[§346-53.62] Federally qualified health centers and rural health clinics; reconciliation ofmanaged care supplemental payments.  (a)  Federally qualified healthcenters or rural health clinics that provide services under a contract with amedicaid managed care organization shall receive estimated quarterly statesupplemental payments for the cost of furnishing such services that are anestimate of the difference between the payments the federally qualified healthcenter or rural health clinic receives from medicaid managed care organizationsand payments the federally qualified health center or rural health clinic wouldhave received under the Benefits Improvement and Protection Act of 2000prospective payment system methodology.  Not more than one month following thebeginning of each calendar quarter and based on the receipt of federallyqualified health center or rural health clinic submitted claims during theprior calendar quarter, federally qualified health centers or rural healthclinics shall receive the difference between the combination of payments thefederally qualified health center or rural health clinic receives fromestimated supplemental quarterly payments and payments received from medicaidmanaged care organizations and payments the federally qualified health centeror rural health clinic would have received under the Benefits Improvement andProtection Act of 2000 prospective payment system methodology.  Balances duefrom the federally qualified health center shall be recouped from the nextquarter's estimated supplemental payment.

(b)  The federally qualified health center orrural health clinic shall file an annual settlement report summarizing patientencounters within one hundred fifty days following the end of a calendar yearin which supplemental payments are received from the department.  The totalamount of supplemental and medicaid managed care organization payments receivedby the federally qualified health center or rural health clinic shall bereviewed against the amount that the actual number of visits provided under thefederally qualified health center's or rural health clinic's contract with themedicaid managed care organization would have yielded under the prospectivepayment system.  The department shall also receive financial records from themedicaid managed care organization.  As part of this review, the department mayrequest additional documentation from the federally qualified health center orrural health clinic and the medicaid managed care organization to resolve differencesbetween medicaid managed care organization and provider records.  Uponconclusion of the review, the department shall calculate a final payment thatis due to or from the participating federally qualified health center or ruralhealth clinic.  The department shall notify the participating federallyqualified health center or rural health clinic of the balance due to or fromthe federally qualified health center or rural health clinic.  The notice ofprogram reimbursement shall include the department's calculation of the balancedue to or from the federally qualified health center or rural health clinic.

(c)  For thepurposes of this section, the payments received from medicaid managed careorganizations exclude payments for non-prospective payment system services,managed care risk pool accruals, distributions, or losses, or anypay-for-performance bonuses or other forms of incentive payments such asquality improvement recognition grants and awards.

(d)  An alternative supplemental managed care paymentmethodology other than the one set forth herein may be implemented as long asthe alternative payment methodology is consented to in writing by the federallyqualified health center or rural health clinic to which the methodologyapplies. [L Sp 2008, c 8, pt of §2]

 

Note

 

  Section effective upon approval of the Hawaii medicaid stateplan by the Centers for Medicare and Medicaid Services. L Sp 2008, c 8, §9.

  L Sp 2008, c 8, §3 provides:

  "SECTION 3.  (a)  Notwithstanding any law tothe contrary, reports for final payment under section [346-53.62], HawaiiRevised Statutes, for each calendar year shall be filed within one hundredfifty days from the date the department of human services adopts forms andissues written instructions for requesting a final payment under that section.

(b)  All payments owed by the department of human servicesshall be made on a timely basis."