HCA begins rulemaking for rural health clinic managed care encounter payment

July 26, 2017

The state legislature recently included a proviso in the operating budget bill requiring Medicaid managed care plans to pay rural health clinics (RHCs), upon request, their full encounter rate at the time of service. Currently, RHCs receive a combination of negotiated fee schedule and state-calculated enhancement payment. The proviso has an effective date of January 1, 2018. HCA recently issued a notice of rulemaking.

Due to a lengthy reconciliation process, some clinics have either been underpaid or overpaid for as long as several years under the current mechanism.  While up-front encounter payment is not expected to eliminate the need for reconciliation, it may significantly reduce the amounts of any overpayments or underpayments going forward. A separate budget proviso instructs the HCA to submit a report to the governor and appropriate committees of the legislature potential administrative or legislative options to reduce or eliminate existing amounts owing from the reconciliation process. (Andrew Busz, andrewb@wsha.org)


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