Presentation on theme: "Primary Practices in Underserved Areas: FQHCs and RHCs"— Presentation transcript:
1 Primary Practices in Underserved Areas: FQHCs and RHCs Elizabeth Morgan Burrows, JD Chief Executive OfficerVermillion Parke Community Health CenterOctober 27th, 2010
2 What are all these “HCs?” FQHC – Federally Qualified Health CenterIn hearing about the Affordable Care Act, Community Health Centers are all FQHCRHC – Rural Health ClinicState-funded CHC – Community Health CenterIndiana provides tobacco settlement money to fund state-funded CHCs.FQHCs and RHCs can also be state-funded CHCs but not all of them are.
3 Currently in Indiana…There are 47 state-funded Community Health Centers19 of the 47 are Federally Qualified Health Centers9 of the 47 are Rural Health Clinics62 Rural Health Clinics (9 are state-funded CHCs)
4 MUA/MUP and HPSATo start an FQHC, the site must be located in a Medically Underserved Area or PopulationTo start an RHC, the site must be in a MUA/MUP or Health Professions Shortage Area
5 Starting an FQHCFQHCs received funding under Section 330 of the Public Health Service Act. This funding is for operational expenses.Program Assistance Letter spells out all the federal requirements.Must be located in an MUA or MUP.New Access Point Funding is currently available through HRSA.
6 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 ScaleMust provide primary, behavioral, and dental services either on-site or through an arrangement for ALL patients
7 Benefits of an FQHC Enhanced Medicaid and Medicare Reimbursement Medical Malpractice under the Federal Tort Claims Act340B Drug PricingNational Health Service CorpsVaccines for Children
8 FQHC Look-AlikeOrganization meets all requirements of a Section 330 grant.No Grant funding for FHQC Look-Alikes.Receives all other FQHC “benefits.”
9 State-Funded CHCsMust meet a set of minimum standards outlined by the stateThese standards are less stringent than FQHC standardsMust have a consumer-driven governing board
10 RHCs Special Medicaid and Medicare reimbursement Must be “certified” through CMSStaffed at least 50% of the time with a midlevel providerCan be for-profit or non-profitCan be provider-basedMust be in a rural area and in a HPSA OR MUA/MUP
11 The Differences FQHCs RHCs Receive federal operational grant fundingSubject to many more federal regulationsMedicaid PPS RateMust be non-profitGoverned and owned by a community governing board; cannot be owned by a hospital or health system (exception for public EntitiesReimbursed at the Medicare All-inclusive rate by Medicaid and MedicareCan be for-profit or non-profitCan be owned by a hospital or other health system
12 Lessons Learned since I started an FQHC 3 years ago. If I knew then what I know now…
13 If I knew then what I know now – Community Support You need to have community support and the support from your medical community.You need individuals that are dedicated to making the health center a success.You also need patients!
14 If I knew then… - Governing Board The consumer-driven governing board is the integral foundation of the FQHC. Having board members that are committed to the health center’s mission is the key to success!
15 If I knew then… - Services You don’t have to do everything on your own from the beginning!PrimaryDentalBehavioralPharmacyOutreach/Enabling Services
16 If I knew then… – 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.
17 If I knew then… – Rapid Growth FQHCs are growing extremely quicklyIn 2008, we completed over 3,500 encounters.In 2009, over 8,000 encounters.In 2010, we are expected to complete over 14,000 encounters.
18 If I knew then… - Policies and Procedures FQHCs must have many policies and procedures established when they are startedQI planCredentialing PlanAfter-hours Call PolicySliding Fee Scale implementedRisk Management PlanRecruitment and Retention PlanAnd Many More
19 If I knew then… - The Deeming Process FQHCs received medical malpractice coverage under the Federal Tort Claims Act.Must be deemed for FTCA coverage.Deeming process reviews your QI plan and the staff and board’s efforts for continual improvement.
20 If I knew then… 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.