Bill Description: Senate Bill 1410 “clarifies and improves the process used to adjust Medicaid encounter rates for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) when there is a change in the scope of services they provide.”
Rating: +1
Does it give government any new, additional, or expanded power to prohibit, restrict, or regulate activities in the free market? Conversely, does it eliminate or reduce government intervention in the market?
Changes in encounter rates due to a scope of services change are already regulated via rules promulgated by the Idaho Department of Welfare (DHW). This legislation provides clarity on timelines and processes but does not meaningfully expand regulation in this already highly regulated field.
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Does it increase government spending (for objectionable purposes) or debt? Conversely, does it decrease government spending or debt?
This legislation clarifies that “A change in scope of services is one that affects the type, intensity, duration, or number of services provided by a FQHC or RHC.” While the federal definition is required and expansive, this legislation is clear that increases in service costs do not count. This ensures that FQHCs and RHCs are not submitting requests for increased payment rates based on nonqualifying criteria.
The legislation also has the additional requirement that “To qualify for a rate adjustment, applications for a rate review must meet a minimum four and one-half percent (4.5%) cumulative/aggregate change in cost per medical or dental visit as measured by comparing the cost per encounter with change in scope of services to the current PPS rate.”
This rightly restricts change in scope of services to more significant changes before they are adjusted upwards. However, facilities could also inflate costs to more easily reach this threshold, although there is no current evidence to support this.
This legislation goes into effect on October 1, 2026. This possibly creates a temporary perverse incentive between the time of the legislation's passage and the effective date where FWHCs and RHCs may attempt as many rate changes as possible while still being governed by the old system.
Finally, this legislation further limits facilities to just one application per fiscal year which should encourage cost control.
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Does it violate the principles of federalism by increasing federal authority, yielding to federal blandishments, or incorporating changeable federal laws into Idaho statutes or rules? Examples include citing federal code without noting as it is written on a certain date, using state resources to enforce federal law, and refusing to support and uphold the tenth amendment. Conversely, does it restore or uphold the principles of federalism?
This legislation makes several references to federal code regarding FQHC’s and RHC’s, but this is unavoidable considering these regulations have to do with a federal program.
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