Where is rural Michigan now? - Free clinics of michigan

Report
Introduction To
Federally Qualified Health
Centers (FQHCs)
What is an FQHC?
• Federally Qualified Health Center (FQHC) -
umbrella term for a number of federallysupported safety-net programs. The term also
determines how the programs will be
reimbursed by Medicaid. These programs
include:
– Community/Migrant Health Centers
– Health Care for the Homeless
– Public Housing Health Centers
– School-based, School-linked Health Centers
There are also FQHC ‘Look-Alikes’ (These meet all FQHC
requirements but receive no grant)
2
FQHCs in Michigan
Thirty one (31) Michigan Community
Health Centers provide quality,
comprehensive, community-oriented
primary health care for nearly 600,000
patients annually at 160 sites across the
state. Of those 31 Community Health
Centers, 28 are Federally Qualified
Health Centers (FQHCs), 2 are FQHC
'Look-Alikes’, and 1 is both a FQHC and a
FQHC ‘Look-Alike’.
3
Where are the FQHC
Organizations?
1.
Alcona
2.
Baldwin
3.
Jackson
4.
Detroit (3)
5.
Grand Rapids
6.
Algonac
7.
East Jordan
8.
Battle Creek (2)
9.
Kalamazoo
10.
Carleton
11.
Muskegon (2)
12.
Flint
13.
Saginaw
14.
Lansing
15.
Benton Harbor (2)
16.
Houghton Lake
17.
Shelby
18.
Sault St. Marie
19.
Sterling
20.
Thunder Bay
21.
Marquette
This list does not include
all access points.
4
FQHC Eligibility Requirements
• Must be located in (or serve) a medically
underserved area (MUA) or serve a
medically underserved population (MUP)
• Must be a private nonprofit entity or a
public entity with a compliant co-applicant
board, including tribal, faith-based and
community based organizations
5
FQHC Requirements
• Must have a governing board (board of
•
•
directors) a majority of which must be
consumers of the center’s health services and as
a group represent those being served.
No more than half of non-consumer members
may derive 10% or more of their income from
the health care industry.
Must have a management team that works with
the governing board to achieve the mission of
the center.
6
FQHC Requirements
• Must be accessible, having extended
hours, and having arrangements for off
hour coverage (24/7)
• Must offer a sliding fee scale to adjust fees
to a patient’s ability to pay (<200% FPL;
nominal for <100% FPL)
• Must accept Medicare & Medicaid
• Must provide culturally competent services
7
FQHC Requirements
• Must provide comprehensive system of
care (either directly or by contract)
available & accessible promptly and in a
manner that assures continuity of care,
including required services:
– Basic primary and preventive services
– Referrals to other providers (specialists when
medically indicated) and health related
services and agencies (substance abuse;
mental health)
8
FQHC Requirements
– Case management services (counseling;
referral & follow-up) and services to
assist patients establishing eligibility for
financial assistance programs
– Enabling services: outreach,
transportation and translation
–Health Education: availability &
proper use of health services
9
FQHC Requirements
–Additional health services as
appropriate
• Behavioral Health
• Comprehensive oral health
• Linguistic and cultural competence
• Special populations services (migrant,
homeless, public housing etc.)
10
FQHC Benefits
• Receive Section 330 funds which significantly
•
•
support expanded access to health care services
to underserved populations (Except Look-Alikes)
Receive Medicaid Agency payment rates under
the Prospective Payment System (PPS) or other
State approved alternative payment
methodology (PAL 2001-09; Sec 1902(bb) SSA)
Receive an FQHC Medicare All-Inclusive Rate
11
FQHC Benefits
• Ability to participate in the Public Health Service
•
•
•
•
Act Sections 340B Drug Pricing Program
Automatic HPSA Designation/access to National
Health Service Corps
Ability to access free medical malpractice
insurance under the Federal Tort Claims Act
(FTCA) Note: This does not apply to Look-Alikes.
Access to the federal Vaccines for Children
Program
Access to Bureau of Primary Health Care
technical assistance
12
How do FQHCs make a difference?
• Their mission is to improve access to primary
health care for all persons regardless of –
– Insurance status
– Location
– Age
– Sex
– Race
– Disease Status
13
How do FQHCs make a difference?
• They offer a sliding fee scale to the uninsured and
underinsured.
• Local governance – Health centers are governed by
a volunteer Board of Directors. The majority of
Board Members must be patients of the center.
Boards must be able to hire/fire executive director
(When owned by public entity, have authority
delegated to them to be able to do so.)
• Responsive to community needs – Health centers
tailor their services to fit the special needs and
priorities of their communities.
14
How do FQHCs make a difference?
• Create jobs and stimulate economic growth.
• The Institute of Medicine recognized health
centers for reducing and eliminating the health
gaps for racial and ethnic minorities.
• Cost-effective care – A recent study in Michigan
demonstrated that health centers provide $44.87
per member per month savings to Michigan
Medicaid as compared to other Medicaid
providers.
15
How do FQHCs make a difference?
(cont’d)
• Health centers meet or exceed nationally
accepted practice standards for treatment
of chronic conditions. All health centers
must have a clinical quality program and
submit reports on their clinical outcomes
(clinical measures).
• Quality of care provided at health centers
is equal to or greater than care provided
elsewhere.
16
Web Resources
• Michigan Primary Care Association
www.mpca.net
• National Association of Communty Health
Centers www.nachc.com
• US HHS HRSA Bureau of Primary Health
Care http://bphc.hrsa.gov/
– http://bphc.hrsa.gov/about/
– http://bphc.hrsa.gov/policy/default.htm
– http://bhpr.hrsa.gov/shortage/
17
For more information
•
•
•
•
Kim Sibilsky, Executive Director
Michigan Primary Care Association
(517) 381-8000
[email protected]
•
•
•
•
Neal Colburn, Technical Assistance Consultant
Michigan Primary Care Association
(517) 381-8000 x220
[email protected]
18

similar documents