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FEDERALLY QUALIFIEDHEALTH CENTERSPROVIDER MANUALChapter Twenty‐two of the Medicaid Services ManualIssued December 1, 2010Claims/authorizations for dates of service on or after October 1, 2015must use the applicable ICD‐10 diagnosis code that reflects the policyintent. References in this manual to ICD‐9 diagnosis codes only apply toclaims/authorizations with dates of service prior to October 1, 2015.State of LouisianaBureau of Health Services Financing
LOUISIANA MEDICAID PROGRAMISSUED:07/14/20REPLACED:06/01/19CHAPTER 22: FEDERALLY QUALIFIED HEALTH CENTERSSECTION: TABLE OF CONTENTSPAGE(S) 3FEDERALLY QUALIFIED HEALTH CENTERSTABLE OF CONTENTSSUBJECTSECTIONOVERVIEWSECTION 22.0COVERED SERVICESSECTION 22.1Physician ServicesServices and Supplies Incident to a Physician’s Professional ServicesPhysician Assistant ServicesNurse Practitioner and Nurse Midwife ServicesServices and Supplies Incident to Physician Assistant, Nurse Practitioner and NurseMidwife ServicesVisiting Nurse Services to the HomeboundPlan of TreatmentClinical PsychologistClinical Social Worker ServicesServices and Supplies Incident to the Services of Clinical Psychologists andClinical Social WorkersOther Ambulatory ServicesDiabetes Self-Management TrainingFluoride Varnish ApplicationsServices Not CoveredEncounterMultiple Same Day VisitsService LimitsExclusionsService DeliveryPROVIDER REQUIREMENTSSECTION 22.2LocationShortage Area DesignationStaffingMedicaid Enrollment CriteriaPage 1 of 3Table of Contents
LOUISIANA MEDICAID PROGRAMISSUED:07/14/20REPLACED:06/01/19CHAPTER 22: FEDERALLY QUALIFIED HEALTH CENTERSSECTION: TABLE OF CONTENTSPAGE(S) 3ServicesBillingDiabetes Self-Management TrainingSatellite ClinicsMobile ClinicsOut of State FQHCs in Trade AreasChangesChange in OwnershipCost ReportsRECORD KEEPINGSECTION 22.3Record Maintenance and AvailabilityProtection of Record InformationAdequacy of RecordsRetention of RecordsREIMBURSEMENTSECTION 22.4RatesDetermination of RateAdjustment of RateOut of State/Trade Area FQHCNotice of Rate SettingAppealsCost Report SubmissionAuditsEncounter VisitsPayment for Adjunct ServicesServices with Alternative Payment MethodologyLong Acting Reversible ContraceptivesEncounter Billing GuidelinesMedical EncountersBehavioral Health Encounters/Psychiatric ServicesPhysicians with a Psychiatric SpecialtyNurse Practitioners or Clinical Nurse Specialists with a PsychiatricSpecialtyLicensed Clinical Social WorkersClinical PsychologistPage 2 of 3Table of Contents
LOUISIANA MEDICAID PROGRAMISSUED:07/14/20REPLACED:06/01/19CHAPTER 22: FEDERALLY QUALIFIED HEALTH CENTERSSECTION: TABLE OF CONTENTSPAGE(S) 3Dental EncountersAdjunct ServicesEarly and Periodic Screening, Diagnosis and Treatment (EPSDT) ScreeningServicesMedicare/Medicaid Dual Eligible BillingOutpatient ServicesInpatient ServicesCONTACT INFORMATIONAPPENDIX AFORMS AND LINKSAPPENDIX BGLOSSARYAPPENDIX CCLAIMS RELATED INFORMATIONAPPENDIX DFQHC SERVICES FACILITY SURVEYAPPENDIX EFQHC Behavioral Health Services ExamplesAPPENDIX FPage 3 of 3Table of Contents
LOUISIANA MEDICAID PROGRAMISSUED:03/10/22REPLACED:07/14/20CHAPTER 22: FEDERALLY QUALIFIED HEALTH CENTERSSECTION 22.0: OVERVIEWPAGE(S) 2OVERVIEWThe Social Security Act §1905(l)(2)(B) defines a Federally Qualified Health Centers (FQHC) forMedicaid purposes as an entity which:1.Is receiving a grant under Section 330 of the Public Health Service (PHS) Act;2.Is receiving funding from such grant under a contract with the beneficiary of sucha grant;3.Meets the requirements to receive a grant under 330 of such Act;4.Based on the recommendation of the Health Resources and Services Administrationwithin the Public Health Service, is determined by the Secretary to meet therequirements for receiving such a grant including requirements of the Secretary thatan entity may not be owned, controlled or operated by another entity; or5.Was treated by the Secretary, for the purposes of Part B of Title XVIII, as acomprehensive Federally funded health center as of January 1, 1990; and includesan outpatient health program or facility operated by a tribe or tribal organizationunder the Indian Self-Determination Act (Public Law 93-638) or by an urban Indianorganization receiving funds under Title V of the Indian Health Care ImprovementAct for the provision of primary health services.FQHCs must be located to make services accessible to residents of a designated MedicallyUnderserved Area (MUA) or Medically Underserved Population (MUP). Location in a HealthProfessional Shortage Area or government designated shortage area does not meet the shortagearea requirements for the FQHC program. FQHC look-alikes may serve a whole or partialMUA/MUP so long as it demonstrates that it serves the neediest population in the service area oraddresses gaps in services and or health disparities.An FQHC provider must be a non-profit organization. All FQHC services provided by qualifiedindividuals employed by or under contract with an FQHC are billed using the organization’sprovider number (e.g., FQHC’s National Provider Identifier (NPI), FQHC’s Medicaid ID numberfor each location) and Tax Identification Number (TIN).The purpose of this chapter is to set forth the conditions and requirements that FQHCs must meetin order to qualify for reimbursement under the Louisiana Medicaid program. The manual chapteris intended to make available to Medicaid providers of FQHC services a ready reference forinformation and procedural material needed for the prompt and accurate filing of claims forservices furnished to Medicaid beneficiaries. The Louisiana Department of Health (LDH), BureauOverviewPage 1 of 2Section 22.0
LOUISIANA MEDICAID PROGRAMISSUED:03/10/22REPLACED:07/14/20CHAPTER 22: FEDERALLY QUALIFIED HEALTH CENTERSSECTION 22.0: OVERVIEWPAGE(S) 2of Health Services Financing (BHSF) is responsible for assuring provider compliance with theseregulations.OverviewPage 2 of 2Section 22.0
LOUISIANA MEDICAID PROGRAMISSUED:03/10/22REPLACED:09/27/21CHAPTER 22: FEDERALLY QUALIFIED HEALTH CENTERSSECTION 22.1: COVERED SERVICESPAGE(S) 12COVERED SERVICESA Federally Qualified Health Center (FQHC) agrees to provide those primary care servicestypically included as part of a physician’s medical practice. Services and supplies that are furnishedby FQHC staff and are incident to the FQHC professional service are considered part of the FQHCservice. An FQHC can also provide services related to the diagnosis and treatment of mentalillness, and, in certain instances, visiting nurse services.The following FQHC reimbursable services are referred to as core services:1.Physician services;2.Services and supplies incident to physician’s services;3.Physician assistant services;4.Nurse practitioners and certified nurse mid-wife services;5.Services and supplies incident to the services of nurse practitioners, physicianassistants, and certified nurse mid-wives;6.Visiting nurse services to the homebound;7.Clinical psychologist services;8.Clinical social worker services; and9.Services and supplies incident to the services of clinical psychologists and clinicalsocial workers.NOTE: For reimbursement purposes, a service visit must be provided in order for a provider tobe paid a Prospective Payment System (PPS) rate. (See Section 22.4 for more information aboutreimbursement).Physician ServicesPhysician services are the professional services performed by a licensed physician for a beneficiaryincluding diagnosis, therapy, surgery, and consultation.Physician services are covered if they are professional services performed by a licensed physicianat the center, or performed away from the center if the physician has an agreement with the centerCovered ServicesPage 1 of 12Section 22.1
LOUISIANA MEDICAID PROGRAMISSUED:03/10/22REPLACED:09/27/21CHAPTER 22: FEDERALLY QUALIFIED HEALTH CENTERSSECTION 22.1: COVERED SERVICESPAGE(S) 12to be paid for the services. The services must be within the scope of his/her profession underLouisiana law.Services and Supplies Incident to a Physician’s ServicesServices and supplies incident to a licensed physician’s professional service are covered if theservice or supply is furnished:1.In a physician’s office;2.Either without charge or included in the center’s bill;3.As an incidental, although integral, part of a physician’s professional services;4.Under the direct, personal supervision of a physician; and5.By a member of the center’s health care staff who is an employee of the center.Only drugs and biologicals that cannot be self-administered are included within the scope of thisbenefit.Physician Assistant ServicesA physician assistant (PA) is eligible to enroll in Medicaid and must obtain a provider number anduse it on the billing form when performing services or prescribing drugs. PA services are covered if:1.Furnished by a licensed PA who is employed by or receives compensation from thecenter and is enrolled in the Louisiana Medicaid Program;2.Identified by placing his/her provider number in the attending licensed physicianspace on the CMS 1500;3.Furnished under the medical supervision of a licensed physician. The licensedphysician supervision requirements are met if the conditions specified and anypertinent requirements of state law are satisfied;4.Furnished in accordance with medical orders for the care and treatment of abeneficiary prepared by a licensed physician;5.Consistent with the type of service the PA is legally permitted to perform; and6.Services are covered by Medicaid.Covered ServicesPage 2 of 12Section 22.1
LOUISIANA MEDICAID PROGRAMISSUED:03/10/22REPLACED:09/27/21CHAPTER 22: FEDERALLY QUALIFIED HEALTH CENTERSSECTION 22.1: COVERED SERVICESPAGE(S) 12Nurse Practitioner and Certified Nurse Mid-wife ServicesServices are covered if:1.Furnished by a licensed nurse practitioner or certified nurse mid-wife who isemployed by or receiving compensation from the center;2.Enrolled in Louisiana Medicaid;3.Identified by placing his/her provider number in the attending physician space onthe CMS 1500;4.Furnished in collaborative practice with a physician. The physician supervisionrequirement is met if the conditions specified and any pertinent requirements ofState law are satisfied;5.Furnished in accordance with any medical orders for the care and treatment of abeneficiary prepared by a licensed physician;6.Performed by a licensed nurse practitioner or certified nurse mid-wife, who islegally permitted to provide this type of service; and7.Services are covered by Medicaid.Nurse practitioners and certified nurse mid-wives are eligible to enroll in Medicaid and must obtaina provider number and use it on the billing form when performing services or prescribing medications.Services and Supplies Incident to Physician Assistant, Nurse Practitioner and NurseMid-wife ServicesServices and supplies incident to a nurse practitioner, nurse mid-wife or physician assistantservices are covered if:1.Furnished in a licensed medical provider’s office;2.Rendered either without charge or included in the center’s bill;3.Furnished as an incidental, although integral part of professional services furnishedby nurse practitioner, PA or certified nurse mid-wife;Covered ServicesPage 3 of 12Section 22.1
LOUISIANA MEDICAID PROGRAMISSUED:03/10/22REPLACED:09/27/21CHAPTER 22: FEDERALLY QUALIFIED HEALTH CENTERSSECTION 22.1: COVERED SERVICESPAGE(S) 124.Furnished under his/her direct, personal supervision. The direct personalsupervision requirement is met only if the person is permitted to supervise theseservices under the written policies governing the center; and5.Furnished by a member of the center’s health care staff who is an employee of thecenter.Only drugs and biologicals that cannot be self-administered are included within the scope of thisbenefit.Visiting Nurse Services to the HomeboundPart time or intermittent visiting nurse care and related supplies are covered if:1.The center is located in an area designated by CMS as a home health agency shortagearea;2.The services are rendered to a homebound individual. For purposes of visiting nurseservices, “homebound” means a Medicaid beneficiary who is permanently ortemporarily confined to his or her place of residence because of a medical or healthcondition. The individual may be considered homebound if he or she leaves the placeof residence infrequently. For this purpose, “place of residence” does not include ahospital or skilled nursing facility;3.The services are furnished by a licensed registered nurse or licensed practical nurse ora licensed vocational nurse, who is employed by or received compensation for theservices from the center; and4.The services are furnished under a written plan of treatment.Plan of TreatmentThe plan of treatment must be established and reviewed at least every 60 days by a supervisingphysician of the center or established by a physician, nurse practitioner, physician assistant or certifiednurse mid-wife, or specialized nurse practitioner and reviewed and approved at least every 60 daysby a supervising physician. The plan must be signed by the nurse practitioner, physician assistant,certified nurse mid-wife or the supervising physician of the center.The plan of treatment must relate visiting nurse services to the beneficiary’s condition. The plan mustspecify the following:Covered ServicesPage 4 of 12Section 22.1
LOUISIANA MEDICAID PROGRAMISSUED:03/10/22REPLACED:09/27/21CHAPTER 22: FEDERALLY QUALIFIED HEALTH CENTERSSECTION 22.1: COVERED SERVICESPAGE(S) 121.Types of services required and prognosis for changes in the beneficiary’s condition;2.Diagnosis and a description of the beneficiary’s functional limitations resulting fromthe illness or injury;3.Type and frequency of nursing services needed;4.Special diets;5.Activities permitted;6.Rehabilitation and therapy services;7.Medical social services;8.Home health aide services; and9.Necessary medical supplies.All changes in orders for controlled substance drugs must be signed by the physician.Clinical PsychologistClinical psychologist services refer to services performed by a licensed clinical psychologist fordiagnosis and treatment of mental illness which the clinical psychologist is legally authorized toperform under State licensure as would otherwise be covered if furnished by a licensed physicianor as an incident to a physician’s services.Clinical Social Worker ServicesClinical social worker services refer to services performed by a licensed clinical social worker fordiagnosis and treatment of mental illness which the clinical social worker is legally authorized toperform under state licensure and such services as would otherwise be covered if furnished by aphysician or as an incident to a physician ‘s professional service.Covered ServicesPage 5 of 12Section 22.1
LOUISIANA MEDICAID PROGRAMISSUED:03/10/22REPLACED:09/27/21CHAPTER 22: FEDERALLY QUALIFIED HEALTH CENTERSSECTION 22.1: COVERED SERVICESPAGE(S) 12Services and Supplies Incident to the Services of Clinical Psychologists and ClinicalSocial WorkersServices are covered if furnished as follows:1.In a physician’s office;2.Either without charge or included in the center’s bill;3.As an incidental, although integral part of professional services furnished by aClinical Psychologist or Clinical Social Worker;4.Under his/her direct, personal supervision. The direct personal supervisionrequirement is met only if the person is permitted to supervise these services underthe written policies governing the center; and5.By a member of the center’s health care staff who is an employee of the center.Only drugs and biologicals that cannot be self-administered are included within the scope of thisbenefit.Other Ambulatory ServicesFQHCs may provide other non-primary care ambulatory services covered by the LouisianaMedicaid State plan that are not included in the listing of FQHC services. These other ambulatoryservices may be provided by the FQHC if the FQHC meets the same standards as other enrolledproviders of those services. Examples include:1.Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services forbeneficiary’s under the age of 21;2.Vision care services (for beneficiaries under the age of 21);3.Speech and language services (for beneficiaries under the age of 21);4.Hearing services (for beneficiaries under the age of 21);5.Dental services;6.Podiatry services;Covered ServicesPage 6 of 12Section 22.1
LOUISIANA MEDICAID PROGRAMISSUED:03/10/22REPLACED:09/27/21CHAPTER 22: FEDERALLY QUALIFIED HEALTH CENTERSSECTION 22.1: COVERED SERVICESPAGE(S) 127.Pregnancy-related services;8.Perinatal case management;9.Chiropractic services;10.Nutrition counseling as part of an encounter;11.Family planning services;12.Physical and occupational therapy services; and13.Behavioral health services provided by licensed professional counselors (LPCs)and licensed marriage and family therapists (LMFTs).The above services are governed by Medicaid policies and procedures specific to each program.The policies and procedures for the FQHC services program do not apply to these “other”ambulatory services. Billing must be submitted according to the policies and procedures for eachprogram. Service visits will be reimbursed at the all-inclusive PPS rate per visit. (See Section 22.4for more information about reimbursement).Diabetes Self-Management TrainingDiabetes self-management training (DSMT) is provided to beneficiaries diagnosed with diabetes.These services are comprised of one hour of individual instruction and nine hours of groupinstruction on diabetes self-management. Beneficiaries shall receive up to ten hours of servicesduring the first 12-month period beginning with the initial training date. After the first 12-monthperiod has ended, beneficiaries shall only be eligible for two hours of individual instruction ondiabetes self-management per calendar year.Fluoride Varnish ApplicationsCoverage shall be provided for fluoride varnish applications performed in the FQHC tobeneficiaries under 21 years of age based on medical necessity. Fluoride varnish applications willbe reimbursed when performed in the FQHC by:1.The appropriate dental providers;2.Physicians;3.Physician assistants;Covered ServicesPage 7 of 12Section 22.1
LOUISIANA MEDICAID PROGRAMISSUED:03/10/22REPLACED:09/27/21CHAPTER 22: FEDERALLY QUALIFIED HEALTH CENTERSSECTION 22.1: COVERED SERVICESPAGE(S) 124.Nurse practitioners;5.Registered nurses;6.Licensed practical nurses; or7.Certified medical assistants.All participating staff must review the Smiles for Life training module for fluoride varnish andsuccessfully pass the post assessment. All staff involved in the varnish application must be deemedas competent to perform the service by the FQHC and be practicing within the licensedpractitioner’s scope of practice.Fluoride varnish applications shall only be reimbursed to the FQHC when performed on the samedate of service as an office visit or preventative screening. Separate encounters for fluoride varnishservices are not permitted and the application of fluoride varnish does not constitute an encountervisitServices Not Covered1.Injections ordered incident to a previous face-to-face encounter (these injectionswould be incident to the initial encounter and part of the PPS reimbursement of theinitial encounter which warranted the injection);2.Medications provided by a pharmacy that is not part of the FQHC;3.Weight or blood pressure check only;4.Services for which medical necessity is not clearly established;5.Information provided to a patient over the telephone;6.Cosmetic surgery;7.A visit for the sole purpose of a patient obtaining a prescription when the need forthe prescription has already been determined;8.Canceled visits or for appointments not kept;9.Foot care such as routine soaking and application of topical medication;Covered ServicesPage 8 of 12Section 22.1
LOUISIANA MEDICAID PROGRAMISSUED:03/10/22REPLACED:09/27/21CHAPTER 22: FEDERALLY QUALIFIED HEALTH CENTERSSECTION 22.1: COVERED SERVICESPAGE(S) 1210.Transsexual surgery or a procedure which is performed as part of the process ofpreparing an individual for transsexual surgery, such as hormone therapy andelectrolysis; and11.Tattoo removal.EncounterMedical (inclusive of DSMT services) encounters are defined as face-to-face visits with aphysician, physician assistant, nurse practitioner, certified nurse mid-wife, or visiting nurse duringwhich a FQHC service is rendered. Behavioral health encounters are defined as face-to-face visitswith a physician with a psychiatric specialty, nurse practitioner with a psychiatric specialty,clinical nurse specialist with a psychiatric specialty, licensed clinical psychologist, licensedclinical social worker, licensed professional counselor, licensed marriage and family therapist,respectively, during which behavioral health service is rendered. A behavioral health specificservice must be rendered in order to bill a behavioral health encounter. The submission of anevaluation and management code only will not suffice, with the exception of certainprovider/specialty combinations identified in Section 22.1 of this manual under “Service Limits.”A medical and a behavioral health encounter are allowed on the same day of service.Multiple medical and/or behavioral health encounters, however, with more than one health carepractitioner or with the same health care practitioner, which take place on the same day at a singlelocation, constitute a single visit, except for cases in which the beneficiary, subsequent to the firstencounter, suffers illness or injury requiring additional diagnosis or treatment. When thebeneficiary suffers illness or injury requiring additional diagnosis or treatment unrelated to theinitial encounter visit an additional medical and/or behavioral health encounter may be billed.A dental encounter is defined as a face-to-face visit with a dentist where dental services arerendered. Multiple dental encounters with more than one health care practitioner or with the samehealth care practitioner, which take place on the same day at a single location, constitute a singlevisit except for cases in which the beneficiary, subsequent to the first encounter, suffers illness orinjury requiring additional diagnosis or treatment.Multiple Same-day VisitsOnly one medical encounter (inclusive DSMT encounters) per day per beneficiary, one behavioralhealth encounter per day per beneficiary, and one dental encounter per day per beneficiary may bebilled except in cases in which the beneficiary, subsequent to the first encounter, suffers illness orinjury requiring additional diagnosis or treatment. Services shall not be arbitrarily delayed or splitin order to bill additional encounters.Covered ServicesPage 9 of 12Section 22.1
LOUISIANA MEDICAID PROGRAMISSUED:03/10/22REPLACED:09/27/21CHAPTER 22: FEDERALLY QUALIFIED HEALTH CENTERSSECTION 22.1: COVERED SERVICESPAGE(S) 12Service LimitsThere is no annual limit placed on the number of federally qualified health center visits(encounters) payable by the Medicaid Program for eligible beneficiaries.Services not defined as an FQHC service or other ambulatory service rendered to LouisianaMedicaid beneficiaries are not permitted to be billed to the Louisiana Medicaid program.Separate encounters for DSMT services are not permitted and the delivery of DSMT services alonedoes not constitute an encounter visit.ExclusionsMedicaid policy does not provide for payment of follow-up visits occurring on the same date as apreviously billed visit, consultation, emergency room care or hospital admission date.Any services “incident to” an encounter code ARE NOT billable. These include, but are notlimited to the following:1.Injections (allergy, antibiotic, steroids, etc.);2.Laboratory tests performed on site, Peak Flow and Spirometry, Respiratory FlowVolume Loop, EKG testing and interpretation, and x-rays;3.Immunizations;4.Hearing/Vision screenings; and5.Filling and/or obtaining prescriptions.Service DeliveryUpon presentation at the clinic, a full mental, physical and dental assessment shall be performedand include a written plan for each identified problem noted in the history and physical exam. Anyhealth problems identified must be addressed to the highest degree possible. Encounters forbeneficiaries under the age of 21 shall include all the aspects of a well-child screening visit unless:1.The provider determines that the child’s medical condition at the time of the visitcontraindicates the well-child screening as inadvisable; orCovered ServicesPage 10 of 12Section 22.1
LOUISIANA MEDICAID PROGRAMISSUED:03/10/22REPLACED:09/27/21CHAPTER 22: FEDERALLY QUALIFIED HEALTH CENTERSSECTION 22.1: COVERED SERVICESPAGE(S) 122.The child’s medical record reflects that he or she is up to date on the well-childscreenings in accordance with the Medicaid periodicity schedule.NOTE: Service delivery for beneficiaries under the age of 21 includes the administration ofrequired immunizations.The medical encounter level of service must include at a minimum:1.An expanded, problem-focused history (chief complaint, brief history of presentillness, problem pertinent system review); or2.An expanded, problem-focused exam (limited exam of the affected body area ororgan system and other symptomatic or related organ systems).This would be low-level complexity of medical decision making (limited number of diagnoses,limited complexity of data to review, the risk of complications and management options- low).A new patient medical encounter level of service is to include the following:1.A detailed history (chief complaint, history of present illness, problem pertinentsystem review, pertinent past, family, social history); and2.A detailed exam with low-to moderate complexity decision making.The dental encounter level of service must include at a minimum:1.Comprehensive oral healthcare. Comprehensive oral healthcare is defined as allof the covered restorative and therapeutic services described in the MedicaidDental Services Manual.NOTE: Dental health preventive services should be rendered on the same day unless otherwiseindicated due to identified medical issues preventing completion of all preventive services.The behavioral health encounter level of service shall include at a minimum:1.Face-to-face visits with a physician with a psychiatric specialty, nurse practitionerwith a psychiatric specialty, clinical nurse specialist with a psychiatric specialty,licensed clinical psychologist, or licensed clinical social worker; (exclusive ofmedication management only;Covered ServicesPage 11 of 12Section 22.1
LOUISIANA MEDICAID PROGRAMISSUED:03/10/22REPLACED:09/27/21CHAPTER 22: FEDERALLY QUALIFIED HEALTH CENTERSSECTION 22.1: COVERED SERVICESPAGE(S) 122.Face–to-face visit with a licensed professional counselor (LPC) or licensedmarriage and family therapist (exclusive of medication management only); and3.A qualified service for the assessment, diagnosis and/or treatment of a behavioralhealth disorder to include services such as psychotherapy, mental healthassessment, psychiatric evaluation, psychological testing and medicationmanagement. These services may be provided in combination with medicationmanagement as well.Behavioral Health Specific Service Delivery LimitsThe below provider type/specialty combinations are the only behavioral health providers allowedto be reimbursed for claims including an evaluation and management HCPCS code as the onlydetailed line:Provider Provider atrist – Addictionologist1926Psychiatrist1927Psychiatrist –Psychiatry, Neurology,Addiction, Medicine192WPsychiatrist – Addictionologist7826Nurse Practitioner (NP) - APRN93943126266GClinical Nurse Specialist (CNS) - APRNPhysician’s Assistant (PA)Medical PsychologistAll other behavioral health provider type/specialty combinations require at least one qualifiedpsychiatric service included as a detailed line on the claim.Covered ServicesPage 12 of 12Section 22.1
LOUISIANA MEDICAID PROGRAMISSUED:03/10/22REPLACED:07/14/20CHAPTER 22: FEDERALLY QUALIFIED HEALTH CENTERSSECTION 22.2: PROVIDER REQUIREMENTSPAGE(S) 7PROVIDER REQUIREMENTSLocationEach Federally Qualified Health Center (FQHC) that receives Public Health Service (PHS) 330grant funding must be located, as appropriate, to make services accessible to the residents of adesignated medically underserved area or medically underserved population.Shortage Area DesignationIn order for FQHCs to be eligible for a Health Professional Shortage Area (HPSA) facilitydesignation, the center shall:1.Not deny requested health care services, and shall not discriminate in the provisionof services to an individual who is unable to pay for services or whose services arepaid by Medicare, Medicaid, or the Children’s Health Insurance Program;2.Prepare a schedule of fees consistent with locally prevailing rates or charges;3.Prepare a corresponding schedule of discounts (including waivers) to be applied tosuch fees or payments, with adjustments made on the basis of the patient’s abilityto pay;4.Make every reasonable effort to secure from patients the fees and payments forservices, and fees should be sufficiently discounted in accordance with theestablished schedule of discounts;5.Enter into agreements with the State Medicaid agency to ensure coverage ofbeneficiaries; and6.Take reasonable and appropriate steps to collect all payments due for services.NOTE: Location in an HPSA alone or government designated shortage area does not meet theshortage area requirement for the FQHC program.StaffingFQHC primary care services are to be provided by licensed physicians, licensed physicianassistants, nurse practitioners, or nurse-midwives operating under the direct supervision of theFQHC physician and within the scope of the physician extender’s licensure or certification.Provider RequirementsPage 1 of 7Section 22.2
LOUISIANA MEDICAID PROGRAMISSUED:03/10/22REPLACED:07/14/20CHAPTER
The Social Security Act §1905(l)(2)(B) defines a Federally Qualified Health Centers (FQHC) for Medicaid purposes as an entity which: 1. Is receiving a grant under Section 330 of the Public Health Service (PHS) Act; 2. Is receiving funding from such grant under a contract with the beneficiary of such a grant; 3.
