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Federally Qualified Health Centers (FQHC) Center

  • Special Open Door Forum

    On November 4, 2013, CMS held a Special Open Door Forum on Proposed Rule CMS-1443-P: Medicare Prospective Payment System for Federally Qualified Health Centers The transcript and audio files are posted in the Downloads section of CMS's Special Open Door Forum webpage at:

  • CMS Proposes a Medicare Prospective Payment System for Federally Qualified Health Centers
    Health Centers will Transition to a New Medicare Payment System and Higher Medicare Reimbursements

    On September 18, CMS issued a proposed rule that would establish methodology and payment rates for a prospective payment system (PPS) for Federally Qualified Health Center (FQHC) services under Medicare Part B beginning on October 1, 2014, in compliance with the statutory requirements of the Affordable Care Act.  CMS is proposing payment to FQHCs based on a single encounter-based per diem rate per Medicare beneficiary. The encounter-based per-diem rate would be calculated based on an average cost per encounter and is estimated to be $155.90, subject to change in the final rule based on more current data. The rate would be adjusted for geographic differences in the cost of services by adopting the Geographic Practice Cost Indices (GPCI) used to adjust payment under the physician fee schedule (PFS). In addition, the rate would be adjusted (increased by approximately 33 percent) for greater intensity and resource use when an FQHC furnishes care to a patient that is new to the FQHC or to a beneficiary receiving a comprehensive initial Medicare visit (i.e., an initial preventive physical examination or an initial annual wellness visit).  FQHCs would transition into the PPS beginning October 1, 2014, based on their cost reporting periods.

    This proposed rule also amends the Clinical Laboratory Improvement Amendments (CLIA) of 1988 to be in alignment with the Taking Essential Steps for Testing (TEST) Act of 2012, proposing the regulatory changes needed to fully implement the TEST Act. This proposed rule outlines the framework for the application of sanctions in proficiency testing (PT) referral cases.

    The proposed rule will be published in the September 23 Federal Register. CMS will accept comments on the proposed rule until November 18, 2013, and will respond to them in a final rule to be issued in 2014.

    Additional information is available in the CMS press release , fact sheet  and proposed rule.  

  • Vaccination is the Best Protection Against the Flu [PDF, 414KB]
  • SE1039Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Billing Guide

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