CFR > Title 42 - Public Health > CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES > SUBCHAPTER B—MEDICARE PROGRAM (parts 405 to 426) > PART 405—FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED > SUBPART X—Rural Health Clinic and Federally Qualified Health Center Services (§405.2400 to §405.2472) > 405.2464—All-inclusive rate.

405.2464—All-inclusive rate.

(a) Determination of rate. (1) An all-inclusive rate is determined by the intermediary at the beginning of the reporting period.
(2) The rate is determined by dividing the estimated total allowable costs by estimated total visits for rural health clinic or Federally qualified health center services.
(3) The rate determination is subject to any tests of reasonableness that may be established in accordance with this subpart.
(b) Adjustment of rate. (1) The intermediary, during each reporting period, periodically reviews the rate to assure that payments approximate actual allowable costs and visits for rural health clinic or Federally qualified health center services and adjusts the rate if:
(i) There is a significant change in the utilization of clinic or center services;
(ii) Actual allowable costs vary materially from the clinic or center's allowable costs; or
(iii) Other circumstances arise which warrant an adjustment.
(2) The clinic or center may request the intermediary to review the rate to determine whether adjustment is required.