1841 Public notice of the Department's intent to amend the Medicaid State Plan for payments to Federally qualified health centers and rural health clinics

Public Notice of the Department's Intent to Amend the Medicaid State Plan for Payments to Federally Qualified Health Centers and Rural Health Clinics

[29 Pa.B. 5671]

   The purpose of this announcement is to provide prior public notice of the Department of Public Welfare's (Department) intent to amend the Medicaid State Plan for payments to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).

   The Department intends to make a change to the Medicaid State Plan to reflect the Department's implementation of provisions of the Balanced Budget Act of 1997 (BBA) that affect FQHCs and RHCs. The BBA requires states to pay FQHCs and RHCs directly, at least quarterly, an amount which represents the difference, if any, between the amounts paid by managed care organizations (MCOs) to FQHCs and RHCs for services provided to MCO enrolled Medical Assistance (MA) recipients and the FQHCs' or RHCs' reasonable costs. The Department has adopted the following process to comply with this provision of the BBA, both prospectively and retroactively to October 1, 1997.

   The FQHCs/RHCs complete a monthly report detailing managed care encounters and managed care receipts for MCO enrolled MA recipients, as well as the total number of encounters for all MA recipients. The FQHCs/RHCs submit these reports to the Department on a quarterly basis. The managed care dollars received by the FQHCs/RHCs are then compared to the amount the FQHCs/RHCs would have received under the MA Program's cost-based reimbursement. If the latter amount is greater than the former amount, the Department will pay the FQHCs/RHCs the difference. This process is completed on a quarterly basis, and a final settlement is completed at the end of the fiscal year (FY).

Fiscal Impact

   For FY 1998-99, the fiscal impact as a result of providing FQHCs/RHCs supplemental payments for the difference between the FQHCs'/RHCs' managed care receipts and their reasonable costs will be an additional expenditure of $7.850 million in total funds ($3.945 million in State General Funds and $3.905 million in Federal funds).

Contact Person

   A copy of this notice is available for review at local County Assistance Offices. Interested persons are invited to submit written comments to the notice within 30 days of this publication. These comments should be sent to the Department of Public Welfare, Office of Medical Assistance Programs, Attention: Suzanne Love, Room 515 Health and Welfare Building, Harrisburg, PA 17105-2675.

   Persons with a disability may use the AT&T Relay Service by calling [phone] (TDD users) or [phone] (voice users). Persons who require an alternate format should contact Thomas Vracarich at [phone].

FEATHER O. HOUSTOUN,   
Secretary

   Fiscal Note:  14-NOT-223. (1) General Fund; (2) Implementing Year 1999-00 is $3.945 Million; (3) 1st Succeeding Year 2000-01 is $5.894 Million; 2nd Succeeding Year 2001-02 is $6.509 Million; 3rd Succeeding Year 2002-03 is $6.509 Million; 4th Succeeding Year 2003-04 is $6.509 Million; 5th Succeeding Year 2004-05 is $6.509 Million; (4)  1998-99 Program--$695.935 Million; 1997-98 Program--$662.740 Million; 1996-97 Program--$798.836 Million; (7)  Medical Assistance--Outpatient; (8)  recommends adoption. Funds will be available in the Department's budget to cover the cost of these payments.

[Pa.B. Doc. No. 99-1841. Filed for public inspection October 29, 1999, 9:00 a.m.]