CMS Releases Final Rule for New Payment System for Health Centers

On Tuesday, CMS published a final rule that will increase Medicare payments to federally qualified health centers by as much as $1.3 billion over the next five years, in compliance with a new reimbursement system established under the Affordable Care Act, Bloomberg reports.

The law replaces the current fee-for-service model with a bundled-payment model (Wayne, Bloomberg, 4/29). CMS will start to transition about 8,900 FQHCs to the new reimbursement system on Oct. 1.

Currently, FQHCs are reimbursed for multiple services performed over the course of one day. CMS reviewed that policy as implemented in 2011 and 2012 and determined that multiple encounters over a single day were "extremely rare," according to Modern Healthcare.

The new system is intended to simplify the reimbursement process by not allowing for multiple encounters in one day (Dickson, Modern Healthcare, 4/29). Clinics will be reimbursed through a single daily fee of about $155 per patient for all services the FQCHs provide for Medicare patients. The daily fee will vary depending on the clinic's location and other factors.

According to Bloomberg, the change could potentially benefit about 3,830 FQCHs, increasing their overall Medicare payments by as much as 33%. Currently, the clinics are sustained by roughly $3.6 billion in federal grants (Bloomberg, 4/29).

CMS said the final rule will have "very little impact" on coordinated care.

However, the National Association of Community Health Centers protested the rule when it was proposed, arguing that the agency's analysis did not account for a recent increase in multiple daily encounters. The "approach is a counterproductive policy decision because it discourages a positive trend in health centers toward integrated models of care," NACHC said in a comment on the proposed rule (Modern Healthcare, 4/29).