Federally Qualified Health Centers

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1
CROSSROADS CONFERENCE
LUBBOCK, TEXAS
JUNE 5, 2013
Building An Effective Coalition
&
Basic Requirements of the Federally Qualified
Health Centers Program
“FQHC 101”
West Texas Area Health Education Center – Big Country Region
Texas Association of Community Health Centers
2
Specific Problem Addressed
Identify if there is a problem
regarding access to care in Abilene
3
Steps to Create Our Coalition
• AHEC – Responded to community need (neutral)
• Recruiting the Right People
• Formed the Coalition
• Devise a Set of Preliminary Objectives/Activities
• Process Begins
4
Who is Our Coalition?
• Facilitator – AHEC Office
• Representatives from the Hospitals
• Mayor/Other City Officials
• County Officials
• Community Foundations/Leaders
• Medical Society
5
Steps Taken with the Coalition
• Additional Resources
• Nonprofit Luncheon/Workshop
• Data Collection
• Physician Survey
• Dental Survey
• What did the data indicate?
• Patterns
• Strengths of Taylor County
• Barriers to Care
6
Community Needs Assessment
• Gaps in Health Services
• Access to Care and Barriers to Care
• Health Disparities of the Community
7
Service Provider Workshop
• Primary Health Care
• Dental Care
• Medical Specialists
• Mental Health Treatment
8
Primary Care Provider Survey
Results
• 30 Primary Care Providers Responded
• 14 Accept Medicare
• 16 Accept Medicaid
• 14 Accept Uninsured Patients
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Next Steps of the Coalition
• Explore Expansion Opportunities with Existing Clinics
• Establish a FQHC
• Other
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Topics of Discussion
• FQHC characteristics
• BPHC Section 330 program
expectations/requirements
• Benefits received from FQHC status
• How FQHC addresses needs assessment
components
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Characteristics of a FQHC
• Community based non-profit or public primary
health care clinics
• Located in or serving a designated Medically
Underserved Area/Population (MUA or MUP)
• Consumer Board governance structure
• Provide health services to persons in all stages
of the life cycle
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Characteristics of a FQHC (cont’d)
• Provide services to all persons regardless of
ability to pay
• Charge for services on a sliding-fee scale
based on patients’ family income and size
• Comply with Section 330 program
expectations/requirements and all applicable
federal and state regulations
13
Paths to Becoming a FQHC
 Collaborate with an existing FQHC to apply for HRSA
New Access Point (NAP) grant
 Create new not-for-profit that will/does meet all
program requirements to apply or HRSA NAP grant
 Extremely competitive grant application – less than
10% success rate
 Apply to be an FQHC Look-Alike (FQHCLA)
 Not-for-profit that meets all program requirements at the time of
application
 No grant support when designated as a FQHCLA
 More competitive when applying for 330 funding
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Section 330 Program Requirements
• Four components:
• Governance
• Mission and Strategy
• Clinical program
• Management and finance
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FQHC Governance
• Board composition
• Governed by community board
• Non-consumer requirements
• 9-25 members
• By-laws prescribe method for selecting board
members
• Employees and relatives are ineligible
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FQHC Governance
• Board of Directors responsibilities
• Carries legal and fiduciary responsibility for clinic
•
•
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•
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operations and grants
Strategic planning and evaluation of progress toward
organizational goals
Approve Annual Budget & Grant Application
Meet At Least Monthly / Keep Minutes
Full authority over all aspects of clinic operations
No other entity/individual can have the ability to
override or veto governing board decisions
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Mission and Strategy
 Mission: improve health status of underserved
populations
 Strategy:
 Needs assessment - starting point but can be based on
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specific parameters in grant application guidance
Design culturally and linguistically appropriate programs
Measure effectiveness through health and financial
outcomes
Operate efficiently – maximize revenue and grow net
assets
Collaborate with other health care and social service
providers
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Why Demonstrating Need for FQHC is
Important
 HRSA NAP guidance (HRSA 11-017)
 “Information provided on need should serve as the basis
for, and align with, the proposed activities and goals
described in the clinical and performance measures and
throughout the application.”
 “Response” section of NAP application should propose activities
that address health care and other needs in community
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Clinical Program
 Provides a continuum of care
 Primary, secondary and tertiary
 Relies on collaboration with system providers to prevent duplication of
services
 Service Delivery Model
 Must have direct control of majority of health care services
 Contracting
 Only to secure services not provided by center
 Written agreements are required
 Health Care Planning
 Develop goals to impact health care needs and monitor via
health outcomes performance
 Clinical Staff
 Clinical Systems & Procedures
 Focus on electronic health and dental records implementation
and meaningful use
 Others tied to operations and patient satisfaction
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Required Services
FQHC must provide directly or through written agreement
• Primary care
• Child and adult immunizations
• Dental
• Eye and ear screening for
• Mental health
• Substance Abuse
•
• Diagnostic lab and x-ray
•
• Prenatal and perinatal services
•
• Cancer and other disease
•
screening
• Blood level screenings
•
• Lead levels
•
•
• Communicable diseases
• Cholesterol
• Well child services
•
children
Family planning services
Emergency medical
Pharmaceutical
Case management
Outreach and education
Eligibility/Enrollment services
Transportation and
interpretation
Referrals
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Management and Finance Systems
 Systems must ensure that CEO and Board of
Directors have access to timely information that is
critical to sustainability
 MIS combines financial and utilization data for
informed decision-making
 Implementation and meaningful use of electronic
health/dental records
 Utilization is reported to federal authorities annually in the
Uniform Data System report
 Financial system must provide for:
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Accounting and Internal controls
Budget
Billing and Collections
Independent Financial Audit
 Facilities
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Benefits of FQHC Status
CENTER
• Federal grants to support costs
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•
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of uncompensated care*
Prospective Payment System
reimbursement for services to
Medicaid and Medicare patients
Medical malpractice coverage
under Federal Tort Claims Act *
PHS Drug Pricing Discounts
Grant support and loan
guarantees for capital
improvements
Right to have outstationed
eligibility workers on-site
COMMUNITY
 Community-based organization
 Medical home for underserved
 Improved access to
comprehensive health services
 Reduction of use of Emergency
Rooms for non-emergent care
 Economic impact of federal and
state investments
 Potential for additional federal
investment
*FQHC look-alikes do not get federal grant or FTCA coverage
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Benefits of FQHC Status (cont’d)
CENTER
• Reimbursement by Medicare
for “first dollar” of services
(deductible is waived)
• Access to Vaccines for
Children (VFC) Program
• Access to National Health
Service Corps (NHSC)
Placements
• Closely align with definition of
Essential Community
Providers for participation in
Health Insurance Exchanges
COMMUNITY
• Assistance with streamlined
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•
•
Medicaid and CHIP enrollment
Less financial strain on
Medicare patients
Free immunizations for
uninsured children
Additional sources of primary
care and other health
providers
Access to comprehensive
primary care and additional
services for newly insured
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How FQHC Addresses Taylor County
Needs Assessment Components
• Required to serve Medically Underserved Area and target
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services to persons under 200% of Federal Poverty Level
Mission is to increase access to care for uninsured and
underinsured
Required to provide linguistically and culturally
appropriate care
History of reducing health disparities
Dental and behavioral health services
Eligibility assistance for public insurance
Need for clinic that will accept uninsured, Medicaid, and
Medicare
Sliding fee discount for services
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Contact Information
Kelly Cheek
Center Director
West Texas Area Health Education Center
Big Country Region
325-672-0495
[email protected]
Daniel Diaz
Director of Community Development
Texas Association of Community Health Centers
512-329-5959
[email protected]
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