On September 23, 2013, CMS published a proposed rule that would establish the methodology and payment rates for the new Medicare Federally Qualified Health Center (FQHC) PPS, as mandated by the ACA. Under the proposed rule, FQHCs would be paid a single encounter-based per diem rate per Medicare beneficiary, which currently is estimated to be $155.90. This amount would be subject to a geographic adjustment factor GAF to reflect geographic differences in costs. In addition, the per diem rate would be increased by approximately 33% when an FQHC furnishes care to a patient that is new to the FQHC or to a beneficiary receiving a comprehensive initial Medicare visit. CMS seeks comments on other potential adjustment factors it considered but is not proposing, including adjustments for preventive care encounters. The FQHC PPS would be effective for cost reporting periods beginning on or after October 1, 2014. The rule also would allow rural health clinics (RHCs) to contract with nonphysician practitioners when statutory requirements for employment of nurse practitioners and physician assistants are met, and make other technical and conforming changes to the RHC and FQHC regulations. Finally, the rule would amend the Clinical Laboratory Improvement Amendments (CLIA) of 1988 with regarding to enforcement actions for proficiency testing referral, in conformance with the Taking Essential Steps for Testing (TEST) Act of 2012. CMS will accept comments on the proposed rule until November 18, 2013.