Federally Qualified Health Centers (FQHC) Center
New Proposals for RHCs and FQHCs on Care Management Services and ACO Assignments - Listening Session
Tuesday, August 1 from 2 to 3:30 pm ET
Register for Medicare Learning Network events here: https://blh.ier.intercall.com/
During this call, CMS experts review proposals for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) in the Physician Fee Schedule proposed rule on requirements and payment for Care Management Services, which includes Chronic Care Management (CCM), General Behavioral Health Integration (BHI), and Psychiatric Collaborative Care Model (CoCM) services. Learn about the CMS CCM Campaign and the proposed new process for using RHC and FQHC claims to assign beneficiaries to Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program.
A question and answer session follows the presentation. We will open the lines for feedback. Note: feedback received during the listening session will not be considered formal comments on the rule. See the proposed rule for information on submitting these comments by the close of the comment period on September 11, 2017.
- Chronic Care Management (CCM) Services – FQHCs can receive payment for CCM when CPT code 99490 is billed alone or with other payable services on a FQHC claim. FQHCs are not authorized to bill for any other CCM or behavioral health integration (BHI) services, and no other CCM or BHI codes should be used. For other information on CCM, please see the MLN Matters Article and FAQs.
- 2017 Update - Medicare Benefit Policy Manual, Chapter 13 - Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services [PDF, 581KB] and MM9864 [PDF, 59KB] .
- FQHC Fact Sheet – (Updated on 1/1/17)
- FQHC PPS Geographic Adjustment Factors (GAFs) for Services Furnished 1/1/17 – 12/31/17
- FQHC PPS Specific Payment Codes [PDF, 336KB] – (Updated on 12/22/16)
- FQHC Preventive Services [PDF, 450KB] - (Updated on 8/10/16)
- Effective 1/1/16, a clinic that is operated by a tribe or tribal organization under the Indian Self-Determination Education and Assistance Act, and was billing as if it were provider-based to an IHS hospital on or before 4/7/00, and is no longer operating as a provider-based department of an IHS hospital, may be certified as a grandfathered tribal FQHC. See MM9267 [PDF, 50KB] and the Grandfathered Tribal FQHCs page.
- Questions on the FQHC PPS? Email FQHC-PPS@cms.hhs.gov
MLN Connects Provider eNews Spotlights
- CY 2017 Payment Rate Update to the FQHC PPS. See MM9831 [PDF, 60KB]
- Medicare Benefit Policy Internet Only Manual: Chapter 13 - Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services [PDF, 581KB]
- FQHC Preventive Services [PDF, 450KB] – Information on preventive services in FQHCs including HCPCS coding, same day billing, and waivers of co-insurance.
- FQHC PPS Specific Payment Codes [PDF, 336KB] (Updated 12/21/2016)
- Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Billing Guide ( SE1039 [PDF, 92KB] )
- Medicare Claims Processing Manual: Chapter 9 - Rural Health Clinics/Federally Qualified Health Centers [PDF, 241KB]
- Chapter 29-(T14) -- Independent Rural Health Clinic and Freestanding Federally Qualified Health Center cost Report Form CMS 222-92 (Instructions) [ZIP, 403KB]
- MLN Matters® Article SE1606 – Guidance on the Physician Quality Reporting System (PQRS) 2014 Reporting Year and 2016 Payment Adjustment for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs)
- 2016 Physician Fee Schedule Final Rule with Comment
Information on CCM, ACP, and Grandfathered Tribal FQHCs. See https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices.html.
- 2015 Physician Fee Schedule Final Rule with Comment
Final policies on specific aspects of the FQHC PPS. The CY 2015 PFS Final Rule is available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices.html.
- FQHC PPS Final Rule with Comment Period
Final methodology and payment rates for the new FQHC PPS. CMS-1443-F (PDF Version) - Opens in a new window
- FQHC PPS Proposed Rule
The FQHC PPS proposed rule with comment period was published in the Federal Register on September 23, 2013. This rule proposed a methodology and payment rates for the new FQHC PPS. CMS-1443-P (PDF Version) - Opens in a new window and CMS-1443-P (Text Version) - Opens in a new window
- Supporting Files Available for the Final Rule with Comment Period
FQHC Summary Data (CMS-1443-F) [ZIP, 577KB] : This file contains data summarized by the CMS Certification Number (CCN) assigned to the FQHC. The data can be used to model the final methodology and calculate projected payments and impacts under the final FQHC PPS.
- Supporting Files Available for the Proposed Rule
FQHC Summary Data (CMS-1443-P) [ZIP, 549KB] : This file contains data summarized by the CMS Certification Number (CCN) assigned to the FQHC. The data can be used to model the proposed methodology and calculate projected payments and impacts under the proposed PPS.
- PPS Structure Design Document
PPS Structure Design Document [PDF, 1MB] : A report prepared by Arbor Research Collaborative for Health that describes analyses performed and options modeled to support the development and implementation of the PPS.
- Change Request 8743
R1383OTN : Implementation of a Prospective Payment System for FQHCs
FQHC PPS Geographic Adjustment Factors (GAFs)
FQHC PPS Training and Information
- June 25, 2014, National Provider Call - Operational requirements for the new Medicare PPS for FQHCs. See http://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/2014-06-25-FQHC-NPC.html.
- May 21, 2014, National Provider Call- Final policies for the new Medicare PPS for FQHCs. See http://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/2014-05-21-FQHC.html.
- November 4, 2013 - Special Open Door Forum - Medicare Prospective Payment System for Federally Qualified Health Centers. See http://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/ODFSpecialODF.html.
- Medicare FQHC PPS Frequently Asked Questions (FAQs) - See FQHC PPS FAQs [PDF, 460KB] .
- Medicare Provider-Supplier Enrollment
- Enrollment Applications
- Conditions for Coverage (CfCs) & Conditions of Participations (CoPs)
- CfC and CoP: Rural Health Clinic/Federally Qualified Health Center
- Survey & Certification - General Information
- National Provider Identifier Standard (NPI)
- Section 10501 of the Patient Protection and Affordable Care Act of 2010, as consolidated and amended through May 10, 2010.
CMS Manuals & Transmittals
Additional CMS Information
How to Stay Informed
- Weekly MLN Connects Provider eNews for the latest Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates
- MLN Homepage
- MLN Publications & Multimedia
- Quarterly Provider Updates
- Open Door Forums
- Press Releases - Opens in a new window