Minnesota Rural Health Conference
“Cornerstones of Rural Health: Access, Community, Quality, Value”
June 27-28, 2011
Duluth, Minnesota
FQHC:
IS NOW THE TIME?
LAURA LIPKIN, MINNESOTA ASSOCIATION OF COMMUNITY HEALTH CENTERS
CRAIG BAARSON, MDH, OFFICE OF RURAL HEALTH & PRIMARY CARE
SHARON ERICSON, CEO, VALLEY COMMUNITY HEALTH CENTER
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• Overview
• Financing
• One Community’s Story
• Questions
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The FQHC Program
• 1960s “War on Poverty”
-- Jobs & Health Care
-- Focus on both Rural & Inner City
-- Local, Community-Based
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The FQHC Program
FQHC = CHC
Community Health Center
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Community Health Centers Today
-- $2.1 Billion Program
-- Urban/Rural Balance
-- 1,200 CHCs with 8,000 Clinic Sites
-- Serve > 20 Million People
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The FQHC Program
• 45 years of strong bipartisan support from
Congress and Presidents
– Doubled capacity during G. W. Bush administration
• Cited by OMB, GAO, & IOM for excellence in
care, disparities reduction, cost-effectiveness,
and community benefit
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MN Community Health Centers
• 17 independent, community-based
organizations
– 6 agencies have 19 locations in Greater Minnesota
– 11 agencies have 25 locations in Twin Cities
• 187,000 Minnesotans served in 2010
– Live in 50% of state’s zip codes
• 1 out of 6 uninsured in MN receive care at a
Community Health Center
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MN Community Health Centers
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20. Urban Health Centers – 11 CHCS
FQHC Program & Health Care Reform
• Vision under Affordable Care Act: FQHCs are a
key component of the Primary Care Delivery
system
• Provides a Trust Fund of $11 B for new and
expanded FQHCs over 5 years starting in 2010
• Additional 20 M people to be served
• Community Health Model of Care
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FQHC Benefits for Communities*
• Federal Grants (PHS 330, under HRSA):
– Up to $650,000/year to improve access to primary health
care services for low-income and uninsured populations
– Eligible for other competitive funding
• Federal loan guarantees
– Network development and capital improvements
• Federal Tort Claims Act (FTCA): malpractice
insurance for the health center and staff clinicians
* thru CHC grantees only
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FQHC Benefits for Communities*
• National Health Service Corps
• Loan Repayment/Scholarships
• Section 340B Drug Pricing Program:
outpatient prescription drugs for CHC patients at
substantial discounts
*also thru FQHC Look-Alikes and some other Safety Net providers
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FQHC Benefits for Communities*
• Enhanced reimbursement on MC & MA visits
Ensures fair payment for costs of patients on Medicare and
Medicaid, so federal grant dollars can be used for
uninsured
Medicare – “Reasonable Cost”
FQHC Rural/Urban cap disparity ends in 2014
Medicaid – “Prospective Payment”
*also thru Look-Alikes & RHCs
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FQHC Benefits for Communities
• Medicare deductibles waived for health center
Medicare beneficiaries, allowing health center to get 1st
dollar reimbursement for those services
• Safe harbor under Anti-kickback Statute waiver of
copayments for patients < 200% federal poverty guidelines
• Federal Vaccine for Children - Free vaccine program
for uninsured children
• Medicaid Eligibility Workers may be available to
health centers at state expense
*also thru Look-Alikes
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FQHC Eligibility Requirements
• Must be located in a Medically Underserved
Area (MUA) or serve a Medically Underserved
Population (MUP).
• Must be incorporated as a non-profit or as a
public organization.
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FQHC Eligibility Requirements
Governance:
• Independent Board of Directors – 51% must be
users, i.e. patients, of the health center (the primary care clinic that
is supported by the CHC grant funding).
• Board truly in control – No other entity can have
authority over the CHC!
• 3 key positions:
– Executive Director must report to CHC Board
– Finance Director & Medical Director must be
supervised by CHC Executive Director
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FQHC Eligibility Requirements
Serving the Uninsured:
• Must accept all patients regardless of ability to
pay and offer a sliding fee scale discount to
patients with incomes < 200% of FPG.
• Full discounts must be offered to those with
incomes < 100% of FPG, but reasonable nominal
fees may be collected.
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FQHC Eligibility Requirements
Community Health Model of Care
• Must offer comprehensive preventive & primary
care services to all age groups.
• Must offer referral, patient case management
and “enabling” services as needed by patient base.
NOTE: “Enabling services” include outreach, referral,
transportation, language translation, etc.
• Partnerships and collaboration are encouraged.
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FQHC Required Services
Community Health Model of Care
• Primary health care related to family medicine,
internal medicine, pediatrics, and ob/gyn
• Preventive health services for all ages
– Includes preventive dental services
• Mental health and substance abuse services
• Diagnostic laboratory and radiology services
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FQHC Required Services
Community Health Model of Care
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Chronic Disease Management
Electronic Health Records/Meaningful Use
Health Care Home
Continuous Quality Improvement
CHC Accountabilities to HRSA
1) Demonstrate program meets all governance,
fiscal, management, and clinical standards
- Scrutiny through
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Federal Project Officer
Federal Site Review
Annual “Budget Period” re-application*
Service Area Competition every 5 years*
*Applications include clinical, business, and quality improvement plans
which the CHCs report on to HRSA.
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CHC Accountabilities to HRSA
2) Demonstrate that funds are being used to
subsidize care for uninsured & underinsured
– Uniform Data System (UDS) Report, annual
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Patients by age, gender, race, poverty level, etc.
Types & costs of services delivered
Utilization and sources of revenue
Percentage of grant used for sliding fee scale discounts
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CHC Accountabilities to HRSA
3) Demonstrate funds are being used in
compliance with federal regulations
-
Administrative Regulations
Cost Principles
Grants Policy Statement
A-133 Single Audit
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CHC Accountabilities to HRSA
You will need experienced management
and financial staff:
• A-133 Single Audit
• Regular Accounting Audit
• Uniform Data System (UDS) Report
• Medicare Cost Report
• Meaningful Use
• Annual Grant Renewal
• 5-year competitive grant cycle
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Competitive Application Process
• In 2007, 79 out of 219 applications funded (~ 1/3)
• 800 applications in 2010: initially expected to fund
300; after 2011 budget reduction, 60-70 to be funded
• 1 application cycle each year
• Good application requires about 250 hours – many
applicants hire professional grant writers
• *Look-Alike applications are an ongoing process.*
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In summary
• The FQHC program offers many ongoing
community benefits; BUT
– Cannot just turn a private practice, RHC, or other
nonprofit clinic into an FQHC
– A complex program with a different culture
– Takes Commitment – Time – Money
-
1 to 2 years of planning
Up to ~ $.5 M for operational set-up
If awarded a HRSA grant, must be operational within
120 days!
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Community Health Centers
IT CAN BE DONE - IT IS BEING DONE!
QUESTIONS? Contact
• Laura Lipkin, Minnesota Association of
Community Health Centers
• [email protected]
• 612-253-4715 x 13
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