Common use of Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs Clause in Contracts

Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs. Federally Qualified Health Centers (FQHCs) are federally-funded Community Health Centers, Migrant Health Centers and Health Care for the Homeless Projects that receive grants under sections 329, 330 and 340 of the US Public Health Service Act.7 Current federal regulations specify that states must guarantee access to FQHCs and RHCs under Medicaid managed care programs; therefore, MCOs must provide access to FQHCs and RHCs to the extent that access is required under federal law. If federal law is amended to revise these access requirements, BMS may alter the requirements imposed on MCOs. The MCO must Contract with as many FQHCs and RHCs as necessary to permit beneficiary access to participating FQHCs and RHCs without having to travel a significantly greater distance past a non-participating FQHC or RHC. The MCO must Contract with the FQHC or RHC – contracts with individual physicians at FQHCs and RHCs do not suffice for this requirement. The MCO must Contract with FQHCs and RHCs in accordance with the thirty (30) minute travel time standards for routinely-used delivery sites as specified in this contract. An MCO with an FQHC or RHC on its panel that has no capacity to accept new patients will not satisfy these requirements. If an MCO cannot satisfy the standard for FQHC and RHC access at any time while the MCO holds a Medicaid contract, the MCO must allow its Medicaid members to seek care from non-contracting FQHCs and RHCs and must reimburse these providers at Medicaid fees. The MCO must offer FQHCs and RHCs terms and conditions, including reimbursement, which are at least equal to those offered to other providers of comparable services. The MCO cannot sign exclusive contracts with any publicly supported providers that prevent the providers from signing contracts with other MCOs. Upon BMS notification to the MCO of any changes to the FQHC/RHC reimbursement rates, the MCO must update payment rates to FQHC/RHCs to the effective date in the notification by BMS. The MCO must pay the new rate for any claims not yet paid with a date of service on or after the effective date of change. If payment has already been made for a claim within SFY 2019 with a date of service on or after the effective date of the rate change, the MCO must reprocess the claim to reimburse at the new rate. The new payment rate must be loaded into the MCO’s claims payment system within thirty (30) calendar days of notification of the payment rate change.

Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs. Federally Qualified Health Centers (FQHCs) are federally-funded Community Health Centers, Migrant Health Centers and Health Care for the Homeless Projects that receive grants under sections 329, 330 and 340 of the US Public Health Service Act.7 Act.10 Current federal regulations specify that states must guarantee access to FQHCs and RHCs Rural Health Clinics (RHCs) under Medicaid managed care programs; therefore, MCOs the MCO must provide access to FQHCs and RHCs to the extent that access is required under federal law. If federal law is amended to revise these access requirements, BMS the Department may alter the requirements imposed on MCOsthe MCO. The MCO must Contract contract with as many FQHCs and RHCs as necessary to permit beneficiary access to participating FQHCs and RHCs without having to travel a significantly greater distance past a non-participating FQHC or RHC. The MCO must Contract with the FQHC or RHC – contracts with individual physicians at FQHCs and RHCs do not suffice for this requirement. The MCO must Contract contract with FQHCs and RHCs in accordance with the thirty (30) minute travel time and distance standards for routinely-used delivery sites as specified in this contract. contract in Appendix K. An MCO with an FQHC or RHC on its panel that has no capacity to accept new patients will not satisfy these requirements. If an MCO cannot satisfy the standard for FQHC and RHC access at any time while the MCO holds a Medicaid contract, the MCO must allow its Medicaid members enrollees to seek care from non-contracting FQHCs 9 Since federal law requires states to assure access to certified pediatric or family nurse practitioners and RHCs certified nurse midwives, and must reimburse these providers at Medicaid fees. The MCO must offer FQHCs and RHCs terms and conditions, including reimbursement, which states are at least equal not allowed to those offered to other providers of comparable services. The MCO cannot sign exclusive contracts with any publicly supported providers that prevent the providers from signing contracts with other MCOs. Upon BMS notification to the MCO of any changes to the FQHC/RHC reimbursement rateswaive this requirement, the MCO MCOs must update payment rates provide access to FQHC/RHCs to the effective date in the notification by BMS. The MCO must pay the new rate for any claims not yet paid with a date of service on or after the effective date of change. If payment has already been made for a claim within SFY 2019 with a date of service on or after the effective date of the rate change, the MCO must reprocess the claim to reimburse at the new rate. The new payment rate must be loaded into the MCO’s claims payment system within thirty (30) calendar days of notification of the payment rate changethese services.

Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs. Federally Qualified Health Centers (FQHCs) are federally-funded Community Health Centers, Migrant Health Centers and Health Care for the Homeless Projects that receive grants under sections 329, 330 and 340 of the US Public Health Service Act.7 Act.10 Current federal regulations specify that states must guarantee access to FQHCs and RHCs under Medicaid managed care programs; therefore, MCOs must provide access to FQHCs and RHCs to the extent that access is required under federal law. If federal law is amended to revise these access requirements, BMS may alter the requirements imposed on MCOs. The MCO must Contract with as many FQHCs and RHCs as necessary to permit beneficiary access to participating FQHCs and RHCs without having to travel a significantly greater distance past a non-participating FQHC or RHC. The MCO must Contract with the FQHC or RHC – contracts with individual physicians at FQHCs and RHCs do not suffice for this requirement. The MCO must Contract contract with FQHCs and RHCs in accordance with the thirty (30) minute travel time and distance standards for routinely-used delivery sites as specified in this contract. contract in Appendix I. An MCO with an FQHC or RHC on its panel that has no capacity to accept new patients will not satisfy these requirements. If an MCO cannot satisfy the standard for FQHC and RHC access at any time while the MCO holds a Medicaid contract, the MCO must allow its Medicaid members enrollees to seek care from non-contracting FQHCs and RHCs and must reimburse these providers at Medicaid fees. The MCO must offer FQHCs and RHCs terms and conditions, including reimbursement, which are at least equal to those offered to other providers of comparable services. The MCO cannot sign exclusive contracts with any publicly supported providers that prevent the providers from signing contracts with other MCOs. Upon BMS notification 9 Since federal law requires states to the MCO of any changes assure access to the FQHC/RHC reimbursement ratescertified pediatric or family nurse practitioners and certified nurse midwives, and states are not allowed to waive this requirement, the MCO MCOs must update payment rates provide access to FQHC/RHCs to the effective date in the notification by BMS. The MCO must pay the new rate for any claims not yet paid with a date of service on or after the effective date of change. If payment has already been made for a claim within SFY 2019 with a date of service on or after the effective date of the rate change, the MCO must reprocess the claim to reimburse at the new rate. The new payment rate must be loaded into the MCO’s claims payment system within thirty (30) calendar days of notification of the payment rate changethese services.

Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs. Federally Qualified Health Centers (FQHCs) are federally-funded Community Health Centers, Migrant Health Centers and Health Care for the Homeless Projects that receive grants under sections 329, 330 and 340 of the US Public Health Service Act.7 Act.10 Current federal regulations specify that states must guarantee access to FQHCs and RHCs under Medicaid managed care programs; therefore, MCOs must provide access to FQHCs and RHCs to the extent that access is required under federal law. If federal law is amended to revise these access requirements, BMS DHHR may alter the requirements imposed on MCOs. The MCO must Contract with as many FQHCs and RHCs as necessary to permit beneficiary access to participating FQHCs and RHCs without having to travel a significantly greater distance past a non-participating FQHC or RHC. The MCO must Contract with the FQHC or RHC – contracts with individual physicians at FQHCs and RHCs do not suffice for this requirement. The MCO must Contract with FQHCs and RHCs in accordance with the thirty (30) minute travel time and distance standards for routinely-used delivery sites as specified in this contract. contract in Appendix K. An MCO with an FQHC or RHC on its panel that has no capacity to accept new patients will not satisfy these requirements. If an MCO cannot satisfy the standard for FQHC and RHC access at any time while the MCO holds a Medicaid contract, the MCO must allow its Medicaid members enrollees to seek care from non-contracting FQHCs and RHCs and must reimburse these providers at Medicaid fees. The MCO must offer FQHCs and RHCs terms and conditions, including reimbursement, which are at least equal to those offered to other providers of comparable services. The MCO cannot sign exclusive contracts with any publicly supported providers that prevent the providers from signing contracts with other MCOs. Upon BMS DHHR notification to the MCO of any changes to the FQHC/RHC reimbursement rates, the MCO must update payment rates to FQHC/RHCs to the effective date in the notification by BMSDHHR. The MCO must pay the new rate for any claims not yet paid with a date of service on or after the effective date of change. If payment has already been made for a claim within SFY 2019 2021 with a date of service on or after the effective date of the rate change, the MCO must reprocess the claim to reimburse at the new rate. The new payment rate must be loaded into the MCO’s claims payment system within thirty (30) calendar days of notification of the payment rate change.

Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs. Federally Qualified Health Centers (FQHCs) are federally-funded Community Health Centers, Migrant Health Centers and Health Care for the Homeless Projects that receive grants under sections 329, 330 and 340 of the US Public Health Service Act.7 Act.10 Current federal regulations specify that states must guarantee access to FQHCs and RHCs under Medicaid managed care programs; therefore, MCOs must provide access to FQHCs and RHCs to the extent that access is required under federal law. If federal law is amended to revise these access requirements, BMS DHHR may alter the requirements imposed on MCOs. The MCO must Contract with as many FQHCs and RHCs as necessary to permit beneficiary access to participating FQHCs and RHCs without having to travel a significantly greater distance past a non-participating FQHC or RHC. The MCO must Contract with the FQHC or RHC – contracts with individual physicians at FQHCs and RHCs do not suffice for this requirement. The MCO must Contract with FQHCs and RHCs in accordance with the thirty (30) minute travel time and distance standards for routinely-used delivery sites as specified in this contract. contract in Appendix K. An MCO with an FQHC or RHC on its panel that has no capacity to accept new patients will not satisfy these requirements. If an MCO cannot satisfy the standard for FQHC and RHC access at any time while the MCO holds a Medicaid contract, the MCO must allow its Medicaid members enrollees to seek care from non-contracting FQHCs and RHCs and must reimburse these providers at Medicaid fees. The MCO must offer FQHCs and RHCs terms and conditions, including reimbursement, which are at least equal to those offered to other providers of comparable services. The MCO cannot sign exclusive contracts with any publicly supported providers that prevent the providers from signing contracts with other MCOs. Upon BMS DHHR notification to the MCO of any changes to the FQHC/RHC reimbursement rates, the MCO must update payment rates to FQHC/RHCs to the effective date in the notification by BMSDHHR. The MCO must pay the new rate for any claims not yet paid with a date of service on or after the effective date of change. If payment has already been made for a claim within SFY 2019 2020 with a date of service on or after the effective date of the rate change, the MCO must reprocess the claim to reimburse at the new rate. The new payment rate must be loaded into the MCO’s claims payment system within thirty (30) calendar days of notification of the payment rate change.

Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs. Federally Qualified Health Centers (FQHCs) are federally-funded Community Health Centers, Migrant Health Centers and Health Care for the Homeless Projects that receive grants under sections 329, 330 and 340 of the US Public Health Service Act.7 Current federal regulations specify that states must guarantee access to FQHCs and RHCs under Medicaid managed care programs; therefore, MCOs must provide access to FQHCs and RHCs to the extent that access is required under federal law. If federal law is amended to revise these access requirements, BMS may alter the requirements imposed on MCOs. The MCO must Contract contract with as many FQHCs and RHCs as necessary to permit beneficiary access to participating FQHCs and RHCs without having to travel a significantly greater distance past a non-participating FQHC or RHC. The MCO must Contract contract with the FQHC or RHC – contracts with individual physicians at FQHCs and RHCs do not suffice for this requirement. The MCO must Contract contract with FQHCs and RHCs in accordance with the thirty (30) -minute travel time standards for routinely-used delivery sites as specified in this contract. An MCO with an FQHC or RHC on its panel that has no capacity to accept new patients will not satisfy these requirements. If an MCO cannot satisfy the standard for FQHC and RHC access at any time while the MCO holds a Medicaid contract, the MCO must allow its Medicaid members to seek care from non-contracting FQHCs and RHCs and must reimburse these providers at Medicaid fees. The MCO must offer FQHCs and RHCs terms and conditions, including reimbursement, which are at least equal to those offered to other providers of comparable services. The MCO cannot sign exclusive contracts with any publicly supported providers that prevent the providers from signing contracts with other MCOs. Upon BMS notification to the MCO of any changes to the FQHC/RHC reimbursement rates, the MCO MCOs must update payment rates to FQHC/RHCs to RHC effective the effective date in the of notification by BMSthe Department. The MCO must pay the new rate for any claims not yet paid with a date of service on or after the effective date of change. If payment has already been made for a claim within SFY 2019 with a date of service on or after the effective date of the rate change, the MCO must reprocess the claim to reimburse at the new rate. The new payment rate must be loaded into the MCO’s claims payment system within thirty (30) calendar 30 days of notification of the payment rate change. BMS will reconcile reasonable costs with FQHCs and RHCs.