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CMS proposes single-encounter rate for federally qualified health centers

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Beginning in October 2014, under a new proposal from the Centers for Medicare & Medicaid Services, federally qualified health centers would get a single-encounter rate per Medicare beneficiary per day for all services provided.

The proposal would increase Medicare payments to these health centers by approximately 30 percent for services furnished to Medicare beneficiaries in medically underserved areas, according to a news release from CMS.

FQHCs provide comprehensive primary and preventive health services, are generally required to treat all patients regardless of their ability to pay and offer a sliding fee scale to people with incomes below 200 percent of the federal poverty line. The majority of FQHCs receive federal grant funds. In 2012, FQHCs accounted for 8,900 service sites serving 21 million people; Medicare was approximately 9 percent of their total billing.

"The new payment system will help even more patients get care in federally-supported health centers," said CMS Administrator Marilyn Tavenner. "The services provided by these centers help ensure patients get important primary and preventive care that lowers costs and improves health outcomes."

Medicare currently pays FQHCs based on reasonable costs and subject to established payment limits. Obamacare required that the proposal account for a number of factors, including the type, intensity and duration of services provided in this setting, without payment limits.

CMS will accept comments on the proposed rule until Nov. 18, and will respond to them in a final rule to be issued in 2014.

Heather Stauffer

Heather Stauffer

Heather Stauffer covers Lancaster County, nonprofits, education and health care. Have a tip or question for her? Email her at heathers@cpbj.com. Follow her on Twitter, @StaufferCPBJ.

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