Section. 2Texas Medicaid Reimbursement

Transcription

1 Section 2Texas Medicaid Reimbursement Reimbursement Electronic Funds Transfer Using Electronic Funds Transfer (EFT) Advantages of EFT Enrollment Procedures Reimbursement Methodology Fee Schedules Physician Services in Outpatient Hospital Setting Drugs/Biologicals Reasonable Cost/Interim Rates Hospitals Provider-Specific Visit Rates Reasonable Charge Payment Methodology Manual Pricing Professional Providers and Outpatient Facilities Reimbursement Reduction Additional Payments to High-Volume Providers Medicaid Service Provided Outside Texas Medicare Crossover Reimbursement Part A Part B Federal Financial Participation (FFP) Rate

2 Section Reimbursement Texas Medicaid Program reimbursements are available to all enrolled providers by check or electronic funds transfer (EFT). With EFT, TMHP directly deposits reimbursement into a provider's bank account. Effective immediately, stale-dated checks (e.g., checks that are older than 180 days) that have not been cashed are voided and/or applied to any outstanding accounts receivable. If the balance on a stale-dated check after it has been applied to accounts receivable is over $5,000, written notification is sent to the provider 30 days before the void occurs Electronic Funds Transfer Electronic funds transfer (EFT) is a method for directly depositing funds into a designated bank account. When providers enroll, TMHP deposits funds from their approved claims directly into their designated bank account. Transactions transmitted through EFT contain descriptive information to help providers reconcile their bank accounts Using EFT As a result of the 76th legislature, House Bill 2085 recommends that all Texas Medicaid service providers receive payment by EFT. All providers are strongly encouraged to participate in EFT. EFT does not require special software and providers can enroll immediately. Complete the EFT form, include a deposit slip or canceled check, and mail the items to: Texas Medicaid & Healthcare Partnership ATTN: Provider Enrollment, MC-B05 PO Box Austin, TX Advantages of EFT Stop payments are no longer necessary because no paper is involved in the transaction process. Payment theft is less likely to occur because the process is handled electronically rather than by paper. Deposited funds are available for withdrawal the Thursday morning following the completed financial cycle. Upon deposit, the bank considers the transaction immediately collected. No float is attached to EFT deposits for Texas Medicaid funds. TMHP includes provider and R&S report numbers with each transaction submitted. If the bank s processing software captures and displays the information, both numbers would appear on the banking statement Enrollment Procedures The Electronic Funds Transfer Form can be requested by contacting the Provider Enrollment department at Completed EFT forms can be faxed to Please include: EFT Enrollment Form Organization name Contact name Address Contact telephone number Contact fax number To enroll for EFT, providers must submit a completed enrollment form to TMHP. A voided check or copy of a deposit slip must be attached to the enrollment form. One form should be filled out for each billing TPI, including an original signature of the provider. TMHP processes the form within five working days of receipt. TMHP issues a prenotification transaction during the next cycle directly to the provider s bank account. This transaction serves as a checkpoint to verify EFT is working correctly. If the bank returns the prenotification without errors, the provider will begin receiving EFT transactions with the third cycle following the enrollment form processing. The provider will continue to receive paper checks until they begin to receive EFT transactions. If the provider changes bank accounts, the provider must submit a new EFT Agreement to Provider Enrollment. The prenotification process is repeated and, once completed, the EFT transaction is deposited to the new bank account. Refer to: Electroncic Funds Transfer (EFT) Authorization Agreement on page B Reimbursement Methodology Medicaid reimburses providers using several different reimbursement methodologies, including fee schedules, reasonable cost with interim rates, hospital reimbursement methodology, provider-specific encounter rates, reasonable charge payment methodology, and manual pricing. Each Texas Medicaid Program service describes the appropriate reimbursement for each service area. Note: Medicaid reimbursement through the State of Texas Access Reform (STAR), STAR+PLUS, and NorthSTAR Program health plans may differ according to the provider s contract with the health plan Fee Schedules The Texas Medicaid Program reimburses certain providers based on rates published in fee schedules. These rates are uniform statewide and by provider type. According to this type of reimbursement methodology, the provider is paid the lower of its billed charges or the Medicaid rate published in the fee schedule. 2 2

3 Texas Medicaid Reimbursement The following provider types are reimbursed based on rates published in fee schedules, with the rates calculated in accordance with the referenced reimbursement methodology as published in the Texas Administrative Code, Part 1 Administration, Part 15 Texas Health and Human Services Commission, and Chapter 355 Reimbursement Rates. Advanced Practice Nurse (APN). According to Title 1 Texas Administrative Code (TAC) , the Medicaid rate for APNs is 85 percent of the rate paid to a physician (MD or DO) for the same service and 100 percent of the rate paid to physicians for laboratory services, X-ray services, and injections. The current APN fee schedule is entitled 2004 APN/CNM Fee Schedule (PRCR401C.xls) and is available on the TMHP website. (See also Section 8 of this Ambulatory Surgical Center (ASC). The Medicaid rates for ASCs are calculated in accordance with 1 TAC The current ASC/Hospital-Based ASC (HASC) fee schedule is entitled 2004 ASC/HASC Fee Schedule (PRCR405C.xls) and is available on the TMHP website. There is also an insert to the fee schedule entitled 2004 ASCHASC-Insert (ASCHASC - Insert.xls) available on the TMHP website. (See also Section 10 of this Birthing Center. The Medicaid rates for birthing centers are calculated in accordance with 1 TAC and are listed in Section 11 of this manual. Blind Children s Vocational Discovery and Development Program. The Medicaid rate for this service is calculated in accordance with 1 TAC and is listed in Section 12 of this manual. Case Management for Early Childhood Intervention (ECI). The Medicaid rate for this service is calculated in accordance with 1 TAC and and is listed in Section 13 of this manual. Case Management for Children and Pregnant Women (CPW). The Medicaid rates for this service are calculated in accordance with 1 TAC and are listed in Section 14 of this manual. Certified Nurse-Midwife (CNM). The Medicaid rates for CNMs are calculated in accordance with 1 TAC The current CNM fee schedule is entitled 2004 APN/CNM Fee Schedule (PRCR401C.xls) and is available on the TMHP website. (See also Section 15 of this Certified Registered Nurse Anesthetist (CRNA). According to 1 TAC , the Medicaid rate for CRNAs is 85 percent of the rate reimbursed to a physician anesthesiologist for the same service. The current CRNA fee schedule is entitled 2004 CRNA Fee Schedule (PRCR400C.xls) and is available on the TMHP website. (See also Section 16 of this Certified Respiratory Care Practitioner (CRCP). The Medicaid rate for CRCP is calculated in accordance with 1 TAC and is $66.68 per daily visit for (See also Section 17 of this Chemical Dependency Treatment Facility (CDTF). The Medicaid rates for CDTF services are calculated in accordance with 1 TAC and are listed in Section 18 of this manual. Chiropractic Services. The Medicaid rates for chiropractic services are calculated in accordance with 1 TAC and 1 TAC and are listed in Section 19 of this manual. Dental. The Medicaid rates for dentists are calculated as access-based fees in accordance with 1 TAC The procedure codes covered for dentists and the applicable rates are listed in Section 20 of this manual. Family Planning Services. The Medicaid rates for family planning services are calculated in accordance with 1 TAC and are listed in Section 21 of this manual. Genetic Services. The procedure codes and Medicaid rates for genetic services are listed in Section 23 of this manual. TMHP manually prices genetic laboratory services that have no established fee. Hearing Aid and Audiometric Evaluations. Newborn hearing screenings are provided at the birthing facility before hospital discharge and, as such, are reimbursed in accordance with the reimbursement methodology for the specific type of birthing facility. Outpatient hearing screening and diagnostic testing services for children are provided by physicians and are reimbursed in accordance with the reimbursement methodology for physician services. (See also Section 24 of this Texas Medicaid (Title XIX) Home Health Services. The reimbursement methodology for professional services delivered by home health agencies (HHAs) are statewide visit rates calculated in accordance with 1 TAC (a). HHAs are reimbursed for durable medical equipment (DME) and expendable supplies in accordance with 1 TAC (b) (c). The current DME fee schedule is entitled 2004 DME Fee Schedule (PRCR409C.xls) and is available on the TMHP website. TMHP manually prices DME/supplies that have no established fee in accordance with the guidelines established in 1 TAC (b) (c). (See also Section 25 of this Independent Laboratory. The Medicaid rates for independent laboratories are calculated in accordance with 1 TAC , 1 TAC , and the Deficit Reduction Act of 1984 (DEFRA). By federal law, Medicaid payments for a clinical laboratory service cannot exceed the Medicare payment for that service. EPSDT/THSteps medical and newborn screening laboratory services provided by the Department of State Health Services (DSHS) Laboratory are reimbursed based on actual costs in accordance with 1 TAC (See also Sections 27 and 42 of this Indian Health Services. The reimbursement methodology for outpatient services provided in Indian Health Services Facilities operating under the authority of 2 2 3

4 Section 2 Public Law is located at 1 TAC The procedure code for reimbursing these services is T1015, and the current encounter rate is $216. In-Home Total Parenteral Hyperalimentation Supplier. The Medicaid rates for these providers are calculated in accordance with 1 TAC The procedure codes reimbursable to these providers are listed in Section 26 of this manual and are reimbursed as a package of services or a global fee of $145 per day, with an annual maximum of $53,000. Licensed Marriage and Family Therapist (LMFT). According to 1 TAC , the Medicaid rate for LMFTs is 70 percent of the rate paid to a psychiatrist or psychologist for a similar service per 1 TAC (See also Section 29 of this Licensed Clinical Social Worker (LCSW). According to 1 TAC , the Medicaid rate for LCSWs is 70 percent of the rate paid to a psychiatrist or psychologist for a similar service per 1 TAC (See also Section 30 of this Licensed Professional Counselors (LPCs). According to 1 TAC , the Medicaid rate for LPCs is 70 percent of the rate paid to a psychiatrist or psychologist for a similar service per 1 TAC (See also Section 31 of this Maternity Service Clinic (MSC). The Medicaid rates for these providers are calculated in accordance with 1 TAC The procedure codes reimbursable to these providers are listed in Section 32 of this manual, and the Medicaid rates are listed in the 2004 Physician Fee Schedule (PRCR402C.xls) which is available on the TMHP website. Mental Health (MH) Mental Retardation (MR). The Medicaid rates for mental health (MH) service coordination are calculated in accordance with 1 TAC and those for mental retardation (MR) service coordination are calculated in accordance with 1 TAC The Medicaid rates for MH rehabilitative services are calculated in accordance with 1 TAC The procedure codes covered by these services are listed in Section 33 of this manual. Physical Therapists/Independent Practitioners. The Medicaid rates for these providers are calculated in accordance with 1 TAC and 1 TAC The procedure codes reimbursable to these providers are listed in Section 35 of this manual and the Medicaid rates are listed in the 2004 Physician Fee Schedule (PRCR402C.xls), which is available on the TMHP website. Physician. The Medicaid rates for physicians and certain other practitioners are calculated in accordance with 1 TAC The current fee schedule is entitled 2004 Physician Fee Schedule (PRCR402C.xls) and is available on the TMHP website. See Section , Physician Services in Outpatient Hospital Setting on page 2-4. (See also Section 36 of this Psychologist. The Medicaid rates for psychologists are calculated in accordance with 1 TAC and 1 TAC The procedure codes reimbursable to psychologists are listed in Section 37 of this manual, and the Medicaid rates are listed in the 2004 Physician Fee Schedule (PRCR402C.xls), which is available on the TMHP website. Radiological and Physiological Laboratory and Portable X-Ray Supplier. The Medicaid rates for these providers are calculated in accordance with 1 TAC and 1 TAC The procedure codes reimbursable to these providers are listed in Section 38 of this manual, and the Medicaid rates are listed in the 2004 Physician Fee Schedule (PRCR402C.xls), which is available on the TMHP website. Renal Dialysis Facility. The Medicaid rates for these providers are composite rates based on calculations specified by the Centers for Medicare & Medicaid Services (CMS). The procedure codes reimbursable to these providers are listed in Section 39 of this manual, and the Medicaid rates are listed in the current 2004 Physician Fee Schedule (PRCR402C.xls), which is available on the TMHP website. School Health and Related Services (SHARS). The Medicaid rates for these providers are calculated in accordance with 1 TAC The procedure codes reimbursable to these providers and the applicable rates are listed in Section 41 of this manual. Texas Health Steps (THSteps). THSteps reimburses by provider type in accordance with 1 TAC Approved providers enrolled in the Texas Medicaid Program are reimbursed for THSteps services in the same manner as they are reimbursed for other Medicaid services. Some of the procedure codes reimbursable under THSteps are listed in Section 42 of this manual. THSteps-CCP reimburses for durable medical equipment (DME) and expendable supplies in accordance with 1 TAC (4)-(5). Tuberculosis (TB) Clinics. The Medicaid rates for these providers are calculated in accordance with 1 TAC Procedure codes and applicable rates for these providers are listed in Section 43 of this manual. Vision Care (Optometrists, Opticians). The Medicaid rates for these providers are calculated in accordance with 1 TAC and 1 TAC The current fee schedule for optometrists is entitled 2004 Optometrist Fee Schedule (PRCR403C.xls) and is available on the TMHP website. (See also Section 44 of this Call the TMHP Contact Center at to request one of the referenced fee schedules Physician Services in Outpatient Hospital Setting Section 104 of the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) requires that Medicare/Medicaid limit reimbursement for those physician services furnished in 2 4

5 Texas Medicaid Reimbursement outpatient hospital settings (e.g., clinics and emergency situations) that are ordinarily furnished in physician offices. The limit is 60 percent of the Medicaid rate for the service furnished in physician offices. The following table identifies the services applicable to the 60 percent limitation when furnished in outpatient hospital settings: Procedure Codes These procedures are designated with note code "1" in the 2004 Physician Fee Schedule (PRCR402C.xls), which is available on the TMHP website. The following list shows the services excluded from the 60 percent limitation: Services furnished in rural health clinics (RHCs) Surgical services that are covered ambulatory surgical center/hospital-based ambulatory surgical center (ASC/HASC) services Anesthesiology and radiology services Emergency services provided in a hospital emergency room after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain), such that the absence of immediate medical attention could reasonably be expected to result in one of the following: Serious jeopardy to the client s health Serious impairment to bodily functions Serious dysfunction of any bodily organ or part Exception: Because of TEFRA, Medicaid reimbursement for a payable nonemergency office service performed in the outpatient department of a hospital is limited to 60 percent of the Medicaid rate for that service. If the condition qualifies as an emergency, the 60 percent professional service reimbursement limit does not apply Drugs/Biologicals Drugs/biologicals are reimbursed as access-based fees under the physician fee schedule in accordance with 1 TAC Texas Medicaid fee decisions for blood clotting factors, pneumococcal and hepatitis B drugs/biologicals, infusion drugs furnished through an item of implanted durable medical equipment, and new drugs/biologicals are based on 89.5 percent of the average wholesale price (AWP). New drugs/biologicals are those that received approval for marketing by the Food and Drug Administration within the past 12 months. For certain, specific drugs/biologicals studied by the Office of Inspector General (OIG)/General Accounting Office (GAO), Medicaid fee decisions are based on the recommended percentages of AWP resulting from those studies (Table 1 in 20 of Chapter 17 of the Medicare Claims Processing Manual, Pub ). For the remaining drugs/biologicals not listed above, Medicaid fee decisions are based on 85.0 percent of the AWP. Texas Health and Human Services Commission (HHSC) reserves the option to use other data sources to determine Medicaid fees for drugs/biologicals when AWP calculations are determined to be unreasonable or insufficient. Payments for drugs/biologicals are excluded from the 2.5 percent Medicaid payment reduction. Prescriptions are covered under the Texas Medicaid Vendor Drug Program (VDP). The reimbursement methodology for pharmacy services is located at 1 TAC Effective October 13, 2003, the dispensing fee was reduced by 2.5 percent (1 TAC ) Reasonable Cost/Interim Rates Outpatient hospital services are reimbursed in accordance with 1 TAC The reimbursement methodology is based on reasonable costs, and providers are reimbursed at an interim rate based on the provider s most recent Medicaid cost report settlement. This interim rate is applied to the provider s allowed amount (per claim detail) to determine the provider s payable amount Hospitals Inpatient hospital services are reimbursed in accordance with 1 TAC Reimbursement for in-state children s hospitals is made in accordance with 1 TAC (o). Guidelines for additional reimbursement to disproportionate share hospitals are located at 1 TAC , while the reimbursement methodology for disproportionate share hospitals is located at 1 TAC Supplemental payment guidelines to certain rural public hospitals are located at 1 TAC Provider-Specific Visit Rates Medicaid provider-specific prospective payment system (PPS) visit rates for rural health clinics (RHCs) are calculated in accordance with 1 TAC , and those for federally qualified health centers (FQHCs) are calculated in accordance with 1 TAC (See also Section 22 for more information regarding FQHCs and Section 40 for RHCs.) Reasonable Charge Payment Methodology Ambulance services are reimbursed according to a reasonable charge payment methodology in accordance with 1 TAC (See also Section 9 of this 2 2 5

6 Section Manual Pricing When services or products do not have an established reimbursement amount, the detail or claim is manually reviewed to determine an appropriate reimbursement. The manual pricing methodology for DME and expendable supplies is included with the reimbursement methodology for these products. 2.3 Professional Providers and Outpatient Facilities Reimbursement Reduction As per Article II of House Bill 1 and Section 2.03 of House Bill 2292, 78th Texas Legislature, Regular Session 2003, Medicaid payments for professional and outpatient services were reduced by 2.5 percent during the claims process. These payment reductions apply to Medicaid fee-forservice, Medicaid Primary Care Case Management (PCCM), Medicaid Managed Care, Family Planning, and the Children with Special Health Care Needs (CSHCN) Services Programs, with the exceptions noted below. The following services are excluded from the 2.5 percent Medicaid payment reduction: Services provided by FQHCs and RHCs Services provided by public providers that certify the state portion of their payments Family Planning (Title X) services Targeted Case Management for Early Childhood Intervention (ECI) services DME and expendable supplies, including nutritional products Children's hospitals CSHCN outpatient and inpatient claims CSHCN hemophilia claims, drug co-payments, and transportation of remains Drugs/biologicals and supplies for physician/practitioner services Medicare crossover claims Providers should continue to bill their usual and customary charges and not make changes to their billed charges based on any Medicaid payment reduction. For those providers whose usual and customary charges exceed Medicaid fees but use Medicaid fees as their billed charges in order to lessen their accounting adjustments, the billed charges should not change because the Medicaid fees have not changed. Payments for Medicaid and Medicaid Managed Care inpatient claims are not reduced during the claims payment process, rather the actual calculations of the standard dollar amount (SDA) and TEFRA cost reimbursement for inpatient hospitals are reduced. A notification letter was mailed later to each hospital stating its SDA amount, effective for services delivered on or after September 1, Payments to pharmacies for prescriptions are not reduced during the claims process, rather the actual amount of the estimated dispensing expense and inventory management factor were reduced. 2.4 Additional Payments to High- Volume Providers Primary care providers (PCPs) include the following medical professionals: Medical doctors Doctors of osteopathy Independently practicing advanced practice nurses (APNs) defined as family/general practice, internal medicine, obstetrics/gynecology, pediatrics, certified registered nurse midwives, and family and pediatric APNs To receive high-volume add-on payments, high-volume PCPs are those providers who were paid a minimum of 3,600 Medicaid units of service for the qualification period. High-volume PCPs get a 1.9 percent add-on payment for all Medicaid services performed. High-volume specialty care providers are medical professionals enrolled with a provider specialty from the following list: Allergy Anesthesiology Cardiovascular disease Certified registered nurse anesthetist (CRNA) Dermatology Ear, nose and throat Gastroenterology General surgery Geriatrics Hand surgery Nephrology Neurosurgery Nuclear medicine Ophthalmology Orthopedic surgery Pathology Physical medicine and rehabilitation Plastic surgery Proctology Psychiatry Pulmonary disease Radiology Thoracic surgery Urology 2 6

7 Texas Medicaid Reimbursement To receive high-volume add-on payments, high-volume specialists are those specialty care providers who provided units of service in the top 50 percent of total services paid within the specialty during the qualification period. High-volume specialists get a 6.1 percent add-on payment for all Medicaid services performed. To receive high-volume dentist payments, high-volume dentists are those dental providers who were paid a minimum of 3,600 units of service during the qualification period. High-volume dental providers get a 3.7 percent add-on payment for all Medicaid services performed. Outpatient hospital services are those services provided by outpatient hospitals, ASCs/HASCs, and birthing centers. The definition of a high-volume outpatient hospital provider is one that was paid a minimum of $200,000 during the qualifying period. This criterion captured about 95 percent of total outpatient hospital spending. Similar criteria were developed for ASCs/ HASCs and birthing centers, such that providers accounting for 95 percent of total payments were designated as high-volume providers. Payments to high-volume outpatient hospitals were increased by 5.2 percent. The new payment amount was implemented by increasing the discount factor for designated high-volume providers of outpatient hospital services from 80.3 percent to percent. ASCs/HASCs and birthing centers that qualify as high-volume providers also receive a 5.2 percent increase in payment rates. Medicaid payments for services provided by physicians, dentists, and other professionals and outpatient services provided in hospitals, ASCs/HASCs, and birthing centers are reduced by 2.5 percent at the end of the claims payment process. Therefore, any applicable high-volume add-on payments are first added to the payment amount before being reduced by 2.5 percent. 2.5 Medicaid Service Provided Outside Texas Any eligible provider in a state other than Texas who provides services to Texans eligible for Medicaid is entitled to bill the Texas Medicaid Program. The provider must contact TMHP Provider Enrollment to obtain the appropriate forms, requirements, and guidelines for claims filing, complete the forms, and return them to TMHP. The Texas Medicaid Program covers medical services provided to eligible clients while out of state, as long as they do not leave Texas to receive medical care that can be received in Texas. Services provided outside the state are covered in the following instances: A medical emergency documented by the attending physician or other provider. The client's health is in danger if he or she is required to travel to Texas. Services are more readily available in the state where the client is located. The customary or general practice for clients in a particular locality is to use medical resources in the other state. All services provided to adopted children receiving adoption subsidies (these children are covered for all services, not just emergency). Other out-of-state medical care may be considered when prior authorized. Payments to out-of-state providers enrolled in the Medicaid program are made according to the usual, customary, and reasonable charges or the stipulated fee for services as appropriate for the provided care. Payment of practitioners, providers, or suppliers who are reimbursed on a reasonable charge basis may not exceed the lesser of: The Medicaid reasonable charge or fee determined for the same services in the State of Texas or When mutually agreed on by the contractor and state agency, 100 percent of the Medicare reasonable charge determination for the same service in the state where the service was provided. Inpatient hospital stays are reimbursed according to the Texas prospective payment methodology (diagnostic related group [DRG]). Payments made on a reasonable cost basis are mutually determined by the state agency and the contractor. TMHP must receive claims from out-of-state providers within 365 days from the date of service. Refer to: Procedure Codes Requiring Prior Authorization on page Medicare Crossover Reimbursement Part A The payment of the Medicare Part A coinsurance and deductibles for Medicaid clients who are Medicare beneficiaries is based on the following: If the Medicare payment amount equals or exceeds the Medicaid payment rate, Medicaid does not pay the Medicare Part A coinsurance/deductible on a crossover claim. If the Medicare payment amount is less than the Medicaid payment rate, Medicaid pays the Medicare Part A coinsurance/deductible, but the amount of the payment is limited to the lesser of the coinsurance/ deductible or the amount remaining after the Medicare payment amount is subtracted from the Medicaid payment rate

8 Section Part B The payment of the Medicare Part B coinsurance and deductibles for Medicaid clients who are Medicare beneficiaries is based on the following: If the Medicaid client is eligible for Medicaid only as a qualified Medicare beneficiary, Medicaid pays the Medicare Part B coinsurance/deductible on valid Medicare claims. If the Medicaid client is not a qualified Medicare beneficiary, Medicaid pays the client s Part B: Deductible liability on valid, assigned Medicare claims. Coinsurance liability on valid, assigned Medicare claims that are within the amount, duration, and scope of the Medicaid program, and would be covered by Medicaid when the services are provided, if Medicare did not exist. Medicaid payment of a client s coinsurance/deductible liabilities satisfies the Medicaid obligation to provide coverage for services that Medicaid would have paid in the absence of Medicare coverage. 2.7 Federal Financial Participation (FFP) Rate The FFP rate for providers who receive the federal matching share portion of Medicaid reimbursement or the enhanced federal matching share portion of Medicaid reimbursement for services provided to Children s Health Insurance Program (CHIP) clients are effective for dates of service according to the following table: Dates of Service on or after Enhanced FFP Rate FFP Rate July 1, % 71.93% October 1, % 72.61% The FFP is subject to change on October 1 of each year, or as otherwise directed by CMS. 2 8