5101:3-28-01 Federally qualified health centers (FQHCs): eligibility and enrollment as a medicaid provider.

(A) A federally qualified health center (FQHC)is:

(1) An entity that has entered into an agreement with the centers for medicare and medicaid services (CMS) to meet medicare program requirements and is receiving a grant under section 330 of the Public Health Service Act or is receiving funding from such a grant under a contract with the recipient of such a grant and meets the requirements to receive a grant under section 330 of the Public Health Service Act.; or

(2) An FQHC look-alike, based on the recommendation of the public health service, determined by CMS to meet all the eligibility requirements of an entity to receive a grant under section 330 of the Public Health Service Act, but does not receive grant funding.

(B) An FQHC, as determined in accordance with paragraph (A)(1) of this rule, must submit to the department appropriate documentation that each service site provides services in accordance with the provisions of section 330 of the Public Health Services Act. Appropriate documentation is any documentation from the health resources and services administration (HRSA) that identifies the specific service site(s) included in the 330 public health services project.

(C) An FQHC, as determined in accordance with paragraph (A)(2) of this rule, must submit to the department a copy of the U.S. secretary of health and human services confirmation letter that the service site(s) meet(s) the requirements for receiving a grant under section 330 of the Public Health Service Act and will be considered an FQHC look-alike with respect to medicaid coverage and payment.

(D) An FQHC, as defined in accordance with paragraph (A)(1) of this rule, will be reimbursed as an FQHC in accordance with Chapter 5101:3-28 of the Administrative Code. An FQHC, as defined in accordance with paragraph (A)(2) of this rule, will be reimbursed as an FQHC for services provided on and after the date the U.S. secretary of health and human services approval is received by the department.

(E) Providers may be enrolled as only one type of alternative payment clinic. An "alternative payment clinic" shall be defined as an FQHC, rural health clinic (RHC), or outpatient health facility (OHF).

Effective: 07/01/2006
R.C. 119.032 review dates: 03/09/2006 and 07/01/2011
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 5111.021
Prior Effective Dates: 4/10/91, 3/1/02