What is Medicaid Change in Scope?

Medicaid Change in Scope (CIS) refers to an adjustment in the reimbursement rate that a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) receives from Medicaid due to significant changes in the scope of services provided. This process ensures that Medicaid payments accurately reflect the costs of delivering care when an FQHC or RHC experiences substantial operational changes.

 
 

Since Medicaid reimburses FQHCs and RHCs based on a Prospective Payment System (PPS), changes in the scope of services can impact costs. Without an updated reimbursement rate, clinics might not receive sufficient Medicaid payments to cover the true costs of providing care. The CIS process allows them to request rate adjustments to align with their current service model.

When may a CIS occur for your Health Center?

If you answered YES

to any of these, We can help you!

 

  • Is your state’s Medicaid CIS process difficult to follow?

  • How many states have recently submitted a Medicaid CIS Cost Report?

  • Could expert guidance improve the submission process for your Health Centers?

  • Do your health centers understand the financial impact of a Medicaid CIS compared to grants?

Here is how CLC can serve you in the Medicaid CIS process:

  • We simplify the Medicaid CIS Application process

  • Offer on-site or virtual training tailored to your Health Center’s needs

  • Develop clearly documented procedures to streamline CIS requests

  • Make it efficient for your Health Center and help unlock financial benefits.