The Centers for Medicare and Medicaid Services (CMS) have issued a proposed rule, or Notice of Public Rulemaking, that could create exceptions to the existing four walls requirement for Indian Health Service (IHS)/Tribal clinics, behavioral health clinics, and clinics located in rural areas. The official language posted to the federal register can be found on page 15 and is below.
“This proposed rule includes a proposal to create exceptions to the Medicaid clinic services benefit four walls requirement, to authorize Medicaid payment for services provided outside the four walls of the clinic for IHS/Tribal clinics, behavioral health clinics, and clinics located in rural areas. Our current regulation at 42 CFR § 440.90(b) includes an exception to the four walls requirement under the Medicaid clinic services benefit only for certain clinic services furnished to individuals who are unhoused. We believe these proposed exceptions would help maintain and improve access for the populations served by IHS/Tribal clinics, behavioral health clinics, and clinics located in rural areas.”
As a reminder, this is a proposed rule intended to announce and explain CMS’ plan to address the problem. As such, all proposed rules must be published in the Federal Register to notify the public and to give them an opportunity to submit comments. The proposed rule and the public comments received on it form the basis of a final rule. Interested parties should provide public comment on this proposed rule to the addresses listed in the federal register by Sept.9, 2024. While CMS works through this process, the Office of Mental Health and Substance Abuse Services (OMHSAS) continues to work toward a more immediate solution for Pennsylvania providers. Reminder, FQHCs are not required to comply with the four walls requirement.