Last week CMS published two documents last week which will strengthen health centers’ and PCAs’ ability to protect their payment rights under Medicaid managed care. They are:
- A letter to State Health Officials addressing “delegated” wrap and managed care contracting requirements
- The Final Rule updating regulations governing Medicaid Managed Care Organizations (MCOs)
We will be providing detailed information on both of these documents in the near future. In the short term, here is a listing of key policies around PPS reimbursement that were announced in these documents:
- Starting in July 2017, States may “delegate wrap” to MCOs only for those FQHCs that have agreed to this approach.
- Starting in July 2017, every Medicaid and CHIP MCO will be required to contract with at least one FQHC in each service area.
- Incentive payments made by Medicaid MCOs may not be counted against PPS payment.
- Value-based payment (VBP) arrangements must adhere to the statutory requirements for PPS.