2006 proposed fee schedule - American Society of Clinical Oncology

of a regional MA plan option. Regional MA plans must be
preferred provider organization (PPO) plans.
Section 237 of the MMA amended section 1833(a)(3) of
282
Act to provide supplemental payments to FQHCs that contract
with MA organizations to, in general, cover the difference,
if any, between the payment received by the health center
for treating enrollees in MA plans offered by the MA
organization and the payment that the FQHC is entitled to
receive under the cost-based all-inclusive payment rate as
set forth in part 405, subpart X. This new supplemental
payment for covered Medicare FQHC services furnished to MA
enrollees augments the direct payments made by MA Plans to
FQHCs for covered Medicare FQHC services. Medicare’s
obligation to provide supplemental payments to FQHCs applies
to centers with direct or indirect subcontract arrangements
following a written agreement with MA organizations.
Centers eligible for supplemental payments under
section 1833(a)(3) of the Act, as revised by Section 237 of
the MMA, include any facility qualified to furnish FQHC
services described in section 1832(a)(2)(D) of the Act.
Only the following entities are qualified to furnish FQHC
services: (1) entities receiving a grant under section 330
(other than subsection (h)) of Public Health Services Act or
receiving funding from this grant under a contract with its
recipient and meets the requirements to receive this grant;