D.C. Mun. Regs. tit. 29, r. 29-4599
For purposes of this chapter, the following terms shall have the meanings ascribed:
Alternative Payment Methodology - A reimbursement model other than a Prospective Payment System Rate for services furnished by an FQHC which meets the requirements set forth in Section 1902(bb)(6) of the Social Security Act.
Capitation payment - A payment an MCO makes periodically to an FQHC on behalf of a beneficiary enrolled with the FQHC pursuant to a contract between the MCO and FQHC. In exchange for the payment, the FQHC agrees to provide or arrange for the provision of the service(s) covered under the contract regardless of whether the particular beneficiary receives services during the covered period.
Encounter - A face-to- face visit between a Medicaid beneficiary and a qualified FQHC health care professional as described in Subsections 4507.2, 4508.2, 4505.15 and 4506.16, who exercises independent judgment when providing services for a primary care, behavioral health service or dental service as described under the State Plan in accordance Section 1905(a)(2) of the Social Security Act. An encounter may also include a visit between a Medicaid beneficiary receiving healthcare services and a provider via telemedicine in accordance with District requirements.
FQHC look-alike - A private, charitable, tax-exempt non-profit organization or public entity that is approved by the federal Centers for Medicaid and Medicare Services and authorized to provide Federally Qualified Health Center Services.
New Provider - An FQHC that enrolls in the District's Medicaid Program after the effective date of the corresponding SPA or after the date that the rates are rebased.
Per Member Per Month (PMPM) payments - A single payment per month by an MCO to an FQHC to cover multiple visits.
Prospective Payment System Rate - The rate paid for services furnished in a particular fiscal year that is not dependent on actual cost experience during the same year in which the rate is in effect.
Single course of treatment - A process or sequence of services that are furnished at the same time or at the same visit.
D.C. Mun. Regs. tit. 29, r. 29-4599