Medicaid for FQHCs: The Basics and a Bit Beyond

October 17, 2022

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.

Target Audience

  • Health Center C-Suite (CEO, COO, CFO, Compliance Officer)
  • Health Center Finance Personnel
  • Primary Care Association Personnel

Learning Objectives

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”
Course summary
Available credit: 
  • 5.00 Certificate of Attendance
Course opens: 
10/22/2021
Course expires: 
12/18/2022
Event starts: 
10/17/2022 - 11:00am EDT
Event ends: 
10/17/2022 - 5:30pm EDT
Cost:
$995.00

Agenda

Monday, October 17, 2022
*Agenda times are all ET*
 
Monday, October 17, 2022
11:00 AM - 5:30 PM ET
11:00 am - 11:15 amIntroductions
11:15 am - 12:00 pmMedicaid as a Joint Federal/State Program
  • Sources of Law and Guidance
  • FQHCs in Medicaid: Key Terms and Enrollment
  • Litigation Challenges
12:00 pm - 12:15 pmBreak
12:15 pm - 1:15 pmAn Introduction to the Medicaid PPS/Per Visit Rate
  • Scope of the Medicaid FQHC Benefit
  • Construction of the Base Rate (Examination of a Medicaid Cost Report and Consideration of Allowable Costs)
  • "Visits" 
  • Rate Setting for New Starts
  • Changes in Scope
  • Alternative Payment Methodologies
1:15 pm - 1:45 pmBreak
1:45 pm - 2:45 pmAn Introduction to the Medicaid PPS/Per Visit Rate (cont.)
  • Common Challenges and Areas of Litigation
    • Dual Eligibles
  • A "Bit Beyond" - Behavioral Health and Telehealth
2:45 pm - 3:00 pmBreak
3:00 pm - 4:00 pmFQHC Payment Protections in Managed Care
  • Comparability Requirement
  • Supplemental Payments
  • Common Challenges and Areas of Litigation
  • A "Bit Beyond": FQHCs and Value Based Payments
4:00 pm - 4:15 pmBreak
4:15 pm - 5:00 pmOverpayments and Audits in the Medicaid Program and Typical Areas of Concern
5:00 pm - 5:30 pmQ&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 learning@ftlf.com or 1-855-200-3822.

KATHY GHILADI

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.

ADDITIONAL INFORMATION

  • Prerequisites: None 
  • Target Audience: Health Center C-Suite (CEO, COO, CFO, Compliance Officer), Health Center Finance Personnel, and 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).

Available Credit

  • 5.00 Certificate of Attendance

Price

Cost:
$995.00
Please login or register to take this course.

Group Discounts

Bring your team! Discounts are available for groups of three (3) or more individuals from the same organization. Please contact us to process your registration.

Groups of 3 - 6
Groups of 7 - 10
Groups of 11 - 15
Over 15 attendees
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  • 30 or more days prior to the event, requests for a full refund or a transfer, minus a $75 administrative fee, will be granted.
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