Federally Qualified Sample Clauses
The 'Federally Qualified' clause defines the criteria or status required for an entity, service, or product to be recognized as meeting specific federal standards or qualifications. In practice, this clause often applies to organizations such as health centers or service providers that must comply with federal regulations to receive certain benefits, funding, or participate in government programs. By clearly establishing what it means to be federally qualified, the clause ensures that only eligible parties can access designated advantages, thereby maintaining compliance and preventing misuse or misallocation of federal resources.
Federally Qualified. Health Centers (FQHCs) and Rural Health Clinics (RHCs)
Federally Qualified. Health Centers (FQHCs) and Rural Health Clinics (RHCs)
1. Prior to September 1, 2007: For claims accruing prior to September 1, 2007, cost settlements apply to all Service Areas except the Nueces Service Area and the STAR+PLUS Service Areas. The HMOs serving the Nueces Service Area and the STAR+PLUS Service Areas must pay the full encounter rates to the FQHCs and RHCs for claims accruing before September 1, 2007.
2. September 1, 2007 to September 1, 2008: For claims accruing on or after September 1, 2007 but prior to September 1, 2008, HMOs are not required to pay full encounter rates to the FQHCs and RHCs. Therefore, HHSC cost settlements for FQHC’s will continue to apply to all STAR and STAR+PLUS Service Areas for this period of time.
3. On or after September 1, 2008: HMOs are required to pay the full encounter rates to RHCs for claims accruing on or after September 1, 2008; therefore, HHSC cost settlements will not apply to RHCs for this period of time. However, HMOs are not required to pay the full encounter rates to FQHCs for claims accruing on or after September 1, 2008; therefore, HHSC cost settlements will apply to FQHCs for this period of time. The HMO must submit monthly FQHC and RHC encounter and payment reports to all contracted FQHCs and RHCs, and FQHCs and RHCs with which there have been encounters, not later than 21 days from the end of the month for which the report is submitted. The format will be developed by HHSC and provided in the Uniform Managed Care Manual. The FQHC and RHC must validate the encounter and payment information contained in the report(s). The HMO and the FQHC/RHC must both sign the report(s) after each party agrees that it accurately reflects encounters and payments for the month reported. The HMO must submit the signed FQHC and RHC encounter and payment reports to HHSC not later than 45 days from the end of the reported month. Encounter and payment reports will not be necessary for
1. the Nueces Service Area and the STAR+PLUS Service Areas for claims accruing before September 1, 2007, since the HMOs in those Areas will pay the full encounter rates to the FQHCs and RHCs for this period of time; and
2. for claims paid to RHCs on or after September 1, 2008, because the HMOs will pay full encounter rates to RHCs for this period of time.
Federally Qualified. Health Center (FQHC)
Federally Qualified. Health Center (FQHC) — an entity that satisfies the criteria set forth in 42 U.S.C. § 1396d(l)(2)(B); includes Rural Health Centers (RHCs) as defined in Section 1861(aa)(2) of the Social Security Act
Federally Qualified. Health Center (FQHC) means a facility that meets the requirements of Social Security Act at 1905(l)(2).
Federally Qualified. Health Centers (FQHCs)
a) In a county where Enrollment in the Contractor's MMC product is voluntary, the Contractor is not required to contract with FQHCs. However, when an FQHC is a Participating Provider of the Contractor network, the Provider Agreement must include a provision whereby the Contractor agrees to compensate the FQHC for services provided to Enrollees at a payment rate that is not less than the level and amount that the Contractor would pay another Participating Provider that is not an FQHC for a similar set of services.
b) In a county where Enrollment in the Contractor's MMC product is mandatory and/or the Contractor offers a FHPlus product, the Contractor shall contract with FQHCs operating in that county. However, the Contractor has the option to make a written request to the SDOH for an exemption from the FQHC contracting requirement if the Contractor can demonstrate, with supporting documentation, that it has adequate capacity and will provide a comparable level of clinical and enabling services (e.g., outreach, referral services, social SECTION 21 (PROVIDER NETWORK) October 1, 2005 21-10 support services, culturally sensitive services such as training for medical and administrative staff, medical and non-medical and case management services) to vulnerable populations in lieu of contracting with an FQHC in the county. Written requests for exemption from this requirement are subject to approval by CMS.
c) When the Contractor is participating in a county where an MCO that is sponsored, owned and/or operated by one or more FQHCs exists, the Contractor is not required to include any FQHCs within its network in that county.
Federally Qualified. Health Center (FQHC) means an entity as defined in Title 22, CCR, Section 53810(r).
Federally Qualified. Health Centers (FQHCs) and Rural Health Clinics (RHCs)
4.8.9.1 The Contractor shall include in its Provider network all FQHCs and RHCs in its Service Region.
4.8.9.2 The Contractor shall maintain copies of all letters and other correspondence related to its efforts to include FQHCs and RHCs in its network. This documentation shall be provided to DCH upon request.
Federally Qualified. Health Centers (FQHCs) In voluntary counties, the Contractor is not required to contract with FQHCs. However, when an FQHC is part of the provider network (voluntary or mandatory counties) the Provider Agreement must include, a provision whereby the SECTION 21 (PROVIDER NETWORK AND AGREEMENTS) OCTOBER 1, 2004 21-10 Contractor agrees to compensate the FQHC for services provided to Enrollees at a payment rate that is not less than the level and amount for a similar set of services which the Contractor would make to a provider that is not an FQHC. In mandatory counties, the Contractor shall contract with FQHCs operating in its Service Area. However, the Contractor has the option to make a written request to the SDOH for an exemption from the FQHC contracting requirement, if the Contractor can demonstrate, with supporting documentation, that it has adequate capacity and will provide a comparable level of clinical and enabling services (e.g., outreach; referral services, social support services, culturally sensitive services such as training for medical and administrative staff, medical and non-medical and case manageMent services) to vulnerable populations in lieu of contracting with an FQHC in its Service Area. Written requests for exemption from this requirement are subject to approval by HCFA When the Contractor is participating in a county where an MCO that is sponsored, owned and/or operated by one or more FQHCs exists, the Contractor is not required to include any FQHCs within its network in that county.