Common use of Federally Qualified Health Centers Clause in Contracts

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. (FQHC), Rural Health Clinics (RHC), and Indian Health Programs.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. (FQHC), Rural Health Clinics (RHC), and American Indian Health Service Programs. A. FQHCs Availability and Reimbursement Requirement If FQHC services are not available in the provider network Provider Network of either the Local Initiative any Medi- Cal Managed Care Health Plan in the county or Contractor, county. 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 Provider that is not a FQHC or RHC. If FQHC services are not available in Contractor's provider networkProvider 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 Provider Network in the county, Contractor shall not be obligated to reimburse non-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 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 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 federal law and shall approve all FQHC and RHC Subcontracts consistent with the provisions of Welfare and Institutions Code, Section 14087.325(h). 14087.325(h).‌ To the extent that American Indian Health Service Programs qualify as FQHCs or RHCs, the above reimbursement requirements shall apply to Subcontracts with American Indian Health Service Programs. Contractor must also pay an amount equal to what Contractor would pay a subcontracted FQHC or RHC and DHCS must pay any supplemental payment, pursuant to 42 CFR 438.14(c) to an American Indian Health Service Program that qualifies as a FQHC or RCH but is not a subcontracted Provider. C. American Indian Health Service Programs Contractor shall attempt to contract with each American Indian Health Service Program as set forth in Title 22 CCR Sections 55120-55180. Contractor shall reimburse American Indian Health Service Programs at the FFS rate for services provided to Members who are qualified to receive services from an American Indian Health Service Program as set forth in 42 USC Section 1396u-2(h)(2), Section 5006 of Title V of the American Recovery and Reinvestment Act of 2009, and, insofar as they do not conflict with federal law or regulations, the reimbursement options set forth in Title 22 CCR Section 55140(a). Contractor shall reimburse an American Indian Health Program Service that qualifies as a FQHC but is not a subcontracted Provider as set forth in 42 CFR 438.14(c)(2).

Federally Qualified Health Centers. (FQHC), Rural Health Clinics (RHC), and American Indian Health Service 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 ContractorProvider Network, 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 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 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 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 federal law and shall approve all FQHC and RHC Subcontracts consistent with the provisions of Welfare and Institutions Code, Code Section 14087.325(h). To the extent that American Indian Health Service Programs qualify as FQHCs or RHCs, the above reimbursement requirements shall apply to Subcontracts with American Indian Health Service Programs. Contractor must also pay an amount equal to what Contractor would pay a subcontracted FQHC or RHC and DHCS must pay any supplemental payment, pursuant to 42 CFR 438.14(c) to an American Indian Health Service Program that qualifies as a FQHC or RCH but is not a subcontracted Provider. C. American Indian Health Service Programs 1) Contractor shall attempt to contract with each American Indian Health Service Program as set forth in Title 22 CCR Sections 55120-55180. Contractor shall reimburse American Indian Health Service Programs at the applicable Fee-For-Service Medi-Cal rate for services provided prior to January 1, 2018 to Members who are qualified to receive services from an American Indian Health Service Program as set forth in 42 USC Section 1396u-2(h)(2), and Section 5006 of Title V of the American Recovery and Reinvestment Act of 2009. Contractor shall reimburse an American Indian Health Service Program that qualifies as a FQHC but is not a subcontracted Provider as set forth in 42 CFR 438.14(c)(1). 2) For services provided on or after January 1, 2018 to Members who are qualified to receive services from an American Indian Health Service Program as set forth under Supplement 6, Attachment

Federally Qualified Health Centers. (FQHC), Rural Health Clinics (RHC), and American Indian Health Service Programs. A. FQHCs Availability and Reimbursement Requirement If FQHC services are not available in the provider network Provider Network of either the Local Initiative any Medi- Cal Managed Care Health Plan in the county or Contractorcounty, 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 Provider that is not a FQHC or RHC. If FQHC services are not available in Contractor's provider networkProvider Network, but are available within DHCS' time and or distance standards for access to Primary Care for Contractor's Members within the Local Initiative Health Plan's provider network Provider Network in the county, Contractor shall not be obligated to reimburse non-non- contracting FQHCs for services provided to Contractor’s Members (unless authorized by Contractor). B. Required Terms and Conditions for Network Provider Agreements with 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 SubcontractsNetwork Provider Agreements. 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 Network Provider Agreement terms and conditions are the same as offered to other subcontractors Network Providers 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 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 federal law and shall approve all FQHC and RHC Subcontracts Network Provider Agreements consistent with the provisions of Welfare and Institutions Code, Section 14087.325(h). To the extent that American Indian Health Service Programs qualify as FQHCs or RHCs, the above reimbursement requirements shall apply to Subcontracts Network Provider Agreements with American Indian Health Service Programs. Contractor must also pay an amount equal to what Contractor would pay a subcontracted FQHC or RHC and DHCS must pay any supplemental payment, pursuant to 42 CFR 438.14(c), to an American Indian Health Service Program that qualifies as a FQHC or RHC but is not a Network Provider. C. American Indian Health Service Program Providers 1) Contractor shall attempt to contract with each American Indian Health Service Program as set forth in Title 22 CCR Sections 55120-55180. Contractor shall reimburse American Indian Health Service Programs at the applicable Fee-For-Service Medi-Cal rate for services provided prior to January 1, 2018 to Members who are qualified to receive services from an American Indian Health Service Program as set forth in 42 USC Section 1396u-2(h)(2), and Section 5006 of Title V of the American Recovery and Reinvestment Act of 2009. Contractor shall reimburse an American Indian Health Service Program that qualifies as a FQHC but is not a Network Provider as set forth in 42 CFR 438.14(c)(1). 2) For services provided on or after January 1, 2018 to Members who are qualified to receive services from an American Indian Health Service Program as set forth under Supplement 6, Attachment