Adjustments under the PPS

30.2 - Adjustments under the PPS (Rev. 3434, Issued: 12-31-15, Effective: 03-31-16, Implementation: 03-31-16) The FQHC PPS rate will be adjusted to account for geographic differences in costs by the FQHC geographic adjustment factor (FQHC GAF). In calculating the PPS rate, the FQHC GAF will be based on the locality of the site where the services are furnished. For FQHC organizations with multiple sites, the FQHC GAF may vary depending on the location of the FQHC delivery site. The FQHC PPS rate for a covered visit will be calculated as follows: Base payment rate x FQHC GAF = PPS rate Updates to the FQHC GAFs will be made in conjunction with updates to the Physician Fee Schedule Geographic Practice Cost Indices for the same period and will be posted on CMS’s FQHC PPS webpage at http://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/FQHCPPS/index.html. The PPS per-diem rate will be adjusted by a factor of 1.3416 when a FQHC furnishes care to a patient who is new to the FQHC (has not been a patient at any site that is part of the FQHC organization within the previous 3 years) or to a beneficiary receiving an IPPE or an annual wellness visit (AWV). This is a composite adjustment factor and only one adjustment per day can be applied. If the patient is new to the FQHC, or the FQHC furnishes an Initial Preventive Physical Examination (IPPE) or Annual Wellness Visit (AWV), the FQHC PPS rate for a covered visit will be calculated as follows: Base payment rate x FQHC GAF x 1.3416 = PPS rate For more information on the FQHC PPS, please see the FQHC PPS Final Rule located at: https://www.cms.gov/Center/Provider-Type/Federally-Qualified-Health-Centers-FQHC- Center.html