MedicaidAdministrativeMedium impact
Clarification on the Process for Establishing an All-Inclusive Cost-Based Rate for FQHCs and RHCs
Maryland Medicaid·MD · Family Medicine, General Practice, Internal Medicine·FQHC
Effective date
Oct 28, 2024
We identified it
Jun 20, 2026
Summary
Maryland Department of Health clarifies the process for establishing all-inclusive cost-based rates for FQHCs and RHCs, including interim rate calculations, cost report submission requirements, and procedures for rate revisions due to scope changes. The policy establishes strict deadlines and consequences, including 20% rate reductions for late cost report submissions and financial sanctions for MCOs that don't complete reconciliations within 30 days.
Action Required
FQHC/RHC billing teams must: 1) Submit cost reports within 3 months of second fiscal year closure to Myers & Stauffer via Tim Forry at Tforry@MSLC.com, 2) Report scope of service changes within 30 days to mdh.FQHCRateReview@maryland.gov with HRSA Notice of Award letter, 3) Notify Department immediately of contact changes for CEO/CFO, 4) Ensure MCO reconciliations are completed within 30 days of rate establishment notices. Failure to submit cost reports on time results in 20% interim rate reduction until submission.