Requirements and FQHC, RHC, and Freestanding Birth Center (FBC) Network Sufficiency under Medicaid and CHIP Managed Care

The Center for Medicaid and CHIP Services (CMCS) issued guidance to states on payment mechanisms states may use to ensure FQHCs and RHCs receive the statutorily required minimum payments under both Medicaid and the Children’s Health Insurance Program (CHIP) managed care delivery systems.  These mechanisms include state supplemental payments to FQHCs and RHCs consistent with §1902(bb)(5) of the Social Security Act (the Act) or an Alternative Payment Methodology (APM) consistent with §1902(bb)(6) of the Act. The letter also provides guidance on FQHC, RHC, and freestanding birth center (FBC) network sufficiency standards applicable to a Medicaid managed care delivery system.

The letter is available online on Medicaid.gov at http://www.medicaid.gov/federal-policy-guidance/federal-policy-guidance.html