MedicaidReimbursementMedium impact
BT2024173: OMPP updates policy for FQHC PPS rate revisions due to changes in scope of services
Indiana Medicaid (IHCP)·IN · Family Medicine, Internal Medicine, General Practice +1 more·Claims & Billing
Effective date
Oct 31, 2024
We identified it
Jun 19, 2026
Summary
Indiana Medicaid has updated policy for Federally Qualified Health Centers (FQHCs) requesting changes to their prospective payment system (PPS) rates due to scope of service changes. Key changes include a 9-month deadline for submissions, new rate caps and floors, and exclusion of site changes from rate adjustments effective October 31, 2024.
Action Required
Immediately: FQHC billing teams must ensure any future Change in Scope of Service (CISS) requests are submitted to Myers and Stauffer within 9 months of the scope change. Update internal procedures to exclude site changes (new locations, relocations, remodeling) from CISS rate adjustment requests as these are no longer eligible for PPS rate changes using current methodology.