Medicare final rule to give clinics billion-dollar pay bump

Medicare will increase payments to federally qualified health centers (FQHC) by as much as 32 percent under a new payment system in the Affordable Care Act. That's 2 percent higher than what the Centers for Medicare & Medicaid Services initially proposed in September 2013.

To encourage comprehensive and integrated care, the new system would pay the roughly 3,830 nonprofit community health clinics a single encounter-based rate of about $155 per patient for all services provided. The average cost per visit will vary depending on geographic differences and new patient visits, according to the final rule issued by CMS.

The Medicare pay bump would total $170 million in 2015, and would reach a combined $1.26 billion over the next five years.

"These FQHCs are essential to countless patients in local communities who depend on them for getting their primary and preventive care," CMS Administrator Marilyn Tavenner said yesterday in a statement.

The final rule will be published in the Federal Register on May 2, 2014. Until then, CMS is looking for comments on creating Medicare-specific payment codes for encounter-based fees, as well as how to adjust payment for chronic care management services, the agency said.

While community health clinics soon will see higher reimbursement from Medicare, they could lose out on Medicaid dollars due to the private expansion. The private option allows states to pay private payers to insure the expanded Medicaid population, and private insurers pay the clinics far less than the Medicaid program does directly, FierceHealthFinance previously reported.

For more:
- here's the final rule (.pdf) and statement