(Recorded Webinar) Medicaid FQHC PPS Changes in Scope

Duration: 60 minutes

Webinar recorded on: 4/15/2020

The Government’s response to COVID-19 has included a consideration of new approaches through Section 1135 waiver authority and additional funding through the recently enacted Coronavirus Aid, Relief, and Economic Security (“CARES”) Act. However, health centers should not lose sight of a more traditional way to update and adjust their Medicaid per visit rates under the prospective payment system (PPS) methodology. 

That traditional mechanism is adjustment to Medicaid per visit rates to account for changes in scope. Federal law requires States to provide mechanisms to adjust FQHC per visit rates to reflect changes in the scope of services provided by FQHCs during the year in which those changes took place. To the extent the COVID-19 pandemic may have affected a health center’s cost experience and those changes have not been compensated through some other mechanism, it will become important for health centers to familiarize themselves with the Medicaid PPS change in scope process to ensure their cost experience is accurately reflected in their Medicaid per visit rates. 

This webinar will cover the ins and outs of the Medicaid change in scope process under federal law and provide examples of common triggers to changes in scope as well as point out some common pitfalls.   

Target Audience

  • Health center management
  • Finance personnel

Learning Objectives

After this webinar, you will be able to:

  • Understand the federal Medicaid change in scope requirement and where it fits into the overall PPS rate calculation
  • Identify common triggers for changes in scope of services with an emphasis of the types of changes that may have taken place as a result of the COVID-19 pandemic
  • Articulate common risk areas and pitfalls with respect to how various States implement their change in scope methodology
Course summary
Available credit: 
  • 1.00 Certificate of Attendance
Course opens: 
Course expires: 


Kathy is a Partner in the firm's health law practice group. In the area of health law, Kathy’s practice focuses on government-sponsored health care programs such as Medicaid, CHIP, Medicare, and the Affordable Care Act, with an emphasis on payment/reimbursement and compliance related issues. Kathy also represents clients in government investigations and audits, litigation before federal and state courts, as well as in administrative appeals with the U.S. Department of Health and Human Services Departmental Appeals Board (DAB) and Provider Reimbursement Review Board (PRRB). She provides reimbursement counseling (including identification, reporting, and repayment of overpayments) with respect to Medicare, Medicaid, and private third-party payors. [Full Bio]

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Available Credit

  • 1.00 Certificate of Attendance


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