Community Health Center Benefits Grant Funded Health Centers & Look-Alikes

Prospective Payment System Provides special Medicaid payments – Based on cost of care – Includes all allowable costs Core services: medical, dental, behavioral health Administration Enabling services Negotiated with State Medicaid programs Provides payment/encounter w/settlement

Enhanced Medicare Payments Special payment rates First dollar coverage (deductibles waived) Cost-based payment formula Subject to national cap Special payment intermediary Requires “Deeming” Limited scope; facility based

Pharmacy Benefit 340B drug pricing program Special program providing lowest drug price available – FQHC price may be adjusted for administrative cost – FQHC price may include margin to increase services to underserved All patients of funded CHC eligible

Recruitment Automatic Health Provider Shortage Area (HPSA) designation, eligible for National Health Service Corps clinical providers – Physicians, physician assistants – Nurse Practitioners, midwives etc – Psychiatrics, LMSWs, psychologists, therapists etc. – Dentists, hygienists NHSC Scholar & Loan Repayment Programs Also state programs, when available

Other Benefits Vaccines for Children program Participation in federal QI programs Access to on-site eligibility workers Part of a national and state community of providers sharing mission & information – HHS HRSA/BPHC; NACHC; MPCA; AHCAHP etc.

Grant Funded Health Centers Additional Benefits Section 330 Grant Funding – Offsets costs of uncompensated care Sliding fee scale, based on ability to pay (<200% FPL) – Offsets costs of enabling services Translation Benefits assistance Transportation Case management Chronic disease management, etc.

Malpractice Coverage (Funded grantees only) Federal Tort Claims Act – Similar to coverage of US military – Covers all in-scope services – Covers the health center corporation CHC grantee must be “deemed” – Eligibility and scope determined – Risk management program required

Other Benefits (Funded grantees only) Federal loan guarantee program (Not Look-Alikes) Eligible to apply for: (Look-Alikes not eligible) – Expanded medical capacity funds – Services expansion funds, etc., etc. – Special benefits (i.e. stimulus awards)

Benefits to Community Providing a health home for all community, particularly the underserved – Alternative to emergency department – Alternative to uncoordinated urgent care Provide needed quality, comprehensive primary care (Providing continuity of care) – Acute primary – Preventive (i.e. immunizations, exams, etc.) – Chronic disease management etc. – Supplemental (health education) and enabling services (translation, cultural competence etc.)

Benefits to Community (Continued) Enhanced insurance and benefit coverage – Medicaid (FQHC bundle of services) – Medicare (First dollar coverage) – Access to benefit eligibility enrollment Medicare Medicaid SCHIP Discounted fees to underserved – Sliding fee scale adjusting fees to ability to pay Special consideration for inclusion in many special federal and state health care programs

Michigan Primary Care Association Neal Colburn Technical Assistance Consultant Michigan Primary Care Association 7215 Westshire Drive Lansing, MI (517) x220