Purpose of the Bill

The aim of this bill is to amend the reimbursement procedures for federally qualified health centers (FQHCs) in Minnesota. The bill seeks to update the rules and requirements surrounding how these health centers are reimbursed for their services through medical assistance programs.

Main Provisions

• Submission of Cost and Visit Reports: New and existing FQHCs must submit detailed reports, including budgeted or actual costs and visit numbers, to the commissioner at specified times.
• Essential Community Provider Status: Initially, FQHCs and rural health clinics must apply for this designation to continue receiving cost-based payments, but the requirement for this designation has been removed as of July 1, 1999.
• Payment Options: FQHCs are given the choice to be reimbursed either through the prospective payment system or an alternative payment methodology, consistent with federal requirements.
• Encounter Rate and Payment Guidelines: Establishment of a medical and dental encounter rate for each FQHC and rural clinic, with specific reimbursements for same-day services.
• Nonallowable Costs: A detailed list of costs not eligible for reimbursement, such as social services, administration, and marketing costs.
• Rebasing and Inflation Adjustment: The payment rates are to be reviewed and updated regularly, with inflation adjustments based on a federal index.
• Change in Scope: Protocols for how FQHCs can request changes to their payment rates based on alterations in the type or quantity of services provided.
• Tribal FQHCs: Special provisions for clinics operated by tribal entities, allowing them to enroll as Tribal FQHCs with adjusted reimbursement methods.

Significant Changes

• Removal of the requirement for FQHCs and rural health clinics to apply for essential community provider status to receive cost-based payments, effective from 1999.
• Clarification and specification of alternative payment methodologies and reimbursement limits in alignment with Medicare cost principles.
• Introduction of an encounter payment rate equivalent to federal standards for Indian health services.
• Establishment of a quality measures workgroup to evaluate clinical and non-clinical performance metrics.

Relevant Terms

federally qualified health centers, FQHC, rural health clinic, medical assistance, reimbursement procedures, essential community provider, prospective payment system, alternative payment methodology, encounter rate, Medicare cost principles, tribal health centers, inflation adjustment, nonallowable costs.