IFD3

The Best of Both Worlds: Risk-Based Managed Care Contracts in Compliance With Federal Rules

Date
November 4, 2016

To encourage the shift from volume to value, risk-based payments are increasingly becoming the norm in provider contracting. In the context of Medicare and Medicaid, however, federal law protects FQHCs when managed care payments fall below amounts that FQHCs would have otherwise received under the Prospective Payment System (PPS). Can these two payment systems co-exist? This session will explain federal law and policy applicable to the calculation of supplemental (wrap-around) payments under the PPS. It will illustrate how these rules should apply to commonly-encountered risk and incentive payment models such as pay-for-performance, shared savings/shared risk for total cost of care, and primary care, professional, and global capitation. Lastly, presenters will explain when federal law permits program income to cover down-side losses.
  • Articulate how supplemental (wrap-around) payments are calculated under the PPS.
  • Recognize common risk and incentive payment models in provider contracting.
  • Identify permissible uses of program income to fund downside risk.

Speaker

Speaker Image for Adam Falcone
Adam J. Falcone, Esq., MPH
Partner, Feldesman Tucker Leifer Fidell LLP

Tracks

Related Products

Thumbnail for Finding the Opportunities in Value-Based Pay - NTTAP Featured
Finding the Opportunities in Value-Based Pay - NTTAP Featured
The American health care system is moving, in fits and starts, to a more value-based pay model. Health centers wishing to participate in value-based pay need to consider two foundational steps: (1) building infrastructure and (2) engaging effectively with payors…
Thumbnail for Understanding Risk and Attribution
Understanding Risk and Attribution
The various value-based payment models present a significant opportunity for health centers to increase revenues and demonstrate their value. However, these opportunities increase risk health center leaders need to recognize and understand how to navigate…
Thumbnail for The Federal Single Audit Under the Uniform Guidance for CHCs in the New World of CARES Act and American Rescue Plan Funding
The Federal Single Audit Under the Uniform Guidance for CHCs in the New World of CARES Act and American Rescue Plan Funding
Community health centers received an influx of funding from several federal stimulus sources in response to COVID-19 via CARES Act and American Rescue Plan Act Funding…
Thumbnail for 340B Under Attack: A Look at Recent Developments
340B Under Attack: A Look at Recent Developments
1.    Discussion of overall implications of pharmacy issues 2.    Impact of manufacturers on CHCs and the risk to the CHC program as a whole 3.    Strategy for moving forward 4.    Split billing and compliance strategy 5.    Legislative updates 6…

Privacy Policy Update: We value your privacy and want you to understand how your information is being used. To make sure you have current and accurate information about this sites privacy practices please visit the privacy center by clicking here.