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CMCS Informational Bulletin on Four Walls: Grace Period Extended through February 2025

On September 8, Deputy Administrator and Director of the Center for Medicaid and CHIP Services (CMCS), Dan Tsai, published a CMCS informational bulletin (CIB) announcing the further extension of the “four walls” grace period to February 2025. CMS’s current interpretation of the clinic benefit regulations provided in 42 C.F.R. § 440.90 prohibits Medicaid reimbursement for “clinic services” provided outside of the four walls of a facility. Without this grace period, the current interpretation prevents access to care, including home visits, telehealth, and other necessary outpatient services. The bulletin clarifies that this grace period extension applies to Tribal, IHS-operated, and state facilities.    

The CIB notes the period of unwinding after the COVID-19 public health emergency has increased workloads and potentially complicated a Tribe’s decision about the Federally Qualified Health Center (FQHC) option presented by CMCS in a CIB published on January 15, 2021. CMCS suggested pursuing FQHC status for facilities as a potential solution because the CMS clinic benefit regulations which create the “four walls” rule do not apply to FQHCs. The bulletin also echoed what Mr. Tsai shared at the last TTAG Face-to-Face meeting in July: this extension is meant to signal the agency’s intention to resolve the four walls issue and to give CMS time to work through the complex regulatory impact of such a change and the statutory barriers that exist.