What is an FQHC Look-Alike and what benefits does one receive?

A Look-Alike is an organization that meets all of the eligibility requirements of an organization that receives a PHS Section 330 grant, but does not receive grant funding. Look-Alikes receive many of the same benefits as FQHCs, including:

  • Reimbursement under the Prospective Payment System (PPS), in which Medicare payment is made based on a national rate which is adjusted based on the location of where the services are furnished. The rate is increased by 34.16 percent when a patient is new to the FQHC/Look-Alike, or an Initial Preventive Physical Exam (IPPE) or Annual Wellness Visit (AWV) is furnished. 
  • Reimbursement under the Prospective Payment System (PPS) or other State-approved Alternative Payment Methodology (APM) for services provided under Medicaid
  • Eligibility to purchase prescription and non-prescription medications for outpatients at reduced cost through the 340B Drug Pricing Program
  • Automatic designation as a Health Professional Shortage Area (HPSA). The HPSA designation provides eligibility to apply to receive National Health Service Corps (NHSC) personnel and eligibility to be a site where a J-1 Visa physician can serve