Federally Qualified Health Center (FQHC)

Patient-Provider Relationship

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Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Federal

Last updated 12/14/2023

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Alabama

Last updated 02/26/2024

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Alaska

Last updated 02/27/2024

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Arizona

Last updated 02/09/2024

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Arkansas

Last updated 02/06/2024

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California

Last updated 12/20/2023

An FQHC is not precluded from establishing a new patient …

An FQHC is not precluded from establishing a new patient relationship through video synchronous interaction.

An FQHC may not establish a new patient relationship using an audio-only synchronous interaction. Notwithstanding this prohibition, the department may provide for specific exceptions to this prohibition, which shall be developed in consultation with affected stakeholders and published in departmental guidance. Exceptions shall include but not be limited to:

  • An FQHC or RHC may establish a new patient relationship using an audio-only synchronous interaction when the visit is related to sensitive services, as defined in subdivision (n) of Section 56.05 of the Civil Code, or when the patient requests an audio-only modality or attests they do not have access to video – in accordance with department-specific requirements and consistent with federal and state laws, regulations, and guidance.

An FQHC is not precluded from establishing a new patient relationship through an asynchronous store and forward modality, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, if the visit meets all of the following conditions:

  • The patient is physically present at the FQHC or RHC, or at an intermittent site of the FQHC or RHC, at the time the service is performed.
  • The individual who creates the patient records at the originating site is an employee or contractor of the FQHC, or other person lawfully authorized by the FQHC to create a patient record.
  • The FQHC determines that the billing provider is able to meet the applicable standard of care.
  • An FQHC patient who receives telehealth services shall otherwise be eligible to receive in-person services from that FQHC pursuant to HRSA requirements.

SOURCE: WIC 14132.100, as amended by SB 184 (2022 Session) and AB 32 (2022 Session). (Accessed Dec. 2023).

New Patient – FQHCs and RHCs are not precluded from establishing a new patient relationship through a synchronous video interaction or asynchronous store and forward if all the following conditions are met:

  • The patient is physically present at an originating site that is a licensed or intermittent site of the FQHC or RHC at the time the service is performed.
  • The individual who creates the patient records at the originating site is an employee or contractor of the FQHC or RHC, or other person lawfully authorized by the FQHC or RHC to create a patient record.
  • The FQHC or RHC determines that the billing provider is able to meet the applicable standard of care.
  • An FQHC or RHC patient who receives telehealth services shall otherwise be eligible to receive in-person services.

Established Patient – A Medi-Cal eligible recipient who meets one or more of the following conditions:

  • The patient has a health record with the FQHC that was created or updated during a visit that occurred in the clinic or during a synchronous telehealth visit in a patient’s residence or home with a clinic provider and a billable provider at the clinic. The patient’s health record must have been created or updated within the previous three years.
  • The patient is homeless, homebound or a migratory or seasonal worker (HHMS) and has an established health record that was created from a visit occurring within the last three years that was provided outside the originating site clinic, but within the FQHC’s service area. All consent for telehealth services for these patients must be documented.
  • The patient is assigned to the FQHC by their Managed Care Plan (MCP) pursuant to a written agreement between the plan and the FQHC.

SOURCE: CA Department of Health Care Services (DHCS). Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual. Jan. 2023. Pg. 12. (Accessed Dec. 2023).

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Colorado

Last updated 01/29/2024

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For general information about forming a patient-provider …

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For general information about forming a patient-provider relationship see: Colorado Professional Requirements Online Prescribing

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Connecticut

Last updated 01/10/2024

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For general information about prescribing see: CT

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For general information about prescribing see: CT Professional Requirements Online Prescribing

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Delaware

Last updated 01/15/2024

No explicit FQHC reference found.

For general information about forming …

No explicit FQHC reference found.

For general information about forming a patient-provider relationship see: DE Professional Requirements Online Prescribing

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District of Columbia

Last updated 12/07/2023

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Florida

Last updated 02/23/2024

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For general information about prescribing see: Florida

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For general information about prescribing see: Florida Professional Requirements Online Prescribing

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Georgia

Last updated 01/31/2024

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Hawaii

Last updated 02/13/2024

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Idaho

Last updated 02/13/2024

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Illinois

Last updated 02/27/2024

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Indiana

Last updated 12/05/2023

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Iowa

Last updated 01/15/2024

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Kansas

Last updated 12/06/2023

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Kentucky

Last updated 12/11/2023

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Louisiana

Last updated 02/15/2024

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Maine

Last updated 02/03/2024

An initial assessment, which must include a direct encounter with …

An initial assessment, which must include a direct encounter with the member, and his/her family if appropriate, shall be performed and included in the member’s FQHC record. The assessment must include the member’s medical and social history and must include the member’s diagnosis and the professional who made the diagnosis and that person’s credentials.

SOURCE: MaineCare Benefits Manual, Federally Qualified Health Centers, 10-144 Ch. 101, Sec. 31, Updated 12/01/16, pg. 7. (Accessed Feb. 2024).

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Maryland

Last updated 02/21/2024

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For general information about forming a patient-provider …

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For general information about forming a patient-provider relationship see: MD Professional Requirements Online Prescribing

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Massachusetts

Last updated 01/12/2024

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Michigan

Last updated 01/19/2024

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Minnesota

Last updated 02/29/2024

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Mississippi

Last updated 12/23/2023

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Missouri

Last updated 01/20/2024

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Montana

Last updated 02/13/2024

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Nebraska

Last updated 01/04/2024

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Nevada

Last updated 12/18/2023

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New Hampshire

Last updated 12/19/2023

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New Jersey

Last updated 02/02/2024

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New Mexico

Last updated 02/26/2024

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New York

Last updated 11/18/2023

Federally Qualified Health Centers will be reimbursed for the provision …

Federally Qualified Health Centers will be reimbursed for the provision of offsite primary care services to existing FQHC patients in need of professional services available at the FQHC, but, due to the individual’s medical condition, is unable to receive the services on the premises of the center. FQHC offsite services must:

  • consist of services normally rendered at the FQHC site.
  • be rendered to an FQHC patient with a pre-existing relationship with the FQHC (i.e., the patient was previously registered as a patient with the FQHC) in order to allow the FQHC to render continuous care when their patient is too ill to receive on-site services, and only to patients expected to recover and return to become an on-site patient again. Off-site services may not be billed for patients whose health status is expected to permanently preclude return to on-site status.
  • be rendered only for the duration of the limiting illness, with the intent that the patient return to regular treatment as an on-site patient as soon as their medical condition allows.
  • be an individual medical service rendered to an FQHC patient by a physician, physician assistant, midwife or nurse practitioner.
  • not be rendered in a nursing facility or long term care facility, to any patient expected to remain a patient in that facility or at that level of care.
  • not be billed in conjunction with any other professional fee for that service, or on the same day as a threshold visit.

SOURCE: NY Codes, Rules and Regulations, Title 10, Section 86-4.9. (Accessed Nov. 2023).

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North Carolina

Last updated 12/12/2023

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North Dakota

Last updated 02/19/2024

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Ohio

Last updated 02/16/2024

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Oklahoma

Last updated 12/04/2023

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Oregon

Last updated 12/20/2023

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Pennsylvania

Last updated 09/11/2023

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Puerto Rico

Last updated 12/18/2023

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Rhode Island

Last updated 02/01/2024

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South Carolina

Last updated 02/08/2024

No explicit FQHC reference found.

For general information about prescribing …

No explicit FQHC reference found.

For general information about prescribing see: SC Professional Requirements Online Prescribing

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South Dakota

Last updated 12/21/2023

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Tennessee

Last updated 01/21/2024

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Texas

Last updated 01/07/2024

The need for a valid practitioner-patient relationship is discussed for …

The need for a valid practitioner-patient relationship is discussed for Medicaid generally, but not specifically for FQHCs.

See: Medicaid Miscellaneous section.

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Utah

Last updated 02/28/2024

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For general information about forming a patient-provider …

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For general information about forming a patient-provider relationship

See: Utah Professional Requirements Online Prescribing

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Vermont

Last updated 12/05/2023

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Virgin Islands

Last updated 12/18/2023

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Virginia

Last updated 01/05/2024

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Washington

Last updated 12/15/2023

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West Virginia

Last updated 02/14/2024

No explicit FQHC reference found.

For general information about forming …

No explicit FQHC reference found.

For general information about forming a patient-provider relationship see: WV Professional Requirements Online Prescribing

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Wisconsin

Last updated 01/09/2024

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Wyoming

Last updated 01/31/2024

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Federally Qualified Health Center (FQHC)

Patient-Provider Relationship

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