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19 Effective Date: July 1, 2009

Approval Date: voluntarily choose a plan, the client will be assigned to a plan when there are two or more plans in their community. MPA contracts with Indian Health Services (IHS) and tribal operated health clinics to provide primary care case management (PCCM) coverage to American Indians/Alaska Natives as an alternative to managed care enrollment. Washington’s CHIP program reimburses Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) using the same alternative payment methodology (APM) as the State’s Medicaid program. There is no difference between the CHIP rates and the Medicaid rates for reimbursing Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC). In the State of Washington, FQHCs/RHCs have the choice of reimbursement under the Prospective Payment System (PPS) as outlined in the Benefits Improvement and Protection Act of 2000 (BIPA) statutory language, or an Alternative Payment Methodology (APM). Prospective Payment System The facility-specific encounter rates were established in 2002, and they are considered the providers’ base encounter rates. The base rates were calculated using cost report data from 1999 and 2000, and in some cases, 2001. The corresponding enhancement rates were also established at this time. Pursuant to the requirements of the PPS, both the FFS encounter rates and managed care enhancement rates for each provider have been increased annually by the percentage change in the MEI. Alternative Payment Methodology The APM encounter rates were established by starting with each provider’s base PPS rate, and trending forward to 2009 using the APM index. The APM index is a Washington State specific health Care index developed by IHS Global Insight. Rates established under the APM will be inflated each year by the Washington State specific health care index. Annual reconciliation is a part of the APM. Rates determined under the APM will be periodically rebased.