FQHC/RHC Prospective Payment System Plus Reimbursement Methodology: Options and Gaps Report

Download this publicationThe purpose of this report is to present the Department of Health Care Policy and Financing with an initial set of options for implementing a new reimbursement methodology, PPS Plus, for Federally Qualified Health Centers and Rural Health Clinics under Colorado’s Children’s Health Insurance Program and Medicaid. This report, through its analysis and discussion of an initial set of potential options and the related gaps and challenges, will facilitate the selection of a smaller set of options for more in-depth analysis to include rate development, impact, and cost estimation.

JSI is has developed four PPS Plus methodology options for moving from the existing PPS payment model to value-based purchasing. The models are not an exhaustive representation of options, but represent prototypes on a continuum of low program impact to high impact. Each option is described in terms of its scope, payment model, quality and efficiency indicators, incentive structures, and financing.

This report first describes the various considerations in methodology design, detailing the range of choices for each aspect of the model. We then present the four prototype options and summarize the rationale for each. Following the description of the options is a discussion of the gaps between current systems and the proposed options, and a discussion of next steps for selecting a sub-set of options for further exploration and analysis. JSI Research & Training Institute, Inc., 2011.

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