Skip to main content
  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice issued 12/28/12

Change in FQHC and RHC Wrap Around Payment

To:​ ​Participating Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC)
​Date: ​December 28, 2012
​Re: Change in FQHC and RHC Wrap Around Payment​

Section 4712 of the federal Balanced Budget Act of 1997 requires that States pay FQHCs/RHCs who contract directly or indirectly with Managed Care Organizations (MCOs) a wrap around payment for providing services to participants assigned to them through the MCO. The wrap around payment is the difference between 100% of reasonable cost and the amount received by the FQHC/RHC under its contract with a MCO.

 

HFS has been paying those FQHCs/RHCs a $12 capitated rate that was calculated based on the difference between the weighted average amount reimbursed by the Department and the average payment by MCOs to FQHCs. HFS has recently been assured by its contracted MCOs that they shall compensate FQHCs/RHCs in a manner that will cover 100% of the FQHC/RHC reasonable costs beginning January 1, 2013. Therefore, after December 31, 2012, HFS will no longer pay the $12 wrap around payment to FQHC/RHCs.

Please work with your contracted MCOs to verify their billing procedures.

Questions regarding this notice may be directed to the Bureau of Managed Care at 217-524-7478.

Theresa A. Eagleson, Administrator

Division of Medical Programs