MedicaidReimbursementMedium impact
5160-28-05.1 - Cost-based clinics: prospective payment system (PPS) method for determining FQHC payment. (Rescind/Final File)
Ohio Medicaid·OH · Family Medicine, Internal Medicine, General Practice +1 more·Reimbursement
Effective date
Jul 1, 2022
We identified it
Jun 20, 2026
Summary
Ohio has rescinded Rule 5160-28-05.1 which governed the prospective payment system (PPS) method for determining FQHC (Federally Qualified Health Center) payment rates under Medicaid. This rule was officially rescinded on July 1, 2022, eliminating the previous PPS reimbursement methodology for cost-based clinics.
Action Required
If your practice is an FQHC in Ohio: Contact the Ohio Department of Medicaid at 614-752-3877 to understand the current reimbursement methodology that replaced the rescinded PPS system. Update billing procedures and rate expectations based on the new payment structure that is now in effect.