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Revised New York State Managed Care Supplemental Payment Program Policy for FQHCs Released


5/25/16

The New York State Department of Health (NYSDOH) released in January 2016 revised guidelines to its March 2011 Managed Care Supplemental Payment Program Policy Document for Federally Qualified Health Centers (FQHCs).  The Policy clearly identifies the State’s position with respect to new health insurance plan contracts.

Highlights of the revised policy include:

  • Program Overview:
    • For managed care visits that are either unpaid or occur outside a contract between the FQHC and a Managed Care Organization (MCO) and/or Independent Practice Association(IPA), the State will reimburse FQHCs at the full FQHC rate under rate codes 4026, 4027 and 4028.
  • Criteria for Submitting Supplemental Payment Claims
    • The Policy has been expanded to include specified services provided to enrollees of Health and Recovery Plan (HARP), Managed Long-Term Care (MLTC), Fully Integrated Duals Advantage (FIDA) and Essential Plans 3 & 4 (Aliessa population).   FQHCs contracting with these plans, along with HIV SNP, Medicaid Advantage (MA) and Medicaid Advantage Plus (MAP), may submit supplemental claims to eMedNY for the specified services.  
    • The policy includes a list of the specific FQHC services eligible for the Supplemental payment  for MLTC, Aliessa, MA and MAP benefit packages   


The complete policy update, MCVR report and certification page can be accessed here.
 
What Does CohnReznick Think?
FQHCs should review the revised Policy Document and determine if the existing practice management configuration identifies all FQHC services eligible for Supplemental payments. An alternate configuration may be required to distinguish which FQHC services for each eligible insurance plan qualifies for the Supplemental payment. Internal reporting must also be updated to ensure the data utilized in the MCVR report is accurate. Now is the time to begin testing and to gather the necessary data required to identify qualifying payments and visits when preparing the 2015 MCVR report. The 2015 MCVR report must be filed with NYSDOH by August 1, 2016.

Contact
 
For more information, please contact Peter Epp, Partner in CohnReznick’s Healthcare Industry Practice, at peter.epp@cohnreznick.com or 646-254-7411 or Dolores DiRe, Manager, at dolores.dire@cohnreznick.com or 646 625-5703.

This has been prepared for information purposes and general guidance only and does not constitute professional advice. You should not act upon the information contained in this publication without obtaining specific professional advice. No representation or warranty (express or implied) is made as to the accuracy or completeness of the information contained in this publication, and CohnReznick LLP, its members, employees and agents accept no liability, and disclaim all responsibility, for the consequences of you or anyone else acting, or refraining to act, in reliance on the information contained in this publication or for any decision based on it.

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