Common use of FQHCs/RHCs Clause in Contracts

FQHCs/RHCs. The MCP is required to ensure member access to any FQHCs/RHCs, regardless of contracting status. Contracting FQHC/RHC providers shall be submitted for ODM review via the MCPN process, or other designated process. Even if no FQHC/RHC is available within the region, the MCP shall have mechanisms in place to ensure coverage for FQHC/RHC services if a member accesses these services outside of the region. The MCP shall also educate their staff and providers on the need to ensure member access to FQHC/RHC services. To ensure any FQHC/RHC can submit a claim to ODM for the state’s wraparound payment per visit as defined in OAC rule 5160-28-01, the MCP shall offer FQHCs/RHCs reimbursement pursuant to the following: 1. The MCP shall provide expedited payment for a service-specific basis, by procedure code, in an amount no less than the payment made to other providers for the same or similar service. 2. If the MCP has no comparable service-specific rate structure, the MCP shall use the regular Medicaid FFS payment schedule for non-FQHC/RHC providers. 3. The MCP shall provide FQHCs/RHCs the MCP’s Medicaid provider number(s) for each region to enable FQHC/RHC providers to ▇▇▇▇ for the ODM wraparound payment.

FQHCs/RHCs. The MCP is required to ensure member access to any FQHCs/RHCs, regardless of contracting status. Contracting FQHC/RHC providers shall be submitted for ODM review via the MCPN process, or other designated process. Even if no FQHC/RHC is available within the region, the MCP shall have mechanisms in place to ensure coverage for FQHC/RHC services if a member accesses these services outside of the region. The MCP shall also educate their staff and providers on the need to ensure member access to FQHC/RHC services. To ensure any FQHC/RHC can submit a claim to ODM for the state’s wraparound payment per visit as defined in OAC rule 5160-28-01, the MCP shall offer FQHCs/RHCs reimbursement pursuant to the following: 1. The MCP shall provide expedited payment for a service-specific basis, by procedure code, in an amount no less than the payment made to other providers for the same or similar service. 2. If the MCP has no comparable service-specific rate structure, the MCP shall use the regular Medicaid FFS payment schedule for non-FQHC/RHC providers. 3. The MCP shall provide FQHCs/RHCs the MCP’s Medicaid provider number(s) for each region to enable FQHC/RHC providers to ▇▇▇▇ bill for the ODM wraparound payment.