Slide 1

Report
RHC AND FQHC:
What are They and
F
How Do I Get One?
Selena Munoz, Community Development Specialist
Texas Association of Community Health Centers (TACHC)
(512) 329-5959/[email protected]
Community Health Centers
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Established in the 1960s
Local, non-profit or public entity
Must be located in a MUA/MUP
Consumer Based Governance – 51% of board
membership must be actual consumers of health
center services
Must charge a Sliding Fee Scale
No Patient Rejected Based on Ability to Pay
Provide health services to persons in all stages of
the life cycle
Meet other service and program requirements
What is a Federally Qualified Health Center
(FQHC)?
• A provider type under Medicaid and Medicare
• Two types of FQHC
o Deemed – a grant funded health center
o Look Alike – a health center that meets all FQHC
requirements but is not funded
What is a Federally Qualified Health Center
(FQHC)?
• PHS Act Section 330 Funded Health Centers:
o Community Health Center (CHC) – 330(e)
o Migrant Health Centers 330(g)
o Health Care for the Homeless Programs 330(h)
o Public Housing Primary Care Programs 330(i)
Goals of the Community Health Center Program
• Improve access to care
• Low costs of care
• Reduce the need for more expensive hospital
in-patient and specialty care
Benefits of FQHC Status
CENTER
COMMUNITY
Federal grants to support costs of
uncompensated care
Community Based Organization
Prospective Payment System
reimbursement for services to
Medicaid and Medicare patients
Access to comprehensive health
services
Medical malpractice coverage under Reduction in use of Emergency
Federal Torts Claim Act (FTCA) –
Rooms for non-emergent care
funded centers only
PHS Drug Pricing Discounts
Additional sources of primary care
and other health providers
Benefits of FQHC Status con’t
CENTER
COMMUNITY
Grant support and loan guarantees
for capital improvements
Economic impact of federal and
state investments
Access to out-stationed eligibility
workers on site
Assistance with streamlined
Medicaid and CHIP enrollment
Access to Vaccines for Children (VFC) Free immunizations for uninsured
program
children
Access to National Health Service
Corps (NHSC) placements
Reduces to barriers to care for the
elderly (Medicare deductible
waived)
Paths to Becoming an FQHC
• Apply to Bureau of Primary Health Care for
330 funding
• Apply to be an FQHC Look-Alike and then later
apply for 330 funding
• Collaborate with an existing FQHC to apply as
an expansion site
Health Center Revenue
Texas Community Health Centers
Insurance Status
Texas Community Health Centers
Section 330 Program Requirements
• Four Components:
o Governance
o Mission and Strategy
o Clinical Program
o Management and Finance
FQHC Governance
• Board Composition:
o Governed by consumer majority community board
o Non-consumer requirements
o 9-25 members
o Bylaws prescribe method for selecting members
Mission and Strategy
• Mission: improve health status of
underserved populations
Strategy
Assess
Operate
Collaborate
Measure
Design
Clinical Program
• Provides continuum of care
• Service Delivery Model – must have direct
control of majority of health care services
• Contracting –secure services Center does not
provide; written agreements required
• Health Care Planning
• Clinical Staff
• Clinical Systems & Procedures
Required Clinical Services:
Directly or Through Contract
Primary Care
Preventive Medical
Care
Pharmaceutical
Dental Services
Well Child Services
Case Management
Referrals (specialty/
hospital)
Child and Adult
Immunizations
Eye and Ear
Screening for Kids
Prenatal and
Perinatal Services
Cancer & Other
Disease Screening
Blood Level
Screenings:
Diagnostic lab &
x-ray
Family Planning
Services
- Lead Levels
- Communicable
diseases
- Cholesterol
Substance Abuse
Emergency Medical
Mental Health
Required Additional Services
Enabling Services:
Patient Education
Interpretation
Social Services
Eligibility/Enrollment
Services
Outreach to the
uninsured/underinsured
Transportation
Management and Finance Systems
• Systems must ensure that CEO and Board have
access to timely information critical to
sustainability
• MIS combines financial and utilization data for
informed decision making
FQHC Look Alike Clinics
• Must meet all of the Section 330 program
expectations/requirements, but do NOT
receive grant support
• Must be fully operational for at least one
month to be eligible to apply for Look Alike
status
FQHC Look Alike Benefits
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Prospective Payment System reimbursement
PHS Drug Pricing Discounts
Outstationed eligibility workers on site
Vaccines for Children (VFC) Program
National Health Service Corps (NHSC)
placements
• “First Dollar” Medicare reimbursement
FQHC Development Resources
TACHC http://www.tachc.org/
o Technical Assistance
o Trainings
o Membership Programs
Texas Primary Care Office
http://www.dshs.state.tx.us/chpr/default.aspx
o Loan Repayment and R&R program
o J1 Visa Waiver
o FQHC Incubator Program
HRSA/BPHC http://www.bphc.hrsa.gov/
o PINs and PALs
o Technical Assistance
NACHC http://www.tachc.org/
o Technical Assistance
o Trainings
o Membership Programs
Thank you!
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Selena Munoz, Community Development Specialist
Texas Association of Community Health Centers (TACHC)
(512) 329-5959/[email protected]

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