COVID-19 Information on Medicaid Coverage for Federal Qualified Health Centers
The Department has made available reimbursement and guidance for telehealth Behavioral Health and Medical services. Please visit the HUSKY Health Provider Bulletin webpage for information on telehealth services and billing. Please note that all covered telehealth services provided by an FQHC are paid at the same encounter rate referenced in the state plan that would be paid to the FQHC for comparable in-person services.
Due to the COVID-19 public health emergency, most Connecticut FQHCs have indicated they have closed or will close dental services based on national guidance from the American Dental Association (ADA). Connecticut Office of Policy and Management (OPM) has approved the monthly issuance of interim dental payments for the second quarter of 2020 as needed.
- The first interim payment will be pushed directly to FQHCs as an EFT under the Medicaid Dental Provider ID the week of April 6th. Payments will be reported on the provider's remittance advice. Amounts will be based on dental visits during a 6-month period between October 2019 to March 2020.
- Since it is impossible to predict the length of the public health emergency, the Department will continue to monitor dental billing volume for decreases and, if appropriate, will issue interim payment in the first week of May and June. If the crisis goes beyond 6/30/2020, the Department will revisit the situation and may request additional documentation outlining financial supports needed from each FQHC.
- It is anticipated there will be a 6-month recoupment of the interim payments beginning 10/1/2020. Again, if the current public health crisis goes beyond this time period, the Department will revisit the timing of the recoupment period.
Additional detail will be forthcoming as the Department works to clarify details and incoming information. Please visit this webpage for the most up-to-date information.
General FQHC Information
Federally Qualified Health Centers (FQHC) are health centers that receive Public Health Service (PHS) Act, Section 330 funds, and provide primary care services in underserved, urban and rural communities. FQHC is a federal designation from the U.S. Dept. of Health & Human Services, Health Resources & Services Administration (HRSA), Bureau of Primary Health Care (BPHC), and the Center for Medicare and Medicaid Services (CMS) that is assigned to private non-profit or public health care organizations that serve predominantly uninsured or medically underserved populations.
The primary purpose of Federally Qualified Health Centers is to expand access to primary health care for uninsured and under served populations, who experience financial, geographic or cultural barriers to care and who live in or near federally designated health professional shortage areas (HPSAs) and medically under-served areas (MUAs).
There are five essential elements which differentiate FQHCs from other health care providers.
- Be located in a federally designated medically underserved area (MUA) or serve a federally designated medically underserved population (MUP);
- Provide comprehensive primary care services, referrals, and other services needed to facilitate access to care, such as case management, translation, and transportation;
- Provide services to all in the service area regardless of ability to pay and offer a sliding fee schedule that adjusts according to income.
- Have nonprofit, public, or tax exempt status;
- Have a governing board, the majority of whose members are patients of the health center.
FQHC clinical services requirements include:
- Patients must have access to all required services, access to specialty and hospital services, and after-hours coverage.
- The location must be physically located on or near a major road or public transportation stop to ensure accessibility.
- Hours of operation must facilitate access to care by having early morning, evening or weekend hours.
- Ensure the appropriate mix of services for the target population to minimize duplication of services and maximize financial resources.
- Should have written agreements with other service providers for those required services not directly provided by health center.
- FQHC must establish and update health care goals and objectives to address the highest priority of health care needs of patients.
- Have a Medical Director that supervises all clinical activities and medical doctors that are licensed and residency trained. Other clinicians must have appropriate licensure.