Health Center Federal Policy, Uncategorized

Preventive Services Payment Clarification for Health Centers in Extenders Bill

by Susan Sumrell

As mentioned in the previous post, the American Jobs and Closing Tax Loopholes Act of 2010 – also known as the Extenders bill – passed the House of Representatives on Friday before the Memorial Day recess.   While the bill was stripped of several key health provisions before passage, including the FMAP extension and COBRA benefits, it did include an important clarification for health centers.

You may remember that the Affordable Care Act included a key expansion of preventive services to the Medicare FQHC service package, allowing for coverage of these services at FQHCs beginning in 2011. The bill also ensured that all Medicare beneficiaries could receive preventive services with no coinsurance in order to guarantee access.   Unfortunately, due a technicality, this coinsurance elimination did not apply to FQHCs.  Thanks to the Extenders bill though, it now will.  The bill clarifies that Medicare will reimburse FQHCs (including look-alikes) 100 percent of the reasonable cost of providing these services, as is currently the practice with pneumococcal and influenza vaccinations.  These reimbursements will be separate from the Medicare per visit payment limit (also known as the Medicare cap).

This is an important clarification for health centers, as the majority of health centers struggle with the outdated Medicare cap and productivity screens.  This new provision ensures that health centers can provide their patients with critically important preventive services – not only at no cost to the patient – but also guarantee that health centers receive proper reimbursement for providing these services.

The bill now will on to the Senate for what the Congressional Leadership hopes will be final consideration; they are expected to take it up upon their return from the Memorial Day recess.