Health Center Regulatory Issues

CMS Releases Final Rule on Medicare FQHC PPS

On May 2, CMS released its final rule with comment period on the development of the Medicare FQHC PPS.  You may remember that Section 10501 of the Patient Protection and Affordable Care Act (PPACA) created a new Medicare reimbursement methodology for FQHCs, known as a Prospective Payment System (PPS). CMS issued a proposed rule, outlining the details of this new reimbursement on September 23, 2013 and issued a final rule with additional comment period on May 2, 2014.  CMS has requested further comment on three specific issues: exceptions to the limit of one PPS payment per day, establishment of G codes, and beneficiary copayment for preventive services. The comment deadline is July 1, 2014.  NACHC has a prepared a summary of the rule, which can be found here.

Also of note, CMS will hold a National Provider Call on May 21 from 12:30-2:00pm EST specifically on this rule. We encourage health centers and PCAs to attend this call, as it is a great opportunity to hear directly from CMS on the details of the rule and ask any questions that you may have. Click here to register, and CMS notes that space may be limited, so please register early.

In the meantime, should you have any questions on this or any other regulatory issues, please contact Susan Sumrell or Roger Schwartz.