Substitute Bill No. 5456 proposes amendments to the reimbursement and regulatory processes for federally qualified health centers (FQHCs). The bill removes the restriction that prevented FQHCs from billing for separate encounters for nonemergency periodic dental services provided on different dates, allowing for more flexible billing practices. It also establishes that FQHCs will be reimbursed based on an all-inclusive encounter rate per client encounter, as per the prospective payment system mandated by federal law. The bill requires the Department of Social Services to rebase each FQHC's encounter rates by December 31, 2024, based on the center's costs and patient encounters in fiscal year 2023, with the condition that the new rate must not be less than the rate received before rebasing and must not affect any annual inflationary rate adjustment. Additionally, the bill outlines a process for FQHCs to request rate adjustments due to increases in the scope of services, including a 30-day review period for the department to assess additional costs.

The bill further details the procedures for FQHCs to follow when there is a change in the scope of services they provide. For increases in services, FQHCs must submit an amended scope of project to the department, which then has 30 days to decide on a rate adjustment. Factors such as profitability and receipt of other funds are not to be considered in the rate review, and FQHCs can appeal the department's decision. For decreases in services, FQHCs must notify the department within 30 days and may face civil penalties for noncompliance. Procedural updates include changes in the reference from subsection (f) to (e), the requirement for the Commissioner of Social Services to post notice of intent to adopt regulations on the eRegulations System, and the mandate that policies and regulations comply with state and federal law. The bill also ensures that Medicaid reimbursement rates for FQHCs will increase annually by the most recent increase in the Medicare Economic Index starting July 1, 2024.

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Raised Bill:
HS Joint Favorable Substitute Change of Reference: