FQHC/RHC Annual Rate Adjustment

October 12, 2021

Effective for dates of service on or after October 1, 2021, per federal requirements, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) received an annual rate adjustment. Under the Prospective Payment System (PPS), reimbursement rates are increased by 1.4 percent to reflect the current Medicare Economic Index (MEI).

An Erroneous Payment Correction (EPC) will be implemented to reprocess claims with dates of service on or after the effective date of this billing policy, that were appropriately submitted, but erroneously paid based on the previous rate because Medi-Cal had not yet implemented the system changes to support appropriate adjudication. Providers may also elect to use this updated billing policy to correct and resubmit previously denied claims as described in the CIF Submission and Timeliness Instructions section of the Provider Manual.