FQHCs/RHCs. The Contractor shall include FQHCs and RHCs in its network unless it can demonstrate that it has both adequate capacity and an appropriate range of services for vulnerable populations to serve the expected enrollment in a service area without contracting with FQHCs or RHCs.
FQHCs/RHCs. The MCP is required to ensure member access to any FQHCs/RHCs, regardless of contracting status. Contracting FQHC/RHC providers shall be submitted for ODM review via the MCPN process, or other designated process. Even if no FQHC/RHC is available within the region, the MCP shall have mechanisms in place to ensure coverage for FQHC/RHC services if a member accesses these services outside of the region. The MCP shall also educate their staff and providers on the need to ensure member access to FQHC/RHC services. To ensure any FQHC/RHC can submit a claim to ODM for the state’s wraparound payment per visit as defined in OAC rule 5160-28-01, the MCP shall offer FQHCs/RHCs reimbursement pursuant to the following:
1. The MCP shall provide expedited payment for a service-specific basis, by procedure code, in an amount no less than the payment made to other providers for the same or similar service.
2. If the MCP has no comparable service-specific rate structure, the MCP shall use the regular Medicaid FFS payment schedule for non-FQHC/RHC providers.
3. The MCP shall provide FQHCs/RHCs the MCP’s Medicaid provider number(s) for each region to enable FQHC/RHC providers to xxxx for the ODM wraparound payment.
FQHCs/RHCs. If Contractor includes FQHCs or RHCs in its network, it agrees to address cost issues related to the scope of services rendered by these providers and must reimburse them either on a capitated (risk) basis considering adverse selection factors or on a cost-related basis. Contractor agrees to reimburse FQHCs/RHCs at a rate not less than that paid for comparable services provided by non-FQHC/RHC based providers.
