Medicare may raise health clinic pay by $1.3 billion

By Alex Wayne

April 30, 2014 at 09:26 AM

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(Bloomberg) – The Centers for Medicare & Medicaid Services (CMS) said Medicare wants to increase payments to nonprofit community health clinics by as much as $1.3 billion over the next five years under a new Patient Protection and Affordable Care Act (PPACA) reimbursement system.

Under the new system, the clinics will be paid a single daily fee of about $155 per patient for all the services they provide Medicare beneficiaries, CMS said. The fee will vary depending on where the clinics are located and other factors.

About 3,830 of the community health clinics stand to benefit from the change.

The change could raise those clinics' payments from Medicare by about one-third, according to the text of new CMS regulations.

The clinics serve mostly low-income patients in communities with few other options for health care and are supported by about $3.6 billion in federal grants.

Elderly and disabled Medicare patients — who generally can go to any doctor they choose — were the fastest growing segment of the clinics' business in 2008, according to the National Association of Community Health Centers, even though they comprise less than 10 percent of patients nationally. The association lobbied the government for increased Medicare reimbursement, arguing the clinics lost at least $51 million a year because of limits on their payments from the program.

The clinics "are essential to countless patients in local communities who depend on them for getting their primary and preventive care," CMS Administrator Marilyn Tavenner said in a statement.

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