CHCF Publication on Post-Pandemic Federally Qualified Health Center Telehealth Reimbursement

California Health Care Foundation recently released a piece titled “Reimbursing FQHCs for Telehealth Post-COVID-19 Pandemic: Medi-Cal’s Options”. The publication addresses needs to continue to support the much-needed telehealth services that have been spearheaded by FQHCs in response to COVID-19. Rafael A. Gomez, Pacific Health Consulting Group, mapped out recommendations including:

  • Exploring prospective payment system (PPS) options;
  • Defining an alternate payment methodology (APM) to experiment with alternatives to the PPS payment structure; and
  • “Carving out” a service from the FQHC PPS so that payments for that service are calculated and made separately from the global rate.

Gomez suggests a carve-out approach may be most appropriate for non-visit services, such as remote patient monitoring or provider-to-provider e-consult.