Thank you for developing this policy in response to Budget Bill Item 28 WWWW and 12VAC30-80-25:B.1. We understand and agree with most of the document. However, we have a few points for consideration.

1. In several places there is reference to a “fiscal year”. Whose fiscal year? The FQHC’s or DMAS’s? That needs to be clear on pages 2 and 3. Everything is dependent on this timeline.
2. On page 4 DMAS indicates a decision will be made within 180 calendar days. That is 6 months. There is no need for it to take more than 90 days. There is not a lot of data to review. And, the FQHC has already been incurring these expenses for a year. The longer the review takes, the more financial strain the FQHC continues to absorb.
3. In response to the actions by the General Assembly, DMAS allowed FQHCs to submit change in scope documentation in late 2024. However, the proposed policy obviously was not in place when this documentation was being prepared and submitted. Asa result, FQHCs were not given official directions about what would serve as qualifying events. We therefore believe that DMAS should allow FQHCs an opportunity to submit additional documentation for prior changes in scope that would qualify under the current policy.

     As a specific example, earlier this year, Tri-Area only submitted documentation for adding a service. We did not provide anything for additional sites because we were told that the interpretation of the DMAS guidance at the time was that adding a site would not qualify as a change in scope. However, the current document clearly would allow new sites to be considered changes in scope that could lead to an increase in the PPS rate. Therefore, Tri-Area will not be receiving the PPS increase we deserve because we did not know we could submit documentation for the 4 sites we added from 2020-2023.

Finally, DMAS was out of compliance for over 20 years. That is 20 years of underpayment for FQHCs. FQHCs should be made whole for the entire time that DMAS was out of compliance. We therefore request payment for any unreimbursed costs incurred prior to the current submission in accordance with applicable federal law.

In keeping with the applicable legislation, we request that any timelines associated with the Change in Scope filing, determination, or appeals process are achievable and timely.

Respectfully submitted, 

James Werth, Jr., PhD, ABPP