fb88

Jun 03, 2022

fb88Care is increasing reimbursement rates for certain services through a cost-of-living adjustment (COLA) as directed by . The COLA will be equal to an increase of 4.94% above the currently established rate(s), which is equal to the percentage increase in the state minimum wage as set by the fb88 Department of Labor as of January 1, 2022.   

These COLAs affect rates for eligible services under the following sections of the fb88Care Benefits Manual (MBM). Services within these Sections with an increase to their rate effective within the 12-month period previous to July 1, 2022 will not receive this COLA. Note that these COLA adjustments only apply to rates specified under these Sections of Policy for eligible services: when a Section of Policy cross-references rates in a separate Section of Policy, the reimbursement provisions in the cross-referenced section of policy dictate the reimbursement amount (e.g. reimbursement for many of the services Section 30 Family Planning providers deliver is driven by reimbursement policy under Section 90. Only those codes referenced under Section 30 would receive this COLA increase—not those under Section 90). 

COLA Rate Adjustments: fb88Care Benefits Manual Section/Title
Section 13
Section 17
Section 23
Section 28
Section 30
Section 40
Section 65
Section 91
Section 92
Section 93
Section 97
Section 102

Medicare Standardization 

fb88Care is amending the year and percentage of Medicare that fb88Care benchmarks for reimbursement of certain services, to move toward a more consistent percentage of Medicare and to utilize current year Medicare rates that the Centers for Medicare & Medicaid Services updates annually.  These changes will be effective July 1, 2022, and are part of the process of implementing recommendations from the Department’s comprehensive rate system evaluation completed by the independent firm Myers and Stauffer, and approved by the legislature in 2021 (P.L. 398).   

Under this updated methodology, the Department will reimburse the indicated services, where Medicare provides a reimbursement rate, at the lowest of the following:  

(1) seventy-two point four percent (72.4%) of the current year’s Medicare rate per code, including appropriate Medicare fee adjustments for place-of-service modifiers in effect at the time of service; or  

(2) the provider’s usual or customary charge.   

This new methodology will apply to services benchmarked to Medicare under the following sections of the fb88Care Benefits Manual. Note that these adjustments only apply to rates and reimbursement methodology specified under these Sections of Policy for eligible services: when a Section of Policy cross-references rates in a separate Section of Policy, the reimbursement provisions in the cross-referenced section of policy dictate the reimbursement amount (e.g. reimbursement for laboratory services under Section 95, Podiatry, is dictated by reimbursement methodology and rates set forth in Section 55, Laboratory Services. Podiatry providers will continue to receive reimbursement for Laboratory services in accordance with Section 55).    

Medicare Benchmark Rate Updates: fb88Care Benefits Manual Section/Title
Section 14
Section 15
Section 30
Section 68
Section 75
Section 85
Section 90	(*see exception below for )
Section 95
Section 101
Section 109

Reimbursement for Enhanced Primary Care Provider services under Section 90, Physician Services will receive 100% of the current year Medicare rate.   

The new rates, effective July 1, 2022, are linked in the table above and are available now on the fb88Care website for all Sections above except for Sections 30 and 101. Rates for Sections 30 and 101 will be available at the corresponding links early in the week of June 6, 2022. On the website, look for the file name that includes the date of July 1, 2022.