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In 2008, Medicaid payments had grown to account for 37% of all CHC revenues. [4] In 1989, Congress created the Federally Qualified Health Center (FQHC) program, which established a preferential payment policy for health centers by requiring "cost-based" reimbursement for both Medicaid and Medicare. [1]
A Federally Qualified Health Center (FQHC) is a community-based health care organization that provides comprehensive primary care and support services to underserved populations in the United States. These centers serve patients regardless of immigration status, insurance coverage, or ability to pay.
In 2000, CMS changed the reimbursement system for outpatient care at Federally Qualified Health Centers (FQHCs) to include a prospective payment system for Medicaid and Medicare. [2] Under this system, health centers receive a fixed, per-visit payment for any visit by a patient with Medicaid, regardless of the length or intensity of the visit.
Rural Health Centers are public, private, or non-profit health centers that provide primary care to Medicaid and Medicare populations in rural areas. RHC status is designated by the Centers for Medicare and Medicaid Services, providing enhanced reimbursements rates for services. A health center cannot be both an RHC and a FQHC.
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards.
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The Center for Medicare and Medicaid Innovation (CMMI; also known as the CMS Innovation Center) is an organization of the United States government under the Centers for Medicare and Medicaid Services (CMS). [1] It was created by the Patient Protection and Affordable Care Act, the 2010 U.S. health care reform legislation.