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FQHCs say payment rules differ from hospitals and urge clarity if reference‑based pricing expands
Summary
Representatives of federally qualified health centers told a committee that FQHCs are paid under a bundled encounter rate and Section 330 grant support, and asked lawmakers to exempt or explicitly account for FQHC payment rules and federal oversight if reference‑based pricing is extended.
Mary Kate Mollman, director of Vermont Public Policy for the Bi‑State Primary Care Association, told the committee that federally qualified health centers (FQHCs) are “paid differently” than hospitals and operate under federal rules that require special treatment in any statutory price‑setting scheme.
Mollman said Medicare and Medicaid pay FQHCs a bundled prospective payment system (PPS) encounter rate for visits, and noted FQHCs also receive federal Section 330 health center grants that support enabling services (sliding‑fee discounts, transportation, case management). She summarized: “FQHCs qualify for this Section 330 funding ... to help FQHCs operate as that sliding fee schedule that…
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