Date: April 8, 2020
To: Participating Federally Qualified Health Centers
Re: Federally Qualified Health Center (FQHC) Short Term Advance Payments under the Medicaid Managed Care Program
This notice describes a short-term advance payment plan for FQHCs, to address any revenue shortfall they may experience in transitioning to a per member, per month (PMPM) payment methodology.
HFS recognizes that changing FQHC payment methodology could take at least a month to implement. As the managed care plans and HFS work through the complications of moving clinics to a PMPM or similar payment methodology from an encounter rate, we understand that some clinics may be seeing a revenue shortfall earlier than other clinics and have less cash on hand to await a PMPM payment. To address this situation, the MCOs have indicated a willingness to make advance payments where needed. These advances will be reconciled against the future PMPM or claims payments.
If your clinic is facing immediate layoffs or closures, please provide the following information.
- A record of Medicaid revenue received in each of the last four weeks by plan
- The number of empaneled patients by plan
- Your weekly revenue from each Medicaid managed care plan for the last four weeks up through the week of March 30-April 3
- The average monthly Medicaid revenue received by each plan over the past 6 months
- Your number of days’ cash on hand
We ask that clinics not submit a request for an advance until it is needed, as trying to calculate and process advances to all clinics only slows the work to move to a PMPM payment methodology.
Interim Medicaid Administrator