Common use of Federally Qualified Health Centers (FQHCs) Clause in Contracts

Federally Qualified Health Centers (FQHCs). In voluntary counties, the Contractor is not required to contract with FQHCs. However, when an FQHC is part of the provider network (voluntary or mandatory counties) the Provider Agreement must include a provision whereby the SECTION 21 (PROVIDER NETWORK AND AGREEMENTS) October 1, 2004 21-10 Contractor agrees to compensate the FQHC for services provided to Enrollees at a payment rate that is not less than the level and amount for a similar set of services which the Contractor would make to a provider that is not an FQHC. In mandatory counties, the Contractor shall contract with FQHCs operating in its Service Area. However, the Contractor has the option to make a written request to the SDOH for an exemption from the FQHC contracting requirement, if the Contractor can demonstrate, with supporting documentation, that it has adequate capacity and will provide a comparable level of clinical and enabling services (e.g., outreach, referral services, social support services, culturally sensitive services such as training for medical and administrative staff, medical and non-medical and case management services) to vulnerable populations in lieu of contracting with an FQHC in its Service Area. Written requests for exemption from this requirement are subject to approval by HCFA. When the Contractor is participating in a county where an MCO that is sponsored, owned and/or operated by one or more FQHCs exists, the Contractor is not required to include any FQHCs within its network in that county.

Federally Qualified Health Centers (FQHCs). In voluntary counties, the Contractor is not required to contract with FQHCs. However, when an FQHC is part of the provider network (voluntary or mandatory counties) the Provider Agreement must include a provision whereby the SECTION 21 (PROVIDER NETWORK AND AGREEMENTS) October 1, 2004 21-10 Contractor agrees to compensate the FQHC for services provided to Enrollees at a Section 21 (PROVIDER NETWORK AND AGREEMENTS) October 1, 1999 21-9 payment rate that is not less than the level and amount for a similar set of services which the Contractor would make to a provider that is not an FQHC. In mandatory counties, the Contractor shall contract with FQHCs operating in its Service Area. However, the Contractor has the option to make a written request to the SDOH for an exemption from the FQHC contracting requirement, if the Contractor can demonstrate, with supporting documentation, that it has adequate capacity and will provide a comparable level of clinical and enabling services (e.g.e. g., outreach, referral services, social support services, culturally sensitive services such as training for medical and administrative staff, medical and non-medical and case management services) to vulnerable populations in lieu of contracting with an FQHC in its Service Area. Written requests for exemption from this requirement are subject to approval by HCFA. When the Contractor is participating in a county where an MCO that is sponsored, owned and/or operated by one or more FQHCs exists, the Contractor is not required to include any FQHCs within its network in that county.