§3174-V. Federally qualified health center reimbursements
Beginning in fiscal year 2003-04, the reimbursement requirements listed in subsections 1 and 2 apply to payments for certain federally qualified health centers as defined in 42 United States Code, Section 1395x, subsection(aa)(1993). [PL 2003, c. 20, Pt. K, §11 (AMD).]
1. Services furnished by center. The department shall reimburse a federally qualified health center no less than 100% of reasonable costs, reduced by the total copayments for which members are responsible, for services furnished by the center within the scope of service approved by the federal Health Resources and Services Administration or the commissioner if that center:
A. Is receiving a grant under Section 330 of the federal Public Health Services Act; or [PL 1999, c. 401, Pt. T, §1 (NEW).]
B. Is receiving funding under contract with the recipient of a grant under Section 330 of the federal Public Health Services Act, is identified as a subrecipient in the Section 330 grantee's approved scope of work and meets the requirements to receive a grant under Section 330 of that Act. [PL 1999, c. 401, Pt. T, §1 (NEW).]
[PL 2003, c. 20, Pt. K, §11 (AMD).]
2. Contracted services. When a federally qualified health center otherwise meeting the requirements of subsection 1 contracts with a managed care plan or the Dirigo Health Program for the provision of MaineCare services, the department shall reimburse that center the difference between the payment received by the center from the managed care plan or the Dirigo Health Program and 100% of the reasonable cost, reduced by the total copayments for which members are responsible, incurred in providing services within the scope of service approved by the federal Health Resources and Services Administration or the commissioner. Any such managed care contract must provide payments for the services of a center that are not less than the level and amount of payment that the managed care plan or the Dirigo Health Program would make for services provided by an entity not defined as a federally qualified health center.
[PL 2005, c. 400, Pt. C, §1 (AMD).]
SECTION HISTORY
PL 1999, c. 401, §T1 (NEW). PL 2003, c. 20, §K11 (AMD). PL 2003, c. 469, §A7 (AMD). PL 2005, c. 400, §C1 (AMD).