The Pennsylvania Department of Human Services (DHS) has been receiving questions regarding opting in to Alternative Payment Methodology (APM) choices that are currently active. There are three active APMs for Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC), issued through Medical Assistance Bulletins (MAB):
MAB 08-16-30 -Effective December 1, 2016. Federally Qualified Health Center Alternative Payment Methodologies for Delivery Services.
MAB 08-17-17 -further clarification Effective June 1, 2017. Discontinuance of Federally Qualified Health Center Alternative Payment Methodologies for Delivery Services in the Federally Qualified Health Center Setting.
MAB 07-17-01, 08-17-22 -Effective June 1, 2017. Opt-In Procedures for Federally Qualified Health Centers and Rural Health Clinics to receive the Prospective Payment System Rate from Managed Care Organizations.
MAB 08-24-15 -Effective October 1, 2024. Federally Qualified Health Center and Rural Health Clinic Payment for SARS-CoV-2 Vaccine Administration.
The Rate Setting Division under the Bureau of Fiscal Management maintains a list of those site locations that have opted in to the above APMs. When an FQHC or RHC opens additional sites, please inform the Division if the site is choosing to opt-in to an APM.
A few reminders:
· The opt-in decision is a “by site,” not “by organization,” decision
· The opt-out procedure is the same as opt-in
· Health centers may opt-in or opt-out at any time, that is, the decision is not permanent
If you have new site location and would like confirmation of your clinic’s opt-in statuses, please inquire at RA-PWOMAPFQHC-RHC@pa.gov. Requests for Opt-In, or Out, should also go to this email address. Be sure to include the Medicaid provider i.d. number, site location number(s), provider name, and type of APM you are requesting.