SF1622

This bill (S.F. No. 1622) proposes modifications to reimbursement procedures for Federally Qualified Health Centers (FQHCs) in Minnesota under the state's Medical Assistance (Medicaid) program. It amends Section 256B.0625, Subdivision 30, of the Minnesota Statutes.

Key Provisions:

1. Payment Structure:

   • Maintains cost-based reimbursement for FQHCs and rural health clinics (RHCs) following federal laws and regulations.
   • Provides FQHCs and RHCs with the option to receive payments based on either:
     • The federal Prospective Payment System (PPS).
     • An Alternative Payment Methodology (APM) based on 100% of allowable costs per Medicare cost principles.

2. Reporting Requirements:

   • Newly established FQHCs must submit budget estimates; existing centers must report actual costs and patient visits.
   • Providers must submit Medicare cost reports to support cost claims.

3. Annual Election of Payment Methods:

   • FQHCs and RHCs may choose either PPS, APM, or, for urban Indian organizations, a special payment method reflecting the Indian Health Services (IHS) encounter rate.

4. Alternative Payment Methodology (APM) Updates:

   • A single medical and dental encounter rate for services.
   • Same-day reimbursement for one medical and one dental visit.
   • Periodic rebasing to adjust payment rates using historical Medicare cost reports.
   • Adjustments allowed for changes in service scope resulting in a 2.5% or greater cost change.

5. Tribal Health Centers:

   • Tribal-operated Indian Health Service facilities may enroll as Tribal FQHCs.
   • Tribal FQHCs are subject to specific payment methods that align with existing Tribal facility payment models.

6. Administrative Updates:

   • Establishes a process for handling disputes about payment calculations.
   • Creates a quality measures workgroup to evaluate clinical and operational performance.
   • Ensures payments account for health care education program participation by FQHCs and RHCs.

Purpose:

The bill aims to streamline payment processes, ensure financial sustainability of FQHCs and RHCs, and provide flexibility in reimbursement models while complying with federal Medicaid requirements.

Would you like further clarification on any aspect of the bill?