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.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 with FQHCs and RHCs in accordance with the time and distance standards for routinely-used delivery sites as specified in this 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 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 9 Since federal law requires states to assure access to certified pediatric or family nurse practitioners and certified nurse midwives, and states are not allowed to waive this requirement, the MCOs must provide access to these 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.10 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 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 in Appendix I. 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 enrollees 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 9 Since federal law requires states sign exclusive contracts with any publicly supported providers that prevent the providers from signing contracts with other MCOs. Upon BMS notification to assure access the MCO of any changes to certified pediatric or family nurse practitioners and certified nurse midwives, and states are not allowed to waive this requirementthe FQHC/RHC reimbursement rates, the MCOs MCO must provide access update payment rates to these servicesFQHC/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.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 with FQHCs and RHCs in accordance with the time and distance standards for routinely-used delivery sites as specified in this contract in Appendix I. 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 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 9 Since federal law requires states to assure access to certified pediatric or family nurse practitioners and certified nurse midwives, and states are not allowed to waive this requirement, the MCOs must provide access to these 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.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 Contract with FQHCs and RHCs in accordance with the time and distance standards for routinely-used delivery sites as specified in this contract in Appendix I. 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 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 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 DHHR. 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 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. 9 Since federal law requires states to assure access to certified pediatric or family nurse practitioners and certified nurse midwives, and states are not allowed to waive this requirement, the MCOs must provide access to these services. 10 Health centers not receiving grants but certified by the Secretary of Health and Human Services as meeting the requirements of the grant program may also apply for FQHC status as an FQHC “look-alike.” All FQHCs are non-profit or public entities and must be located in areas designated by the federal government as medically underserved.

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.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 Contract with FQHCs and RHCs in accordance with the time and distance standards for routinely-used delivery sites as specified in this contract in Appendix I. 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 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 9 Since federal law requires states sign exclusive contracts with any publicly supported providers that prevent the providers from signing contracts with other MCOs. Upon DHHR notification to assure access the MCO of any changes to certified pediatric or family nurse practitioners and certified nurse midwives, and states are not allowed to waive this requirementthe FQHC/RHC reimbursement rates, the MCOs MCO must provide access update payment rates to these servicesFQHC/RHCs to the effective date in the notification by DHHR. 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 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.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 Contract with FQHCs and RHCs in accordance with the time and distance standards for routinely-used delivery sites as specified in this contract in Appendix I. 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 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 9 Since federal law requires states sign exclusive contracts with any publicly supported providers that prevent the providers from signing contracts with other MCOs. Upon DHHR notification to assure access the MCO of any changes to certified pediatric or family nurse practitioners and certified nurse midwives, and states are not allowed to waive this requirementthe FQHC/RHC reimbursement rates, the MCOs MCO must provide access update payment rates to these servicesFQHC/RHCs to the effective date in the notification by DHHR. 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 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.10 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 with FQHCs and RHCs in accordance with the 30-minute travel time and distance standards for routinely-used delivery sites as specified in this contract in Appendix I. 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 enrollees 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 9 Since federal law requires states sign exclusive contracts with any publicly supported providers that prevent the providers from signing contracts with other MCOs. Upon BMS notification to assure access the MCO of any changes to certified pediatric or family nurse practitioners and certified nurse midwives, and states are not allowed to waive this requirementthe FQHC/RHC reimbursement rates, the MCOs must provide access update payment rates to these servicesFQHC/RHC effective the date of notification by the Department. The MCO must pay the new rate for claims not yet paid with a date of service on or after the effective date of change. The new payment rate must be loaded into the MCO’s claims payment system within 30 days of notification of the payment rate change. BMS will reconcile reasonable costs with FQHCs and RHCs.