MedicaidReimbursementMedium impact
5160-28-05 - FQHC and RHC services: prospective payment system (PPS) method for determining payment. (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 has updated Rule 5160-28-05 regarding the prospective payment system (PPS) method for determining payment rates for Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC). This amendment to the payment methodology became effective July 1, 2024.
Action Required
By July 1, 2024 (already effective): FQHC and RHC billing teams in Ohio must review and implement the updated prospective payment system methodology for Medicaid claims. Verify that billing systems are configured to use the new PPS rates established under the amended rule. Contact Ohio Medicaid at 614-752-3877 if clarification is needed on payment calculations.