
• Alternative Payment Methodology
• Indian Health Service
• Medicare Cost Principles
• Tribal Health Center