1. Pathways to Becoming an FQHC American Muslim Health Conference May 9, 2015
Pamela Xichel Cairns, MHA President

2. What are Federally Qualified Health Centers
Topics
What are Federally Qualified Health Centers
Pathways: FQHC and FQHC Look Alike
Decision Points

3. Leading Healthy Futures & Lake County Violence Coalition
What are FQHCs?
Leading Healthy Futures & Lake County Violence Coalition
SHOULD BE 1:10

4. Health Center Program: History and National Context
Started in 1965; War on Poverty
Dr. Jack Geiger: Boston MA, Mound Bayou, MI
Combine federal funds with community resources
Empower communities to establish and direct health services at the local level
Largest system of primary care in the U.S.
Serve 23 million people
Low income. Uninsured, publically insured, under-insured
Instrumental in the implementation of ACA
Access to services for newly insured
Training centers: primary care, nursing, behavioral health
Proven to be cost-effective, high-quality
Save $24 billion annually in reduced hospitalization and emergency room visits

5. From the National Association of Community Health Centers

6. Defining Characteristics All Section 330 Health Centers
Leading Healthy Futures & Lake County Violence Coalition
Defining Characteristics All Section 330 Health Centers
Defined in Section 330 of Public Health Service Act
Non-profit, Community-directed
Serve low-income, medically underserved communities
Provide comprehensive high quality health services
Ensure access regardless of ability to pay
19 rigorous requirements.
Governing board
Required services
Sliding fee scale; billing Medicare and Medicaid
Clinical and operational performance expectations
primary medical; dental; mental health, substance abuse; diagnostic, pharmaceutical; enabling services such as enrollment, care coordination; hospital admissions.

7. FQHC – Financial Basics
Leading Healthy Futures & Lake County Violence Coalition
FQHC – Financial Basics
Revenues
Expenses
Federal Grant*
Usually 20% of total revenue
Enhanced Medicaid Reimbursement
“Wrap-around” – protection in risk-based Medicaid contracts
Access to National Health Service Corps Trainees
Reduced-cost prescription medicine – 340B
Most professional liability exposure is covered through Federal Tort Claims Act*
Probable increase in costs associated with compliance
Staff roles
Clinical Services
* Does not apply to Look Alikes

8. FQHCs – Financial Basics
Opportunities
Risks and Challenges
Many previously uninsured now covered by Medicaid
Significant increase of low income patients covered by Exchange-based insurance products
Federal grant opportunities specifically for FQHCs, in addition to base awards
State grant programs and private foundations tend to understand and support FQHCs
Access to specialty care
Medicaid is increasingly complex in expansion States – Churning eligibility and enrollment
Competing on open market – Previously uninsured can choose private providers
Federal funding not “guaranteed”
Must communicate effectively with individual donors and private foundations – may perceive no longer need their support

9. Pathways into the Health Center Program
Leading Healthy Futures & Lake County Violence Coalition
SHOULD BE 1:10

10. Two Paths into Health Center Program
Funding
Health Center Program
Look Alike Designation (No federal grant)
Become an “FQHC”
Highly Competitive Grant Applications
New Access Point (NAP)
Service Area Competition (SAC)
Become an “FQHC Look Alike”
Apply at any time, if eligible

11. Two Paths into Health Center Program
Funding
Health Center Program
Look Alike Designation
Key eligibility for New Access Point
Independent, nonprofit; cannot apply on behalf of another organization
Propose new access point:
Primary medical care is main purpose
Provide all required services without regard to ability to pay
Ensures access to all individuals in target population or service area
At least one permanent site, not already in the health center program
If new start:
Medically underserved area
Ensure fulfillment of 19 requirements within 120 days of award
Eligibility Requirements
Independent, nonprofit; cannot apply on behalf of another organization
Serve
general underserved population,
OR special population: Homeless, migrant farmworkers, public housing residents
Fully operational and compliant for 6 months before submission … “the operational period”
Board
Audit
All required services
Primary medical = main service
Billing Medicaid and Medicare
Medically underserved area

12. Two Paths into Health Center Program
Funding
Key eligibility requirements Service Area Competition
Nonprofit; cannot apply on behalf of another organization
Current grantee, Current OR Expanded Service Area; OR Health center seeking to serve existing grantee’s service area through 1+ sites
Propose to serve defined service area and at least 75% currently served patients
Propose appropriate use of grant funds; within defined maximum
Relatively uncommon as a pathway into the Health Center Program, compared to NAP and Look-Alike Designations

13. Milestones to FQHC 3 – 6 months 2 – 3 months Several months
Planning
Needs Assessment
Plan Services; Budgets
Define Collaborations
Get External Support
Federal Announcement of Opportunity to Apply
Usually a few months from Announcement to Submission
Not enough time for planning and grant application
200 page narrative (NAP) and many forms and attachments
Federal Announcement of Awards
At least a few months from submission; can be longer
If funded, notice of grant award
If not funded, summary of score and review of application
First 120 Days
Begin providing primary care
Fulfill 19 Compliance requirements
3 – 6 months
2 – 3 months
Several months

14. Milestones to FQHC Look Alike
Planning
Needs Assessment
Plan Services; Budgets
Define Collaborations
Get External Support
Start “Operational Period”
All 19 requirements
Board of Directors
All required Services
Revenue Stream
Prepare application page narrative, extensive forms and attachments
HRSA Review
Complete and Eligible? (If not, disapproval)
Compliant? (if not, maybe tech assistance, maybe disapproval)
Recommendations to Medicare/Medicaid
On-site review
Decision
After Designation
Apply for FQHC Medicare and Medicaid numbers, for enhanced reimbursement
Can be 6 months
3 – 6 months
6 months

15. Leading Healthy Futures & Lake County Violence Coalition
Decision Points
Leading Healthy Futures & Lake County Violence Coalition
SHOULD BE 1:10

16. Organizational culture
Decision Points
Strategic
Why pursue FQHC status? What are the alternatives?
Where are your starting? Free clinic, behavioral health provider, private practice, residency clinic…?
Financial
Costs of preparation
Budget during operational period (Look Alike)
Multiple sources of financial support
Organizational culture
Board of Directors, Providers, Staff

17. Additional Resources
- Five-minute video

18. Thank you!
Pamela Xichel Cairns, MHA President, Leading Healthy Futures