I have served for over 7 years on the BOD and the Finance Committee for Rockbridge Area Community Health Center and have seen first hand the improvement in community health that this center has promoted.   Over the past several we have provided an average of 35,000 visits/year, the majority of which are Medicaid patients that would otherwise have a very difficult time accessing medical care as many local private practices do not accept Medicaid patients.    Additionally, over the past several years we have expanded from 2 sites to 9 sites in order to improve access to care for this vunerable population.   The financial burden of providing this care is overwhelming as we need to compete for qualified providers by offering competitive saleries and benefits and the cost of supplies continues to increase every year.  In short;  we are asked every year to do more with less and there comes a point where that is just not possible.    We need to be fairly compensated for our Medicaid visits with a fair PPS rate.                                                                                                 The regulation 12VAC30-80-25:B.1 outlines theat beginning October 1, 2001,and for each fiscal year thereafter, each Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) should receive a per-visit payment adjusted annually based on the Medicare Economic Index (MEI) for primary care services.  The reimbursement should also account for any changes in the scope of services offfered by the center.                                                    In light of this, we are asking for the Department of Medical Assistance Services (DMS) to implement a process, as required by the Budget Bill - item 288 WWWW, no later than January 1, 2025, to allow FQHC's to notify the department of changes in the scope of servies we offer.  Additionally, we request reimbursement for any unreimbursed costs incurred prior to this submission as outlined by Federal Law.