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SF1622 (Legislative Session 94 (2025-2026))

Federally qualified health centers reimbursement procedures modifications

Related bill: HF2760

AI Generated Summary

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?

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
February 19, 2025SenateFloorActionIntroduction and first reading
February 19, 2025SenateFloorActionReferred toHealth and Human Services
March 09, 2025SenateFloorActionAuthor added
March 12, 2025SenateFloorActionAuthor added

Citations

 
[
  {
    "analysis": {
      "added": [
        "A new payment system allowing FQHCs to select an alternative payment methodology."
      ],
      "removed": [
        "Requirement for FQHCs or rural health clinics to apply for essential community provider designation."
      ],
      "summary": "This bill modifies reimbursement procedures for federally qualified health centers under section 256B.0625.",
      "modified": [
        "Adjustments to the calculation of allowable costs for reimbursement."
      ]
    },
    "citation": "256B.0625 Subdivision 30"
  },
  {
    "analysis": {
      "added": [
        "Inclusion of new criteria for maintaining cost-based payment."
      ],
      "removed": [
        "Elimination of strict compliance timelines previously in place."
      ],
      "summary": "This bill amends section 62Q.19 regarding the guidelines for essential community provider status.",
      "modified": [
        "Revised process for applying to become an essential community provider."
      ]
    },
    "citation": "62Q.19 Subdivision 7"
  },
  {
    "analysis": {
      "added": [
        "None, reference to federal definition unchanged."
      ],
      "removed": [
        "None, as it is a reference to federal law."
      ],
      "summary": "Defines rural health clinic services and federally qualified health center services with respect to US law.",
      "modified": [
        "None, as it is a reference to federal law."
      ]
    },
    "citation": "42 US Code Section 1396a(a)(2)(B)"
  },
  {
    "analysis": {
      "added": [
        "Mention of alternative payment methods consistent with federal law."
      ],
      "removed": [
        "None, as it details federal compliance."
      ],
      "summary": "Defines the use of alternative payment methodologies consistent with US federal requirements.",
      "modified": [
        "None, as it clarifies compliance with federal statutes."
      ]
    },
    "citation": "42 US Code Section 1396a(a)(3)"
  },
  {
    "analysis": {
      "added": [
        "Incorporation of the CMS FQHC Market Basket inflator."
      ],
      "removed": [
        "None, since it's an added measure for payment adjustments."
      ],
      "summary": "This relates to the annual inflation update for the CMS FQHC Market Basket.",
      "modified": [
        "None, purely an addition for payment calculation."
      ]
    },
    "citation": "42 US Code Section 1395m(o)"
  },
  {
    "analysis": {
      "added": [
        "Tax reimbursement component included in payment."
      ],
      "removed": [
        "None, as the tax reference was added for reimbursement calculations."
      ],
      "summary": "Reference to tax requirements to be reimbursed to FQHCs and rural health clinics.",
      "modified": [
        "None, as it introduces new reimbursement conditions."
      ]
    },
    "citation": "295.52"
  }
]

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