FQHC/RHC PPS Plus Reimbursement Methodology: Data Collection Pilot Findings and Implications

Download this publicationIn late 2010, the Department of Health Care Policy and Financing (the Department) received a grant from the Centers for Medicaid and Medicare services to assist with implementation of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) requirements related to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) reimbursement. Additionally, the Department sought to take the opportunity associated with implementing the requirement to develop a value-based payment methodology for FQHCs and RHCs in CHP+ and Medicaid. The Department contracted with JSI to assist in developing a payment methodology for FQHCs and RHCs, which would go beyond the current Prospective Payment System (PPS) to provide quality/outcome incentives in the state CHP+ and Medicaid programs.

One component of the project was a data collection pilot designed to 1) identify and provide recommendations to the Department regarding the use of cost, access, and quality measures for a future value-based payment methodology, and 2) assess and define considerations related to implementation of a value-based payment methodology. Three FQHCs, one RHC and a CHP+ managed care organization (MCO) participated in the pilot, providing information about their ability to capture, report on, and validate nine measures related to cost, quality, or access. The report presents the data collection pilot findings and implications. JSI Research & Training Institute, Inc. 2012

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