Introduction To Federally Qualified Health Centers (FQHCs)

2 What is an FQHC? Federally Qualified Health Center (FQHC) - umbrella term for a number of federally- supported safety-net programs. The term also determines how the programs will be reimbursed by Medicaid. These programs include: Federally Qualified Health Center (FQHC) - umbrella term for a number of federally- supported safety-net programs. The term also determines how the programs will be reimbursed by Medicaid. These programs include: –Community/Migrant Health Centers –Health Care for the Homeless –Public Housing Health Centers –School-based, School-linked Health Centers There are also FQHC ‘Look-Alikes’ (These meet all FQHC requirements but receive no grant)

3 FQHCs in Michigan Thirty one (31) Michigan Community Health Centers provide quality, comprehensive, community-oriented primary health care for nearly 600,000 patients annually at 160 sites across the state. Of those 31 Community Health Centers, 28 are Federally Qualified Health Centers (FQHCs), 2 are FQHC 'Look-Alikes’, and 1 is both a FQHC and a FQHC ‘Look-Alike’. Thirty one (31) Michigan Community Health Centers provide quality, comprehensive, community-oriented primary health care for nearly 600,000 patients annually at 160 sites across the state. Of those 31 Community Health Centers, 28 are Federally Qualified Health Centers (FQHCs), 2 are FQHC 'Look-Alikes’, and 1 is both a FQHC and a FQHC ‘Look-Alike’.

4 Where are the FQHC Organizations? 1.Alcona 2.Baldwin 3.Jackson 4.Detroit (3) 5.Grand Rapids 6.Algonac 7.East Jordan 8.Battle Creek (2) 9.Kalamazoo 10.Carleton 11.Muskegon (2) 12.Flint 13.Saginaw 14.Lansing 15.Benton Harbor (2) 16.Houghton Lake 17.Shelby 18.Sault St. Marie 19.Sterling 20.Thunder Bay 21.Marquette This list does not include all access points.

5 FQHC Eligibility Requirements Must be located in (or serve) a medically underserved area (MUA) or serve a medically underserved population (MUP) Must be located in (or serve) a medically underserved area (MUA) or serve a medically underserved population (MUP) Must be a private nonprofit entity or a public entity with a compliant co-applicant board, including tribal, faith-based and community based organizations Must be a private nonprofit entity or a public entity with a compliant co-applicant board, including tribal, faith-based and community based organizations

6 FQHC Requirements Must have a governing board (board of directors) a majority of which must be consumers of the center’s health services and as a group represent those being served. Must have a governing board (board of directors) a majority of which must be consumers of the center’s health services and as a group represent those being served. No more than half of non-consumer members may derive 10% or more of their income from the health care industry. No more than half of non-consumer members may derive 10% or more of their income from the health care industry. Must have a management team that works with the governing board to achieve the mission of the center. Must have a management team that works with the governing board to achieve the mission of the center.

7 FQHC Requirements Must be accessible, having extended hours, and having arrangements for off hour coverage (24/7) Must be accessible, having extended hours, and having arrangements for off hour coverage (24/7) Must offer a sliding fee scale to adjust fees to a patient’s ability to pay (<200% FPL; nominal for <100% FPL) Must offer a sliding fee scale to adjust fees to a patient’s ability to pay (<200% FPL; nominal for <100% FPL) Must accept Medicare & Medicaid Must accept Medicare & Medicaid Must provide culturally competent services Must provide culturally competent services

8 FQHC Requirements Must provide comprehensive system of care (either directly or by contract) available & accessible promptly and in a manner that assures continuity of care, including required services: Must provide comprehensive system of care (either directly or by contract) available & accessible promptly and in a manner that assures continuity of care, including required services: –Basic primary and preventive services –Referrals to other providers (specialists when medically indicated) and health related services and agencies (substance abuse; mental health)

9 FQHC Requirements –Case management services (counseling; referral & follow-up) and services to assist patients establishing eligibility for financial assistance programs –Enabling services: outreach, transportation and translation –Health Education: availability & proper use of health services

10 FQHC Requirements –Additional health services as appropriate Behavioral Health Behavioral Health Comprehensive oral health Comprehensive oral health Linguistic and cultural competence Linguistic and cultural competence Special populations services (migrant, homeless, public housing etc.) Special populations services (migrant, homeless, public housing etc.)

11 FQHC Benefits Receive Section 330 funds which significantly support expanded access to health care services to underserved populations (Except Look-Alikes) Receive Section 330 funds which significantly support expanded access to health care services to underserved populations (Except Look-Alikes) Receive Medicaid Agency payment rates under the Prospective Payment System (PPS) or other State approved alternative payment methodology (PAL ; Sec 1902(bb) SSA) Receive Medicaid Agency payment rates under the Prospective Payment System (PPS) or other State approved alternative payment methodology (PAL ; Sec 1902(bb) SSA) Receive an FQHC Medicare All-Inclusive Rate Receive an FQHC Medicare All-Inclusive Rate

12 FQHC Benefits Ability to participate in the Public Health Service Act Sections 340B Drug Pricing Program Ability to participate in the Public Health Service Act Sections 340B Drug Pricing Program Automatic HPSA Designation/access to National Health Service Corps Automatic HPSA Designation/access to National Health Service Corps Ability to access free medical malpractice insurance under the Federal Tort Claims Act (FTCA) Note: This does not apply to Look-Alikes. Ability to access free medical malpractice insurance under the Federal Tort Claims Act (FTCA) Note: This does not apply to Look-Alikes. Access to the federal Vaccines for Children Program Access to the federal Vaccines for Children Program Access to Bureau of Primary Health Care technical assistance Access to Bureau of Primary Health Care technical assistance

13 How do FQHCs make a difference? Their mission is to improve access to primary health care for all persons regardless of – Their mission is to improve access to primary health care for all persons regardless of – –Insurance status –Location –Age –Sex –Race –Disease Status

14 How do FQHCs make a difference? They offer a sliding fee scale to the uninsured and underinsured. They offer a sliding fee scale to the uninsured and underinsured. Local governance – Health centers are governed by a volunteer Board of Directors. The majority of Board Members must be patients of the center. Boards must be able to hire/fire executive director (When owned by public entity, have authority delegated to them to be able to do so.) Local governance – Health centers are governed by a volunteer Board of Directors. The majority of Board Members must be patients of the center. Boards must be able to hire/fire executive director (When owned by public entity, have authority delegated to them to be able to do so.) Responsive to community needs – Health centers tailor their services to fit the special needs and priorities of their communities. Responsive to community needs – Health centers tailor their services to fit the special needs and priorities of their communities.

15 Create jobs and stimulate economic growth. Create jobs and stimulate economic growth. The Institute of Medicine recognized health centers for reducing and eliminating the health gaps for racial and ethnic minorities. The Institute of Medicine recognized health centers for reducing and eliminating the health gaps for racial and ethnic minorities. Cost-effective care – A recent study in Michigan demonstrated that health centers provide $44.87 per member per month savings to Michigan Medicaid as compared to other Medicaid providers. Cost-effective care – A recent study in Michigan demonstrated that health centers provide $44.87 per member per month savings to Michigan Medicaid as compared to other Medicaid providers. How do FQHCs make a difference?

16 Health centers meet or exceed nationally accepted practice standards for treatment of chronic conditions. All health centers must have a clinical quality program and submit reports on their clinical outcomes (clinical measures). Health centers meet or exceed nationally accepted practice standards for treatment of chronic conditions. All health centers must have a clinical quality program and submit reports on their clinical outcomes (clinical measures). Quality of care provided at health centers is equal to or greater than care provided elsewhere. Quality of care provided at health centers is equal to or greater than care provided elsewhere. How do FQHCs make a difference? (cont’d)

17 Web Resources Michigan Primary Care Association Michigan Primary Care Association National Association of Communty Health Centers National Association of Communty Health Centers US HHS HRSA Bureau of Primary Health Care US HHS HRSA Bureau of Primary Health Care – – –

18 For more information Kim Sibilsky, Executive Director Kim Sibilsky, Executive Director Michigan Primary Care Association Michigan Primary Care Association (517) (517) Neal Colburn, Technical Assistance Consultant Michigan Primary Care Association (517) x220