The Centers for Medicare & Medicaid Services (CMS) has delivered some good news to Community Health Centers and their growing Medicare patient population. CMS issued a final rule that could potentially boost Medicare payments to health centers by as much as 32 percent.The new payment system, as outlined in the Affordable Care Act, establishes a Medicare prospective payment system. Health centers have long struggled with the old system, which is based on an outdated payment methodology that outpaced the actual costs of providing care. A Government Accountability Office study back in 2010 also showed that health centers lost money with each Medicare beneficiary they served under the old way. Bipartisan Members of Congress also pursued legislative remedies to the problem.
Under the new rule, Medicare will pay health centers a single encounter rate per beneficiary per day for all services provided, with some exceptions. The rate will be adjusted according to the geographic variation in costs. The rate will also be adjusted for the higher costs associated with providing care to new patients and when the health center furnishes an initial preventive physical examination or an annual wellness visit to a Medicare patient. Also, the same services that have been paid for by Medicare in the past will continue to be covered under the new system. The final rule also allows health centers to bill for same day visits for a medical and mental health visit, or even visits on the same day if there is a subsequent illness or injury.
NACHC is still reviewing the rule, but issued a preliminary statement to media in response, noting, “We appreciate CMS’ recognition of the importance of ensuring health centers receive fair payment in order to best serve their Medicare patients. We applaud CMS for their work on the final rule and attention to the concerns raised in response to the proposed rule and look forward to working with them on the implementation of this important rule in the upcoming months.”
“The new payment system helps increase the ability and capacity of federally qualified health centers to provide essential and affordable services for even more patients who need care,” said CMS Administrator Marilyn Tavenner in a press release. “These FQHCs are essential to countless patients in local communities who depend on them for getting their primary and preventive care.”
You can read the final rule when it is published in the Federal Register on May 2, 2014.