HAR §17-1740.1-9. Fee-for-service interim payments

Until the baseline PPS rates are calculated and implemented, interim payment to FQHCs and RHC will continue at rates established as of December 31, 2000. When the PPS rates are implemented, adjustments for the period from January 1, 2001 through the date of PPS implementation will be made. [Eff 11/20/03] (Auth: HRS §346-14, 42 C.F.R. §431.10) (Imp: Pub. L. No. 106-554) §17-1740.1-10 Supplemental managed care payments under PPS methodology. FQHCs or RHCs that provide services under a contract with a Medicaid managed care entity (MCE) will receive quarterly state supplemental UNOFFICIAL 1740.1-6 payments for the cost of furnishing such services that are an estimate of the difference between the payments the FQHC or RHC receives from MCE(s) (excluding managed care risk pool accruals, distributions or losses) and payments the FQHC or RHC would have received under the BIPA PPS methodology. At the end of each calendar year, the total amount of supplemental and MCE payments received, excluding managed care risk pool accruals or distributions, by the FQHC or RHC will be reviewed against the amount that the actual number of visits provided under the FQHCs or RHCs contract with the MCE(s) would have yielded under PPS. The FQHC or RHC will be paid the difference between the PPS amount calculated using the actual number of visits, and total amount of supplemental and MCE payments received by the FQHC or RHC, if the PPS amount exceeds the total amount of supplemental and MCE payments. The FQHC or RHC will refund the difference between the PPS amount calculated using the actual number of visits, and the total amount of supplemental and MCE payments received by the FQHC or RHC, if the PPS amount is less than the total amount of supplement and MCE payments. [Eff 11/20/03] (Auth: HRS §346-14, 42 C.F.R. §431.10) (Imp: Pub. L. No. 106-554) §17-1740.1-11 Adjustment for changes to scope of services. The PPS payment rates may be adjusted for any increases or decreases in the scope of services furnished by the FQHC or RHC. (1) Providers must notify the department in writing of any changes to the scope of services and the reasons for those changes within sixty days of the effective date of such changes. (2) Providers must submit data, documentation, and schedules that substantiate any changes in services and the related increases or decreases of reasonable costs following Medicare principles of reimbursement. (3) Providers must propose a projected adjusted rate to which the department must agree. Upon agreement by the department, the provider will be paid the projected rate effective the date of change in scope of services through the date that a rate is calculated based on the submittal of cost UNOFFICIAL 1740.1-7 reports for the first two full fiscal years which include change in scope of services as required by section 17-1740.1-13(b)(1). (4) Upon receipt of the costs reports required by section 17-1740.1-13(b)(1), the PPS rate will be adjusted following a review by the fiscal agent of the cost reports and documentation. (5) Adjustments will be made for payments for the period from the effective date of the change in scope of services through the date of the final adjustment of the PPS rate. [Eff 11/20/03] (Auth: HRS §346-14, 42 C.F.R. §431.10) (Imp: Pub. L. No. 106-554)