On September 17, 2021, the U.S. Departments of Health and Human Services and Treasury finalized the 2022 Notice of Benefit and Payment Parameters (NBPP) rule and announced a significant expansion of their oversight of health plans’ provider networks. This expert perspective reviews provisions of the rule of particular import to the state-based marketplaces (SBMs) and state insurance regulators.
Implementing State Payment Reform Strategies at Federally Qualified Health Centers (FQHCs)
Beth Waldman and Mary Beth Dyer, Bailit Health Purchasing, LLC and James Waldinger, Public Consulting Group
Federally Qualified Health Centers (FQHCs) traditionally provide health care services primarily to low-income individuals who are covered by Medicaid or who are uninsured. As state Medicaid programs increase their focus on value-based payment, it is important to consider how FQHCs may participate in payment reform strategies. Through their focus on improved health outcomes, patient satisfaction, and access to appropriate care, alternative payment methodologies (APMs) can benefit FQHCs, the state purchaser, and most importantly Medicaid beneficiaries. This brief describes a number of state-level payment reform strategies that include FQHCs and offers strategies and considerations for states and FQHCs alike.