Definitions

Definitions The Division of Medicaid defines: A. A Federally Qualified Health Center (FQHC) encounter as a face-to-face visit for the provision of services provided by physicians, physician assistants, nurse practitioners, nurse midwives, dentists, optometrists, clinical psychologists, Licensed Clinical Social Workers (LCSWs), Licensed Professional Counselors (LPCs), Licensed Marriage and Family Therapists (LMFTs), and Board Certified Behavioral Analysts (BCBAs). B. An encounter rate as a prospective payment system (PPS) rate per encounter. C. Clinician Administered Drugs and Implantable Drug System Devices (CADD) as certain physician-administered drugs, with limited distribution or limited access for beneficiaries and administered in an appropriate clinical setting, which may be reimbursed under the pharmacy benefit to the extent the CADDs were not included in the calculation of the FQHC’s PPS rate, as determined by the Division of Medicaid. D. Change in the scope of service as a change in the type, intensity, duration and/or amount of services. 1. A change in the scope of services occurs if: a) The FQHC has added or has dropped any services that meet the definition of an FQHC service as provided in federal regulations. b) The service is included as a covered Medicaid service under the Mississippi Medicaid State Plan. c) A change in the intensity is a change in the amount of health care services provided by the FQHC during an average encounter. 2. A change in the scope of service does not mean: a) The addition or reduction of staff members to or from an existing service. b) An increase or decrease in the number of encounters. c) A change in the cost of a service is not considered in and of itself a change in the scope of service. E. Allowable costs as costs that: 1. Result from providing covered services, 2. Are reasonable in amount and are necessary for the efficient delivery of those services, 3. Include the direct cost center component (i.e., salaries and supplies) of providing the covered services, and 4. Are an allocated portion of overhead (i.e., administration and facility). F. Co-mingling as the simultaneous operation of an FQHC and another physician practice where the two (2) practices share: 1. Hours of operation, 2. Use of the space, 3. Professional staff, 4. Equipment, 5. Supplies, and 6. Other resources.