Federally Qualified Health Centers. (FQHCs) and Rural Health Clinics (RHCs)
Federally Qualified Health Centers. (A) The Contractor shall not restrict an Enrollee’s right to obtain FQHC services outside the PMHP through the Fee For Service Medicaid program.
(B) If the Contractor subcontracts with an FQHC the Contractor shall reimburse the FQHC an amount not less than what the Contractor pays comparable Providers that are not FQHCs.
Federally Qualified Health Centers. All organizations receiving grants under section 330 of the Public Health Service Act, certain tribal organizations, and FQHC Look-Alikes. FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. FQHCs must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors.
Federally Qualified Health Centers. (FQHC) operated by a federally-recognized tribe in the Service Area; and
Federally Qualified Health Centers. The Contractor must enter into a subcontract with at least one Federally Qualified Health Center (“FQHC”). The Contractor shall reimburse the FQHC an amount not less than what the Contractor pays comparable Providers that are not FQHCs.
Federally Qualified Health Centers. The Contractor shall not restrict an Enrollee’s right to obtain FQHC services outside the PMHP through FFS.
Federally Qualified Health Centers. For facilities reimbursed by Medicare at the Medicare Federally Qualified Health Center Rate, VA shall pay for services to Eligible AI/AN Veterans at the Medicare Federally Qualified Health Center rate.
Federally Qualified Health Centers. (FQHC), Rural Health Clinics (RHC), and Indian Health Programs.
A. FQHCs Availability and Reimbursement Requirement If FQHC services are not available in the provider network of either the Local Initiative Health Plan in the county or Contractor, Contractor shall reimburse non-contracting FQHCs for services provided to Contractor's Members at a level and amount of payment that is not less than the Contractor makes for the same scope of services furnished by a provider that is not a FQHC or RHC. If FQHC services are not available in Contractor's provider network, but are available within DHCS' time and distance standards for access to Primary Care for Contractor's Members within the Local Initiative Health Plan's provider network in the county, Contractor shall not be obligated to reimburse non-contracting FQHCs for services provided to Contractor’s Members (unless authorized by Contractor).
B. Federally Qualified Health Centers/Rural Health Clinics (FQHC/RHC) Contractor shall submit to DHCS, within 30 calendar days of a request and in the form and manner specified by DHCS, the services provided and the reimbursement level and amount for each of Contractor’s FQHC and RHC Subcontracts. Contractor shall certify in writing to DHCS within 30 calendar days of DHCS’ written request that, pursuant to Welfare and Institutions Code Section 14087.325(b) and (d), as amended by Chapter 894, Statutes of 1998, FQHC and RHC Subcontract terms and conditions are the same as offered to other subcontractors providing a similar scope of service and that reimbursement is not less than the level and amount of payment that Contractor makes for the same scope of services furnished by a provider that is not a FQHC or RHC. Contractor is not required to pay FQHCs and RHCs the Medi-Cal per visit rate for that facility. At its discretion, DHCS reserves the right to review and audit Contractor’s FQHC and RHC reimbursement to ensure compliance with State and Federal law and shall approve all FQHC and RHC Subcontracts consistent with the provisions of Welfare and Institutions Code, Section 14087.325(h). To the extent that Indian Health Programs qualify as FQHCs or RHCs, the above reimbursement requirements shall apply to Subcontracts with Indian Health Programs.
Federally Qualified Health Centers. Community Clinics or health centers either licensed as a “community clinic” or “free clinic”, by the State under Health and Safety Code section 1204, subdivision (a), or exempt from licensure under Health and Safety Code section 1206.
Federally Qualified Health Centers. (A) The Contractor shall enter into a Network Provider agreement with at least one Federally Qualified Health Center within the Service Area.
(B) The Contractor shall not be responsible to enter into a Network Provider agreement with FQHC providers designated as an Indian health care program operated by Indian Health Services, or by an Indian Tribe, Tribal Organization, or an Urban Indian Organization.
(C) The Contractor shall reimburse the FQHC providers an amount not less than what the Contractor pays comparable Providers that are not FQHC providers.
