Common use of Federally Qualified Health Centers Clause in Contracts

Federally Qualified Health Centers. (FQHCs) and Rural Health Clinics (RHCs) Federally Qualified Health Centers (FQHCs) are federally funded Community Health Centers, Migrant Health Centers and Health Care for the Homeless Projects that receive grants under sections 329, 330 and 340 of the US Public Health Service Act.10 Current federal regulations specify that states must guarantee access to FQHCs and RHCs under Medicaid and CHIP managed care programs; therefore, MCOs must provide access to FQHCs and RHCs to the extent that access is required under federal law. If federal law is amended to revise these access requirements, BMS may alter the requirements imposed on MCOs. The MCO must Contract with as many FQHCs and RHCs as necessary to permit beneficiary access to participating FQHCs and RHCs without having to travel a significantly greater distance past a non-participating FQHC or RHC. The MCO must Contract with the FQHC or RHC – contracts with individual physicians at FQHCs and RHCs do not suffice for this requirement. The MCO must contract with FQHCs and RHCs in accordance with the time and distance standards for routinely used delivery sites as specified in this contract in Appendix I. An MCO with an FQHC or RHC on its panel that has no capacity to accept new patients will not satisfy these requirements. If an MCO cannot satisfy the standard for FQHC and RHC access at any time while the MCO holds a MHT contract, the MCO must allow its Medicaid and WVCHIP enrollees to seek care from non-contracting FQHCs and RHCs and must reimburse these providers at Medicaid FFS rates. The MCO must offer FQHCs and RHCs terms and conditions, including reimbursement, which are at least equal to those offered to other providers of comparable services. The MCO cannot sign exclusive contracts with any publicly supported providers that prevent the providers from signing contracts with other MCOs. Upon BMS notification to the MCO of any changes to the FQHC/RHC reimbursement rates, the MCO must update payment rates to FQHC/RHCs to the effective date in the notification by BMS. The MCO must pay the new rate for any claims not yet paid with a date of service on or after the effective date of change. If payment was already made for a claim within the current SFY with a date of service on or after the effective date of the rate 9 Since federal law requires states to assure access to certified pediatric or family nurse practitioners and certified nurse midwives, and states are not allowed to waive this requirement, the MCOs must provide access to these services.

Federally Qualified Health Centers. (FQHCs) and Rural Health Clinics (RHCs) Federally Qualified Health Centers (FQHCs) are federally federally-funded Community Health Centers, Migrant Health Centers and Health Care for the Homeless Projects that receive grants under sections 329, 330 and 340 of the US Public Health Service Act.10 Act.7 Current federal regulations specify that states must guarantee access to FQHCs and RHCs under Medicaid and CHIP managed care programs; therefore, MCOs must provide access to FQHCs and RHCs to the extent that access is required under federal law. If federal law is amended to revise these access requirements, BMS DHHR may alter the requirements imposed on MCOs. The MCO must Contract with as many FQHCs and RHCs as necessary to permit beneficiary access to participating FQHCs and RHCs without having to travel a significantly greater distance past a non-participating FQHC or RHC. The MCO must Contract with the FQHC or RHC – contracts with individual physicians at FQHCs and RHCs do not suffice for this requirement. The MCO must contract Contract with FQHCs and RHCs in accordance with the thirty (30) minute travel time and distance standards for routinely routinely-used delivery sites as specified in this contract in Appendix I. contract. An MCO with an FQHC or RHC on its panel that has no capacity to accept new patients will not satisfy these requirements. If an MCO cannot satisfy the standard for FQHC and RHC access at any time while the MCO holds a MHT Medicaid contract, the MCO must allow its Medicaid and WVCHIP enrollees members to seek care from non-contracting FQHCs and RHCs and must reimburse these providers at Medicaid FFS ratesfees. The MCO must offer FQHCs and RHCs terms and conditions, including reimbursement, which are at least equal to those offered to other providers of comparable services. The MCO cannot sign exclusive contracts with any publicly supported providers that prevent the providers from signing contracts with other MCOs. Upon BMS DHHR notification to the MCO of any changes to the FQHC/RHC reimbursement rates, the MCO must update payment rates to FQHC/RHCs to the effective date in the notification by BMSDHHR. The MCO must pay the new rate for any claims not yet paid with a date of service on or after the effective date of change. If payment was has already been made for a claim within the current SFY 2020 with a date of service on or after the effective date of the rate 9 change, the MCO must reprocess the claim to reimburse at the new rate. The new payment 6 Since federal law requires states to assure access to certified pediatric or family nurse practitioners and certified nurse midwives, and states are not allowed to waive this requirement, the MCOs must provide access to these services.

Federally Qualified Health Centers. (FQHCs) and Rural Health Clinics (RHCs) Federally Qualified Health Centers (FQHCs) are federally federally-funded Community Health Centers, Migrant Health Centers and Health Care for the Homeless Projects that receive grants under sections 329, 330 and 340 of the US Public Health Service Act.10 Current federal regulations specify that states must guarantee access to FQHCs and RHCs under Medicaid and CHIP managed care programs; therefore, MCOs must provide access to FQHCs and RHCs to the extent that access is required under federal law. If federal law is amended to revise these access requirements, BMS may alter the requirements imposed on MCOs. The MCO must Contract with as many FQHCs and RHCs as necessary to permit beneficiary access to participating FQHCs and RHCs without having to travel a significantly greater distance past a non-participating FQHC or RHC. The MCO must Contract with the FQHC or RHC – contracts with individual physicians at FQHCs and RHCs do not suffice for this requirement. The MCO must contract with FQHCs and RHCs in accordance with the time and distance standards for routinely routinely-used delivery sites as specified in this contract in Appendix I. J. An MCO with an FQHC or RHC on its panel that has no capacity to accept new patients will not satisfy these requirements. If an MCO cannot satisfy the standard for FQHC and RHC access at any time while the MCO holds a MHT Medicaid contract, the MCO must allow its Medicaid and WVCHIP enrollees to seek care from non-contracting FQHCs and RHCs and must reimburse these providers at Medicaid FFS ratesfees. The MCO must offer FQHCs and RHCs terms and conditions, including reimbursement, which are at least equal to those offered to other providers of comparable services. The MCO cannot sign exclusive contracts with any publicly supported providers that prevent the providers from signing contracts with other MCOs. Upon BMS notification to the MCO of any changes to the FQHC/RHC reimbursement rates, the MCO must update payment rates to FQHC/RHCs to the effective date in the notification by BMS. The MCO must pay the new rate for any claims not yet paid with a date of service on or after the effective date of change. If payment was already made for a claim within the current SFY 2021 but with a date of service on or after the effective date of the rate 9 Since federal law requires states to assure access to certified pediatric or family nurse practitioners and certified nurse midwiveschange, and states are not allowed to waive this requirementincluding dates of service in a preceding period, the MCOs MCO must provide access reprocess the claim to these servicesreimburse at the new rate. The new payment rate must be loaded into the MCO’s claims payment system within thirty (30) calendar days of notification of the payment rate change.

Federally Qualified Health Centers. (FQHCs) and Rural Health Clinics (RHCs) Federally Qualified Health Centers (FQHCs) are federally federally-funded Community Health Centers, Migrant Health Centers and Health Care for the Homeless Projects that receive grants under sections 329, 330 and 340 of the US Public Health Service Act.10 Current federal regulations specify that states must guarantee access to FQHCs and RHCs under Medicaid and CHIP managed care programs; therefore, MCOs must provide access to FQHCs and RHCs to the extent that access is required under federal law. If federal law is amended to revise these access requirements, BMS may alter the requirements imposed on MCOs. The MCO must Contract with as many FQHCs and RHCs as necessary to permit beneficiary access to participating FQHCs and RHCs without having to travel a significantly greater distance past a non-participating FQHC or RHC. The MCO must Contract with the FQHC or RHC – contracts with individual physicians at FQHCs and RHCs do not suffice for this requirement. The MCO must contract with FQHCs and RHCs in accordance with the time and distance standards for routinely routinely-used delivery sites as specified in this contract in Appendix I. J. An MCO with an FQHC or RHC on its panel that has no capacity to accept new patients will not satisfy these requirements. If an MCO cannot satisfy the standard for FQHC and RHC access at any time while the MCO holds a MHT Medicaid contract, the MCO must allow its Medicaid and WVCHIP enrollees to seek care from non-contracting FQHCs and RHCs and must reimburse these providers at Medicaid FFS ratesfees. The MCO must offer FQHCs and RHCs terms and conditions, including reimbursement, which are at least equal to those offered to other providers of comparable services. The MCO cannot sign exclusive contracts with any publicly supported providers that prevent the providers from signing contracts with other MCOs. Upon BMS notification to the MCO of any changes to the FQHC/RHC reimbursement rates, the MCO must update payment rates to FQHC/RHCs to the effective date in the notification by BMS. The MCO must pay the new rate for any claims not yet paid with a date of service on or after the effective date of change. If payment was already made for a claim within the current SFY with a date of service on or after the effective date of the rate 9 Since federal law requires states to assure access to certified pediatric or family nurse practitioners and certified nurse midwives, and states are not allowed to waive this requirement, the MCOs must provide access to these services.

Federally Qualified Health Centers. (FQHCs) and Rural Health Clinics (RHCs) Federally Qualified Health Centers (FQHCs) are federally federally-funded Community Health Centers, Migrant Health Centers and Health Care for the Homeless Projects that receive grants under sections 329, 330 and 340 of the US Public Health Service Act.10 Current federal regulations specify that states must guarantee access to FQHCs and RHCs under Medicaid and CHIP managed care programs; therefore, MCOs must provide access to FQHCs and RHCs to the extent that access is required under federal law. If federal law is amended to revise these access requirements, BMS DHHR may alter the requirements imposed on MCOs. The MCO must Contract with as many FQHCs and RHCs as necessary to permit beneficiary access to participating FQHCs and RHCs without having to travel a significantly greater distance past a non-participating FQHC or RHC. The MCO must Contract with the FQHC or RHC – contracts with individual physicians at FQHCs and RHCs do not suffice for this requirement. The MCO must contract Contract with FQHCs and RHCs in accordance with the time and distance standards for routinely routinely-used delivery sites as specified in this contract in Appendix I. K. An MCO with an FQHC or RHC on its panel that has no capacity to accept new patients will not satisfy these requirements. If an MCO cannot satisfy the standard for FQHC and RHC access at any time while the MCO holds a MHT Medicaid contract, the MCO must allow its Medicaid and WVCHIP enrollees to seek care from non-contracting FQHCs and RHCs and must reimburse these providers at Medicaid FFS ratesfees. The MCO must offer FQHCs and RHCs terms and conditions, including reimbursement, which are at least equal to those offered to other providers of comparable services. The MCO cannot sign exclusive contracts with any publicly supported providers that prevent the providers from signing contracts with other MCOs. Upon BMS DHHR notification to the MCO of any changes to the FQHC/RHC reimbursement rates, the MCO must update payment rates to FQHC/RHCs to the effective date in the notification by BMSDHHR. The MCO must pay the new rate for any claims not yet paid with a date of service on or after the effective date of change. If payment was has already been made for a claim within the current SFY 2021 with a date of service on or after the effective date of the rate 9 Since federal law requires states to assure access to certified pediatric or family nurse practitioners and certified nurse midwives, and states are not allowed to waive this requirementchange, the MCOs MCO must provide access reprocess the claim to these servicesreimburse at the new rate. The new payment rate must be loaded into the MCO’s claims payment system within thirty (30) calendar days of notification of the payment rate change.

Federally Qualified Health Centers. (FQHCs) and Rural Health Clinics (RHCs) Federally Qualified Health Centers (FQHCs) are federally funded Community Health Centers, Migrant Health Centers and Health Care for the Homeless Projects that receive grants under sections 329, 330 and 340 of the US Public Health Service Act.10 Current federal regulations specify that states must guarantee access to FQHCs and RHCs under Medicaid and CHIP managed care programs; therefore, MCOs must provide access to FQHCs and RHCs to the extent that access is required under federal law. If federal law is amended to revise these access requirements, BMS may alter the requirements imposed on MCOs. The MCO must Contract with as many FQHCs and RHCs as necessary to permit beneficiary access to participating FQHCs and RHCs without having to travel a significantly greater distance past a non-participating FQHC or RHC. The MCO must Contract with the FQHC or RHC – contracts with individual physicians at FQHCs and RHCs do not suffice for this requirement. The MCO must contract with FQHCs and RHCs in accordance with the time and distance standards for routinely used delivery sites as specified in this contract in Appendix I. An MCO with an FQHC or RHC on its panel that has no capacity to accept new patients will not satisfy these requirements. If an MCO cannot satisfy the standard for FQHC and RHC access at any time while the MCO holds a MHT Medicaid contract, the MCO must allow its Medicaid and WVCHIP enrollees to seek care from non-contracting FQHCs and RHCs and must reimburse these providers at Medicaid FFS rates. The MCO must offer FQHCs and RHCs terms and conditions, including reimbursement, which are at least equal to those offered to other providers of comparable services. The MCO cannot sign exclusive contracts with any publicly supported providers that prevent the providers from signing contracts with other MCOs. Upon BMS notification to the MCO of any changes to the FQHC/RHC reimbursement rates, the MCO must update payment rates to FQHC/RHCs to the effective date in the notification by BMS. The MCO must pay the new rate for any claims not yet paid with a date of service on or after the effective date of change. If payment was already made for a claim within the current SFY with a date of service on or after the effective date of the rate 9 Since federal law requires states to assure access to certified pediatric or family nurse practitioners and certified nurse midwives, and states are not allowed to waive this requirement, the MCOs must provide access to these servicesfees.

Federally Qualified Health Centers. (FQHCs) and Rural Health Clinics (RHCs) Federally Qualified Health Centers (FQHCs) are federally funded Community Health Centers, Migrant Health Centers and Health Care for the Homeless Projects that receive grants under sections 329, 330 and 340 of the US Public Health Service Act.10 Current federal regulations specify that states must guarantee access to FQHCs and RHCs under Medicaid and CHIP managed care programs; therefore, MCOs must provide access to FQHCs and RHCs to the extent that access is required under federal law. If federal law is amended to revise these access requirements, BMS may alter the requirements imposed on MCOs. The MCO must Contract with as many FQHCs and RHCs as necessary to permit beneficiary access to participating FQHCs and RHCs without having to travel a significantly greater distance past a non-participating FQHC or RHC. The MCO must Contract with the FQHC or RHC – contracts with individual physicians at FQHCs and RHCs do not suffice for this requirement. The MCO must contract with FQHCs and RHCs in accordance with the time and distance standards for routinely used delivery sites as specified in this contract in Appendix I. An MCO with an FQHC or RHC on its panel that has no capacity to accept new patients will not satisfy these requirements. If an MCO cannot satisfy the standard for FQHC and RHC access at any time while the MCO holds a MHT Medicaid contract, the MCO must allow its Medicaid and WVCHIP enrollees to seek care from non-contracting FQHCs and RHCs and must reimburse these providers at Medicaid FFS ratesfees. The MCO must offer FQHCs and RHCs terms and conditions, including reimbursement, which are at least equal to those offered to other providers of comparable services. The MCO cannot sign exclusive contracts with any publicly supported providers that prevent the providers from signing contracts with other MCOs. Upon BMS notification to the MCO of any changes to the FQHC/RHC reimbursement rates, the MCO must update payment rates to FQHC/RHCs to the effective date in the notification by BMS. The MCO must pay the new rate for any claims not yet paid with a date of service on or after the effective date of change. If payment was already made for a claim within the current SFY with a date of service on or after the effective date of the rate 9 Since federal law requires states to assure access to certified pediatric or family nurse practitioners and certified nurse midwives, and states are not allowed to waive this requirement, the MCOs must provide access to these services.

Federally Qualified Health Centers. (FQHCs) and Rural Health Clinics (RHCs) Federally Qualified Health Centers (FQHCs) are federally federally-funded Community Health Centers, Migrant Health Centers and Health Care for the Homeless Projects that receive grants under sections 329, 330 and 340 of the US Public Health Service Act.10 Current federal regulations specify that states must guarantee access to FQHCs and RHCs under Medicaid and CHIP managed care programs; therefore, MCOs must provide access to FQHCs and RHCs to the extent that access is required under federal law. If federal law is amended to revise these access requirements, BMS DHHR may alter the requirements imposed on MCOs. The MCO must Contract with as many FQHCs and RHCs as necessary to permit beneficiary access to participating FQHCs and RHCs without having to travel a significantly greater distance past a non-participating FQHC or RHC. The MCO must Contract with the FQHC or RHC – contracts with individual physicians at FQHCs and RHCs do not suffice for this requirement. The MCO must contract Contract with FQHCs and RHCs in accordance with the time and distance standards for routinely routinely-used delivery sites as specified in this contract in Appendix I. K. An MCO with an FQHC or RHC on its panel that has no capacity to accept new patients will not satisfy these requirements. If an MCO cannot satisfy the standard for FQHC and RHC access at any time while the MCO holds a MHT Medicaid contract, the MCO must allow its Medicaid and WVCHIP enrollees to seek care from non-contracting FQHCs and RHCs and must reimburse these providers at Medicaid FFS ratesfees. The MCO must offer FQHCs and RHCs terms and conditions, including reimbursement, which are at least equal to those offered to other providers of comparable services. The MCO cannot sign exclusive contracts with any publicly supported providers that prevent the providers from signing contracts with other MCOs. Upon BMS notification to the MCO of any changes to the FQHC/RHC reimbursement rates, the MCO must update payment rates to FQHC/RHCs to the effective date in the notification by BMS. The MCO must pay the new rate for any claims not yet paid with a date of service on or after the effective date of change. If payment was already made for a claim within the current SFY with a date of service on or after the effective date of the rate 9 Since federal law requires states to assure access to certified pediatric or family nurse practitioners and certified nurse midwives, and states are not allowed to waive this requirement, the MCOs must provide access to these services.