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

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

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

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

From the National Association of Community Health Centers

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.

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

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

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

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

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

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

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

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. 160 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

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

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

Additional Resources http://bphc.hrsa.gov/programopportunities/howtoapply/index.html http://bphc.hrsa.gov/about/requirements/ http://chchistory.nachc.org/ - Five-minute video

Thank you! Pamela Xichel Cairns, MHA President, Leading Healthy Futures 708-927-8121 pam@leadinghealthyfutures.com www.leadinghealthyfutuyres.com