Presentation on theme: "Rebecca M. Johnson, MNPL Mark Meye, CPA"— Presentation transcript:
1 FQHCs and FQHC Look-alikes: A Sustainable Business Model for RW Part C Programs
2 Rebecca M. Johnson, MNPL Mark Meye, CPA Presenters:Rebecca M. Johnson, MNPLMark Meye, CPA
3 Community Link Consulting Your knowledgeable resourcein all things FQHC
4 New Access Point, Service Area Competition Budget Period Renewal Ryan White Grants & Program Support FQHC and Look-alike Grantee Support & Services Financial Management Cost Reporting, UDS, FFR Fee Schedule Review Corporate Compliance / Compliance Reporting Management / Staff / Board Training Strategic Planning Residency Development IT Infrastructure Development and Support
6 RW Reauthorization Uncertainty Why now?Affordable Care ActRW Reauthorization UncertaintyChanges in HIV Disease
7 Objectives: By the end of the presentation you will: Understand the benefits of becoming an FQHC or FQHC LAKnow how the programs differKnow which model best supports your programHave basic information to begin strategic discussions about becoming an FQHC/FQHC-LAHave a road map for pursuing FQHC/LA status
8 Federally Qualified Health Center’s Mission Improve the health of underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary health care services
9 Ultimate Goal…Improving health status (i.e., patient outcomes) of all populations in the target area served by a health center, especially underserved.PIN-96-23
11 1. Reach Medically Underserved Communities Impact: CHCs serve populations who otherwise would not get the care they need; CHCs see publicly insured and uninsured patients in areas where there is a lack of providers and/or providers willing to see this population.
12 2. Governing with Community Involvement Impact: CHCs reflect the needs of the communities they serve.
13 3. Treat Patients Regardless of Ability to Pay Impact: Community Health Centers (CHCs) are the primary care safety net for the uninsured.
14 4. Provide a Comprehensive Scope of Services Impact: No other model of primary health care service delivery offers more services in one location or targets more special populations through one model of care.» Reduce/eliminate health disparities.» Help vulnerable patients successfully manage chronic conditions.» Save money in the health care delivery system by keeping patients out of the hospital and ER.
15 Program Benefits – FQHC Only Grant Funding for Operations under Section 330 of the Public Health Services Act -- $650,000 for New Access PointFTCA – Federal Tort Claims Act Coverage
16 Additional Program Benefits National Service CorpsEnhanced Medicaid/Medicare Rates340 B Pharmacy Access
17 Program Requirements: Comprehensive primary care (directly or contract)After hours careWrap around “enabling” servicesRobust QI Program
18 System Requirements: Ability to bill third party payors Medicaid and Medicare electronic billingFinancial management policies/procedures
19 Shared Compliance Requirements: Annual Uniform Data Set (UDS) Report (similar to RDR/RSR)Grant Cycles (similar to Part C)Cost ReportsFinancial Audit (A-133)
21 SF424A Personnel Fringe Travel Supplies Equipment Contractual Other ExpenseSF424APersonnelFringeTravelSuppliesEquipmentContractualOther
22 Typically 80% Buckets (i.e., programs) Staffing Ratio Expectations PersonnelTypically 80%Buckets (i.e., programs)Staffing Ratio Expectations
23 Revenue Non-Program Revenue Program Income Grants Contracts Donations/FundraisingOther (interest, meaningful use)Program Income
24 Program Income Enhanced Reimbursement Rates Access to Prospective Payment System - wrap payment for MedicaidCost-based reimbursement for Medicaid and Medicare
25 Medicaid Rate Setting Year Medicaid – not intuitiveImpact – long term and potentially detrimental
26 340B PharmacyDiscount drug pricing program requires drug manufacturers to provide outpatient drugs to covered entities at a reduced price
27 Benefits of 340B ProgramReported savings that range between 25-50% for covered outpatient drugs as a result of the low 340B pricesReduces the price of medications for patientsExpands the number of drugs on formulariesIncreases the number of indigent patients servedExpands other services offered to patients by the entity – flexible “profit” – unlike RW
28 Simplified Grant Accounting Typically tied to payrollNo Double Dipping- Charge only one grant
29 Applying for FQHC Grants Needs AssessmentServices – Required and OptionalBusiness PlanGovernance
30 Rebecca M. Johnson, MNPL Health Center Solutions, Inc Rebecca M. Johnson, MNPL Health Center Solutions, Inc Mark Meye, CPA
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