Contracting with Managed Care Organizations: Key Issues for Health Centers

By Published On: June 2, 2014

Contracting with Managed Care Organizations (MCOs) and other payors can significantly expand access to Federally Qualified Health Center (FQHC) services and need not be an intimidating process. Before signing your next MCO contract, keep these pointers in mind:

  • FQHCs shouldn’t sign contracts from payors as-is – even if the contact is presented as a “take it or leave it” agreement. FQHCs must comply with special federal regulations, and negotiations may be necessary to ensure that your federal requirements are being met.
  • Be sure to include a robust definitions section – this can save you headaches (and avoid possible litigation) down the road if there are questions about what certain terms in the contract mean.
  • Always obtain and review documents that are cross-referenced in the contract, such as the MCO’s Provider Manual, prior to signing the agreement.
  • Watch out for “all-products” clauses where an MCO attempts to bind the health center to future, unexamined insurance products; the FQHC should include language to preserve its ability to review and opt-in to future products rather than be obligated to join all products.
  • FQHCs should be sure that MCO contracts preserve their ability to seek wraparound payments and apply their sliding fee scale discount when appropriate.
  • Check out NACHC’s Managed Care Handbook for contract checklists and other helpful information.

Have more questions about contracting with MCOs? FTLF can help! Contact our Health Care group at (202) 466-8960.