Bill > S1410

This bill requires the Department of Health and Welfare to submit state plan amendments to adjust payment rates for federally qualified health centers (FQHCs) and rural health clinics (RHCs) when they change the scope of services they offer, as mandated by federal law (42 U.S.C. 1396a(bb)(3)(B)). A change in scope is defined as altering the type, intensity, duration, or number of services provided, not just the cost of existing services. To qualify for a rate adjustment, clinics must demonstrate a significant cumulative change in cost per visit (at least 4.5%) after fully implementing the new services for six consecutive months. The bill outlines a process for clinics to apply for these rate adjustments, including providing detailed cost reports and narratives, and sets timelines for the department to review and issue decisions on these applications, with a final rate effective from the date the service change began. Additionally, specific administrative rules related to Medicaid Plan Benefits will become void on October 1, 2026, though clinics that started a scope change before that date can complete the process under the old rules.

Health and Social Services, Justice

State Affairs Committee (Senate)

https://legislature.idaho.gov/sessioninfo/2026/legislation/S1410/