Hawaii Administrative Rules
Title 17 - DEPARTMENT OF HUMAN SERVICES
Department of Human Services
Chapter 1740.1 - REIMBURSEMENT OF FEDERALLY QUALIFIED HEALTH CENTERS AND RURAL HEALTH CLINICS
Section 17-1740.1-10 - Supplemental managed care payments under PPS methodology

FQHCs or RHCs that provide services under a contract with a Medicaid managed care entity (MCE) will receive quarterly state supplemental payments for the cost of furnishing such services that are an estimate of the difference between the payments the FQHC or RHC receives from MCE(s) (excluding managed care risk pool accruals, distributions or losses) and payments the FQHC or RHC would have received under the BIPA PPS methodology. At the end of each calendar year, the total amount of supplemental and MCE payments received, excluding managed care risk pool accruals or distributions, by the FQHC or RHC will be reviewed against the amount that the actual number of visits provided under the FQHCs or RHCs contract with the MCE(s) would have yielded under PPS. The FQHC or RHC will be paid the difference between the PPS amount calculated using the actual number of visits, and total amount of supplemental and MCE payments received by the FQHC or RHC, if the PPS amount exceeds the total amount of supplemental and MCE payments. The FQHC or RHC will refund the difference between the PPS amount calculated using the actual number of visits, and the total amount of supplemental and MCE payments received by the FQHC or RHC, if the PPS amount is less than the total amount of supplement and MCE payments.