Resource - Indiana Rural Health Association

Report
CAH and FQHC: Friend or Foe
Elizabeth Morgan Burrows, JD
Chief Executive Officer
Vermillion Parke Community Health Center
June 7, 2011
What are all these “HCs?”
• FQHC – Federally Qualified Health Center
– In hearing about the Affordable Care Act,
Community Health Centers are all FQHC
• RHC – Rural Health Clinic
• State-funded CHC – Community Health Center
– Indiana provides tobacco settlement money to
fund state-funded CHCs.
• FQHCs and RHCs can also be state-funded
CHCs but not all of them are.
Currently in Indiana…
• There are 47 state-funded
Community Health
Centers
• 19 of the 47 are Federally
Qualified Health Centers
• 9 of the 47 are Rural
Health Clinics
• 62 Rural Health Clinics (9
are state-funded CHCs)
MUA/MUP and HPSA
• To start an FQHC, the
site must be located in
a Medically
Underserved Area or
Population
• To start an RHC, the
site must be in a
MUA/MUP or Health
Professions Shortage
Area
FQHCs
• Non-profit entity
• Governed by a consumer driven governing
board (51% of the board members must be
patients of the clinic)
• Serve ALL patients regardless of their ability to
pay through a Sliding Fee Scale
• Be located in a Medically Underserved
Area/Population
• Must provide primary, behavioral, and dental
services either on-site or through an
arrangement for ALL patients
Benefits of an FQHC
• Enhanced Medicaid and Medicare
Reimbursement
• Medical Malpractice under the Federal Tort
Claims Act
– Medical Malpractice Insurance is free!
• 340B Drug Pricing
• National Health Service Corps
– Student Loans are Repaid!
• Vaccines for Children
State-Funded CHCs
• Must meet a set of minimum standards
outlined by the state
• These standards are less stringent than FQHC
standards
• Must have a consumer-driven governing
board
RHCs
• Special Medicaid and Medicare
reimbursement
• Must be “certified” through CMS
• Staffed at least 50% of the time with a
midlevel provider
• Can be for-profit or non-profit
• Can be provider-based
• Must be in a rural area and in a HPSA OR
MUA/MUP
The Differences
FQHCs
• Receive federal operational
grant funding
• Subject to many more federal
regulations
• Medicaid PPS Rate
• Must be non-profit
• Governed and owned by a
community governing board;
cannot be owned by a hospital
or health system (exception
for public Entities
RHCs
• Reimbursed at the Medicare
All-inclusive rate by
Medicaid and Medicare
• Can be for-profit or nonprofit
• Can be owned by a hospital
or other health system
Reimbursement
FQHC
• Medicaid: $148
• Medicare: $119
• Commercial: Same
(contracted rate)
• Must accept uninsured
on a sliding fee scale!
Private Practice Physician
• Medicaid: $30
• Medicare: $50
• Commercial: Same
(contracted rate)
• Do not need to accept
uninsured.
Lessons Learned: Services
• You don’t have to do everything on your own
from the beginning!
• Primary
• Dental
• Behavioral
• Pharmacy
• Outreach/Enabling Services
Lessons Learned: Community Support
• Without the support of Union
Hospital Clinton and the entire Union
Hospital Organization, we would not
be the success that we are now.
How do we work together?
•
•
•
•
•
•
Labs
Ancillary Services
ER Referrals
In-patient services
After-hours phone service
Strong partnership for community activities
Strong Partnership = Rapid Growth
• FQHCs are growing extremely
quickly
• In 2008, we completed over
3,500 encounters.
• In 2009, over 8,000
encounters.
• In 2010, over 13,800
encounters.
• In 2011, over 25,000
encounters.
Final Thoughts
• FQHCs are hard work!
• The feds are actually there to help!
• There are always more people to
serve than the capacity that you
have.
• Other FQHCs and associations are
there to help.
• Serving members of my community
is the most rewarding experience of
my life.
Conclusion
• In Vermillion and Parke Counties in Indiana,
Union Hospital Clinton and Vermillion Parke
Community Health Center are…
BEST FRIENDS!
• But there are still constant challenges that
require a lot of communication and commitment
to the partnership!
Resources
•
•
•
•
•
www.hrsa.gov
www.isdh.in.gov
www.raconline.org
www.indianapca.org
www.indianaruralhealth.org
Elizabeth Morgan Burrows, JD
Vermillion-Parke Community
Health Center
[email protected]
765-828-1003 or 765-492-9042

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