MedicaidReimbursementMedium impact
5160-28-06.1 - FQHC and RHC services: limits on a per-visit payment amount (PVPA) determined on the basis of a cost report for an FQHC PPS service. (Amend/Final File)
Ohio Medicaid·OH · Family Medicine, Internal Medicine, General Practice +1 more·Reimbursement
Effective date
Jul 1, 2024
We identified it
Jun 20, 2026
Summary
Ohio Department of Medicaid amended Rule 5160-28-06.1 regarding per-visit payment amount (PVPA) limits for Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) under the Prospective Payment System. This amendment updates how Medicaid determines reimbursement rates based on cost reports for these clinic types.
Action Required
FQHC and RHC billing teams in Ohio should review their current Medicaid reimbursement calculations and ensure cost reporting procedures align with the updated PVPA determination methodology. Contact Ohio Medicaid at 614-752-3877 for specific guidance on how this amendment affects your clinic's per-visit payment amounts.