New Medicaid Rural Health Clinic rate methodology approved

Posted on: 10/18/19

The Oklahoma Health Care Authority (OHCA) has received approval from the federal government for a change proposed by the Oklahoma Hospital Association. Oklahoma Rural Health Clinics (RHCs) can now elect to be paid by Medicaid under a new alternative payment methodology (APM). Under the APM, RHCs will receive the same payment rate from Medicaid as has been approved by the Medicare Administrative Contractor for Medicare services at the RHC.

The payment rate change will be backdated to July 1, 2019 for RHCs that submit required information to OHCA by Nov. 15, 2019. Claims will be reprocessed for payment at the new rate.  For RHCs that apply for the APM rate after Nov. 15, the rate change will not be backdated. Unlike Medicare RHC rates, the Medicaid payment rates are final and not subject to cost report settlement.

RHCs electing to be paid under the APM should send a letter agreeing to the APM rate, along with a copy of their Medicare RHC periodic rate notification for a full fiscal year, by e-mail to [email protected], or fax to (405) 530-3477.

To view The OHCA Provider Reimbursement Notice 2019-09 about this change, click here. (Rick Snyder)