FQHC Medicaid Reimbursement
FQHC is a designation by the Federal Government.
FQHCs may participate in the APG reimbursement methodology as an "alternative rate setting methodology " as authorized by Public Health Law Section 2807(8)(f). FQHCs cannot be negatively impacted in their Medicaid reimbursement due to opting into the APG reimbursement methodology. If a facility's Medicaid reimbursement under APGs is lower than what their payment would have been under the Federal Prospective Payment System (PPS) rate, the facility is entitled to receive a supplemental payment reflecting the difference between what they were paid under APGs and what they would have been paid using the PPS rate.
If a facility is currently being reimbursed using their PPS rate and would like to participate in the APG reimbursement methodology, complete the FQHC Medicaid Reimbursement Option (11-25-14) (PDF, 440KB, 2pg.). To opt into the APG reimbursement methodology for the upcoming calendar year, FQHCs must declare their intention by downloading and signing the Option Declaration Form and submitting it to the Department of Health before November 1st of the year prior to the calendar year the FQHC wishes to participate in APGs. The change in reimbursement from the PPS method to the APG method is effective on January 1st of the calendar year following receipt of the Option Declaration Form.
Once an FQHC submits the declaration form, the APG method of payment will continue until the provider submits a request in writing to be removed from the APG reimbursement method and return to the PPS reimbursement method. A provider does not need to submit the request to 'opt in' to APGs every year.
If a provider chooses to be removed from the APG reimbursement method and be placed back on the PPS reimbursement method, a written request is required and should be mailed to the same address as displayed on the Option Declaration Form and should be submitted before November 1st of the year prior to the calendar year the FQHC wishes to participate in the PPS payment method. The change in reimbursement from the APG method to the PPS method is effective January 1st of the year following receipt of the letter requesting the change.
- CHCANYS Conference: October 21, 2014 (PPTX, 940KB, 41pg.)
- CHCANYS Conference: June 10, 2013 (PPTX, 940KB, 41pg.)
FQHC Policy Updates
- Revised Part 86-4.16(d) due to amended CON Legislation for FQHCs
- Schedule of rates (posted July 6, 2015)
- Schedule of FQHC rate ceilings
- 2014 Managed Care Visit and Revenue (MCVR) Report