Revised Billing for Tribal Federally Qualified Health Centers

On January 1, 2024, ForwardHealth changed how it reimburses for services provided by Tribal federally qualified health centers (FQHCs). A Tribal FQHC is an outpatient health program or facility operated by a Tribe or Tribal organization receiving funds under the Indian Self-Determination Act (Public Law 93-638).

ForwardHealth is not changing coverage of services and prior authorization requirements.

Beginning January 1, 2024, Wisconsin Tribal FQHCs could receive reimbursement for Medicaid-covered services by one of two options:

• Prospective payment system (PPS)—ForwardHealth establishes a prospective encounter rate for each Tribal FQHC that reflects their estimated reasonable costs of providing care, in accordance with the Benefits Improvement and Protection Act of 2000.
• All-inclusive rate (AIR)—Indian Health Services (IHS) calculates and publishes all-inclusive reimbursement rates each year in the Federal Register. The rates are based on annual cost reports prepared by IHS’s contractor.

Tribal FQHCs can find relevant information in the Tribal Federally Qualified Health Center service area of the ForwardHealth Online Handbook. Providers can access policy information in the Online Handbook without a secure ForwardHealth Provider Portal account.