FQHC Rule Boosts Rates, Implements Lab Changes
May 1—A new Medicare pay scale for federally qualified health centers (FQHCs) has been established by a final payment rule that also implements new laboratory testing requirements.
The Centers for Medicare & Medicaid Services (CMS) issued a final rule April 29 to establish the FQHC payment system, which would boost the payments that the health centers receive from Medicare by up to 32 percent, according to a CMS fact sheet.
The FQHC prospective payment system will replace a reasonable cost-based payment system, which provides an all-inclusive rate subject to productivity standards and an upper payment limit of $111.67 for rural FQHCs and $129.02 for urban FQHCs. The encounter-based per-diem base rate, which is based on an average cost per encounter, is $158.85 and is adjusted for geographic differences in the cost of services and for greater intensity and resources required for new patients.
The rule also gives rural health clinics more flexibility in meeting employment requirements under the Rural Health Clinic Services Act of 1977 by allowing them to contract with non-physician practitioners, which was a change sought by the American Hospital Association.
Additionally, the rules implemented tweaks to the clinical laboratory requirements of the Taking Essential Steps for Testing Act of 2012. The law required laboratories to participate in proficiency testing to ensure the accuracy and reliability of test results and prohibited them from referring proficiency testing samples for testing at another laboratory. The rule limited revocation of the laboratory’s Clinical Laboratory Improvement Amendments certificate and the most serious sanctions for the most egregious intentional violations.
Publication Date: Thursday, May 01, 2014