Primary Practices in Underserved Areas: FQHCs and RHCs Elizabeth Morgan Burrows, JD Chief Executive Officer Vermillion Parke Community Health Center October 27th, 2010

What are all these “HCs?” FQHC – Federally Qualified Health Center In hearing about the Affordable Care Act, Community Health Centers are all FQHC RHC – Rural Health Clinic State-funded CHC – Community Health Center Indiana provides tobacco settlement money to fund state-funded CHCs. FQHCs and RHCs can also be state-funded CHCs but not all of them are.

Currently in Indiana… There are 47 state-funded Community Health Centers 19 of the 47 are Federally Qualified Health Centers 9 of the 47 are Rural Health Clinics 62 Rural Health Clinics (9 are state-funded CHCs)

MUA/MUP and HPSA To start an FQHC, the site must be located in a Medically Underserved Area or Population To start an RHC, the site must be in a MUA/MUP or Health Professions Shortage Area

Starting an FQHC FQHCs received funding under Section 330 of the Public Health Service Act. This funding is for operational expenses. Program Assistance Letter 98-23 spells out all the federal requirements. Must be located in an MUA or MUP. New Access Point Funding is currently available through HRSA.

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 Scale Must provide primary, behavioral, and dental services either on-site or through an arrangement for ALL patients

Benefits of an FQHC Enhanced Medicaid and Medicare Reimbursement Medical Malpractice under the Federal Tort Claims Act 340B Drug Pricing National Health Service Corps Vaccines for Children

FQHC Look-Alike Organization meets all requirements of a Section 330 grant. No Grant funding for FHQC Look-Alikes. Receives all other FQHC “benefits.”

State-Funded CHCs Must meet a set of minimum standards outlined by the state These standards are less stringent than FQHC standards Must have a consumer-driven governing board

RHCs Special Medicaid and Medicare reimbursement Must be “certified” through CMS Staffed at least 50% of the time with a midlevel provider Can be for-profit or non-profit Can be provider-based Must be in a rural area and in a HPSA OR MUA/MUP

The Differences FQHCs RHCs Receive federal operational grant funding Subject to many more federal regulations Medicaid PPS Rate Must be non-profit Governed and owned by a community governing board; cannot be owned by a hospital or health system (exception for public Entities Reimbursed at the Medicare All-inclusive rate by Medicaid and Medicare Can be for-profit or non-profit Can be owned by a hospital or other health system

Lessons Learned since I started an FQHC 3 years ago. If I knew then what I know now…

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!

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!

If I knew then… - Services You don’t have to do everything on your own from the beginning! Primary Dental Behavioral Pharmacy Outreach/Enabling Services

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.

If I knew then… – Rapid Growth FQHCs are growing extremely quickly In 2008, we completed over 3,500 encounters. In 2009, over 8,000 encounters. In 2010, we are expected to complete over 14,000 encounters.

If I knew then… - Policies and Procedures FQHCs must have many policies and procedures established when they are started QI plan Credentialing Plan After-hours Call Policy Sliding Fee Scale implemented Risk Management Plan Recruitment and Retention Plan And Many More

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.

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.

Resources www.hrsa.gov www.isdh.in.gov www.raconline.org www.indianapca.org www.indianaruralhealth.org

Elizabeth Morgan Burrows, JD Vermillion-Parke Community Health Center emorgan@vpchc.org 765-828-1003 or 765-492-9042