United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2001-06-19 monographic deposited born digital 29 p. GA 1.13:GAO-01-577 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-01-577 P0b002ee18037580f f:d01577 DGPO 2010-08-12 2011-03-28 GAOREPORTS-GAO-01-577 machine generated eng fdlp REPORT GAOREPORTS-GAO-01-577 GAO-01-577 Community health services Health care costs Health insurance cost control State-administered programs Medicaid Program Medicaid Prospective Payment System Other Written Product A01031 To increase the accessibility of primary and preventive health services for low-income people living in medically underserved areas, Congress made federally qualified health centers (FQHC) and rural health clinics (RHC) eligible for Medicaid payments. Since 1989, federal law has required the Medicaid program to reimburse both FQHCs and RHCs based on the reasonable costs they incurred in providing services to beneficiaries. Cost-based reimbursement can ensure that service providers are reimbursed for necessary costs; it is also regarded as inflationary because providers can increase their payments by raising their costs. In part because of their mandate to preserve and expand necessary primary health care services, FQHCs and RHCs have traditionally received reimbursement based on their costs in an effort to ensure adequate payment. However, this approach does little to encourage efficiency. The new payment system mandated by the Benefits Improvement and Protection Act attempts to ensure adequacy by basing payments on historical rates while promoting efficiency by limiting increases. However, the combination of reimbursement limits imposed historically by most states and the inflation adjustments in the new prospective payment system may contain future Medicaid payment to some FQHCs and RHCs. Finding a mechanism to strike the proper balance between payment adequacy and incentives for efficiency has been, and will likely be, a challenge. https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-01-577/html/GAOREPORTS-GAO-01-577.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-01-577/pdf/GAOREPORTS-GAO-01-577.pdf GAO-01-577 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-01-577 Other Written Product GAO-01-577; Health Centers and Rural Clinics: Payments Likely to Be Constrained Under Medicaid's New System; Community health services Health care costs Health insurance cost control State-administered programs Medicaid Program Medicaid Prospective Payment System Volume 91 Page 1485 91 Stat. 1485 Volume 103 Page 2258 103 Stat. 2258 Public Law 95-210 Public Law 101-239 Public Law 105-33 Public Law 106-113 Public Law 106-554