Federally Qualified Health Center (FQHC)

FQHC is a designation by the Federal Government.

The defining legislation for FQHCs (under the Consolidated Health Center Program) is Section 1905(l)(2)(B) of the Social Security Act.

Alternate Rate Setting Methodology (APG)

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.

Please note that, if a facility chooses to participate in the APG reimbursement methodology for the Department of Health clinic services, it is also choosing to participate in APGs for the Office of Mental Health (OMH) and Office of Addition Services and Supports (OASAS) clinic services. If a provider chooses to participate in the APG methodology for one agency, it is choosing to participate in APGs for all 3 agencies.

Further information regarding the option process, along with the option forms, are provided here:
FQHC Medicaid Reimbursement Option

Presentations

FQHC Policy Updates

FQHC Rates

FQHC Ceilings

FQHC Forms

FQHCs Policy Document