Medicaid for FQHCs: The Basics and a Bit Beyond
The Medicaid program is the largest source of insurance coverage for low-income and disabled people in the country, and health centers (both Section 330 grantees and look-alikes) play an important role in providing primary and preventive care to Medicaid-covered individuals.
This workshop will provide health centers with an understanding of their enrollment and participation in the Medicaid program together with the associated rights and obligations. The training will further help FQHCs understand their Medicaid per visit rate, whether that rate is derived from a prospective payment system (“PPS”) methodology or alternative payment methodology (“APM”). Knowing how that rate is calculated and what that rate covers is important for health centers as they seek to add or modify their Medicaid-covered services. The workshop will discuss significant legal protections that apply to the payment of a health center’s per visit rate under federal law.
Additionally, the presenters will cover important aspects of the Medicaid program, including Medicaid enrollment requirements, audits, and overpayments. Services or modalities that pose particular challenges for health centers, such as dual eligibles, behavioral health, telehealth, and value-based payments, will be considered.
Attendees will gain the foundational information they need to understand the rights and responsibilities of FQHCs in the Medicaid program and a framework that will arm them with the tools they need to spot issues and address challenges as they arise.
- Health Center C-Suite (CEO, COO, CFO, Compliance Officer)
- Health Center Finance Personnel
- Primary Care Association Personnel
After this training, you will be able to:
- Identify the special FQHC payment protections in Medicaid and articulate their rationale
- Understand how Medicaid FQHC per visit rates should be calculated under federal law
- Develop a familiarity with particular modalities or service types that may pose challenges or are novel to FQHCs in the Medicaid program in order to issue spot and be able to take a “deeper dive”
Tuesday, March 28, 2023
11:00 a.m–5:30 p.m. ET
|11:00 a.m.–11:15 a.m.||Introductions|
|11:15 a.m.–12:00 p.m.||Medicaid as a Joint Federal/State Program|
|12:00 p.m.–12:15 p.m.||Break|
|12:15 p.m.–1:15 p.m.||An Introduction to the Medicaid PPS/Per Visit Rate|
|1:15 p.m.–1:45 p.m.||Break|
|1:45 p.m.–2:45 p.m.||An Introduction to the Medicaid PPS/Per Visit Rate (cont.)|
|2:45 p.m.–3:00 p.m.||Break|
|3:00 p.m.–4:00 p.m.||FQHC Payment Protections in Managed Care|
|4:00 p.m.–4:15 p.m.||Break|
|4:15 p.m.–5:00 p.m.||Overpayments and Audits in the Medicaid Program and Typical Areas of Concern|
|5:00 p.m.–5:30 p.m.||Q&A and Wrap Up|
FTLF'S VIRTUAL CLASSROOM
This live, interactive training will take place in FTLF's Virtual Classroom, hosted by Zoom. Should you have any technical questions or would like more information, please contact us at email@example.com or 1-855-200-3822.
Kathy is a Partner in Feldesman Tucker’s health law practice group. In the area of health law, Kathy’s practice focuses on government-sponsored health care programs such as Medicaid, CHIP, Medicare, and the Affordable Care Act, with an emphasis on payment/reimbursement and compliance related issues. Kathy also represents clients in government investigations and audits, litigation before federal and state courts, as well as in administrative appeals with the U.S. Department of Health and Human Services Departmental Appeals Board (DAB) and Provider Reimbursement Review Board (PRRB). She provides reimbursement counseling (including identification, reporting, and repayment of overpayments) with respect to Medicare, Medicaid, and private third-party payors. [Full Bio]
SUSANNAH VANCE GOPALAN
Susannah is a Partner in the firm’s health law practice group where she focuses on health care litigation and regulatory counseling, with a focus on Medicaid and Medicare payment, financing, and compliance issues. Susannah brings regulatory expertise to bear when advising clients and pursuing litigation on their behalf. She has experience negotiating Medicaid waivers and managed care arrangements on behalf of providers, provider associations, and governmental entities. She represented a group of providers in reaching a settlement in major Medicaid litigation. [Full Bio]
Participants can earn up to 5.40 CPE credits in Specialized Knowledge and Applications upon completion of all course requirements.
- Prerequisites: None
- Target Audience: Health Center C-Suite (CEO, COO, CFO, Compliance Officer), Health Center Finance Personnel, Primary Care Association Personnel
- Advanced Preparation: None
- Program Level: All
- Delivery Method: Group Internet Based
Feldesman Tucker Leifer Fidell LLP is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website www.nasbaregistry.org (formerly www.learningmarket.org).
- 5.00 Certificate of Attendance
- 5.40 CPEFTLF is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors.
TRAINING IS NOT RECORDED
This training will not be recorded for later viewing, as we would like attendees to be comfortable and candid, sharing their experiences and asking scenario-based questions. The discourse between the attorneys and participants is a valued part of each training.
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