A New Payment Opportunity for FQHCs
FQHCs will soon have the chance to apply for a new payment opportunity in California. This historic moment comes after approximately two decades of the Prospective Payment System (PPS) being in place. This new opportunity - an alternative payment methodology (APM) - aims to build on the best parts of PPS, while helping FQHCs stabilize payment and leverage more of their care teams to deliver even better patient-centered quality care.
CPCA and health centers have been working towards this new opportunity since 2012. Prompted by the instability created from the COVID-19 pandemic and the urging of CPCA, the state commenced a stakeholder process in 2021 to build the APM. Three CPCA APM Committees and the PPS Payment Modernization Workgroup have met regularly over the last eight months to work through the details. The expectation is that an application for the new payment methodology will be released in 2022 and then the state will select FQHCs to participate. It is completely voluntary for FQHCs to apply and to change their PPS payment to a Per Member Per Month PPS equivalent.
There remain outstanding details on the specifics of the APM, but the principal agreements are that FQHCs are entitled to PPS and will be made whole to PPS no matter what. For many FQHCs, this commitment, plus the flexibility afforded in the new model, will help to stabilize cash flow and position FQHCs for more innovative care delivery models. Over the course of 2022, details and processes will be finalized with input from health centers.
CPCA and the regional consortia are actively working with health centers on APM readiness assessments and there are a litany of other tools and supports already created and will soon be made available to those FQHCs interested in applying. The California Health Care Foundation, who is funding CPCA’s APM policy work, is also supporting the development of an APM Implementation Guide that will be ready in April 2022 for those FQHCs interested in the APM. The guide will provide an array of tools to help FQHCs think through the array of elements and impacts of the APM model.
Health centers interested in learning more are encouraged to explore and utilize the APM Initiative Page. uccessfully addressed.