[§346-53.62] 
Federally qualified health centers and rural health clinics; reconciliation of
managed care supplemental payments.  (a)  Federally qualified health
centers or rural health clinics that provide services under a contract with a
medicaid managed care organization shall receive estimated quarterly state
supplemental payments for the cost of furnishing such services that are an
estimate of the difference between the payments the federally qualified health
center or rural health clinic receives from medicaid managed care organizations
and payments the federally qualified health center or rural health clinic would
have received under the Benefits Improvement and Protection Act of 2000
prospective payment system methodology.  Not more than one month following the
beginning of each calendar quarter and based on the receipt of federally
qualified health center or rural health clinic submitted claims during the
prior calendar quarter, federally qualified health centers or rural health
clinics shall receive the difference between the combination of payments the
federally qualified health center or rural health clinic receives from
estimated supplemental quarterly payments and payments received from medicaid
managed care organizations and payments the federally qualified health center
or rural health clinic would have received under the Benefits Improvement and
Protection Act of 2000 prospective payment system methodology.  Balances due
from the federally qualified health center shall be recouped from the next
quarter's estimated supplemental payment.



(b)  The federally qualified health center or
rural health clinic shall file an annual settlement report summarizing patient
encounters within one hundred fifty days following the end of a calendar year
in which supplemental payments are received from the department.  The total
amount of supplemental and medicaid managed care organization payments received
by the federally qualified health center or rural health clinic shall be
reviewed against the amount that the actual number of visits provided under the
federally qualified health center's or rural health clinic's contract with the
medicaid managed care organization would have yielded under the prospective
payment system.  The department shall also receive financial records from the
medicaid managed care organization.  As part of this review, the department may
request additional documentation from the federally qualified health center or
rural health clinic and the medicaid managed care organization to resolve differences
between medicaid managed care organization and provider records.  Upon
conclusion of the review, the department shall calculate a final payment that
is due to or from the participating federally qualified health center or rural
health clinic.  The department shall notify the participating federally
qualified health center or rural health clinic of the balance due to or from
the federally qualified health center or rural health clinic.  The notice of
program reimbursement shall include the department's calculation of the balance
due to or from the federally qualified health center or rural health clinic.



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



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



 



Note



 



  Section effective upon approval of the Hawaii medicaid state
plan 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 to
the contrary, reports for final payment under section [346-53.62], Hawaii
Revised Statutes, for each calendar year shall be filed within one hundred
fifty days from the date the department of human services adopts forms and
issues written instructions for requesting a final payment under that section.



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