Louisiana FQHC Reimbursement Watch

Medicaid Payment Policy Updates

• 🔥 CMS Proposed Rule on State Directed Payments: The new CMS proposed rule on Medicaid Managed Care State...

CMS released a proposed rule on Medicaid managed care state directed payments and FFS targeted practitioner payments, with a 60-day comment period ending July 21, 2026. The rule targets payment structures under 42 CFR 438 and 42 CFR 447.

Louisiana's plan under the $50 billion CMS Rural Health Transformation Program (2026-2030) focuses on digital equity through FQHCs.

• Subsidized...

Federal telehealth policy draws from four distinct regimes—Medicare statute, DEA controlled substances rules, HIPAA, and FCC broadband...

Medicare has reimbursed Community Health Integration, Principal Illness Navigation, and Chronic Care Management since January 2024 for work nurses...

Billing & Coding Updates

• 🔥 CLFS & CLIA HCPCS Quarterly Update: New quarterly CLFS & CLIA HCPCS code updates for waived tests and reasonable...

The July 2026 quarterly update addresses CLFS & CLIA HCPCS codes, waived tests, and reasonable charge payments. Louisiana FQHC staff should review these changes to maintain accurate billing, correct modifier application, and reimbursement compliance.

CMS unveiled a rule to limit state-directed payments and targeted practitioner payments, capping them at 100% of Medicare rates in expansion states to...

FQHCs can strengthen payer negotiations by leading with network adequacy and prevention value rather than just rates.

• Audit first: Review all...

FQHC Medicaid PPS Updates

• 🔥 Encounter-Based Reimbursement: Medicaid reimburses FQHCs through an encounter-based prospective payment system...

CMS is finalizing new policies for the Medicare Part B Drug Inflation Rebate Program and Medicare Part D Drug Inflation Rebate Program for CY 2026 as part of the Medicare Physician Fee Schedule updates.

CMS finalized the 2027 Notice of Benefit and Payment Parameters on Friday, introducing significant new policies for Affordable Care Act exchanges....

Medicaid reimburses FQHCs through an encounter-based prospective payment system (PPS), directly tying payment to each qualifying patient visit.

Wyoming's community-driven rural health plan emphasizes stabilizing foundational services and integrating FQHCs, offering timely ideas for Louisiana...

340B Program Integrity

• 🔥 Lawsuits Target CVS 340B Practices: Three major hospital systems filed separate federal lawsuits accusing CVS Health...

Medicare policy shifts push practices past basic reimbursement questions toward operating decisions that reshape billing contracts. Revenue at risk matters, yet it is only one piece of the operator puzzle.

Three major hospital systems filed federal lawsuits accusing CVS Health of secretly diverting millions in 340B savings through an alleged scheme. This...

CMS is expanding access to low-premium catastrophic plans for consumers with income changes who no longer qualify for ACA subsidies, following the end...

Louisiana FQHCs face unique Medicaid billing challenges that demand expert handling to protect revenue and compliance.

• Encounter-based billing and...

The American College of Physicians is pressing CMS for reforms across nine areas to counter Medicare Advantage plans' negative effects on physician...