FQHC/RHC Prospective Payment System Plus Reimbursement Methodology Project - Review and Research Report
The Department intends to develop a rate methodology for FQHCs and RHCs tentatively referred to as PPS Plus, which will go beyond the current prospective payment system used in Medicaid to provide quality/outcome incentives in the state CHP+ and Medicaid programs.
In order to inform the state’s approach to CHIPRA PPS implementation, JSI conducted research on CHIPRA PPS implementation, value-based purchasing, and Colorado’s current programs and systems. The research included a review of pertinent reports and articles; research into Colorado’s payment methodologies, quality initiatives, and value-based strategies; input from key stakeholders including FQHCs, RHCS, their state associations and Medicaid/CHP+ managed care organizations (MCOs); and key informant interviews with national experts and state Medicaid/CHIP programs to identify pertinent national trends and understand the experience of other states with PPS implementation in CHIP and value-based purchasing strategies and methodologies. This report presents the research findings. JSI Research & Training Institute, Inc. 2012
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