1. CAH and FQHC: Friend or Foe Elizabeth Morgan Burrows, JD Chief Executive Officer Vermillion Parke Community Health Center June 7, 2011

2. 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.

3. 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)

4. 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

5. 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 Be located in a Medically Underserved Area/Population Must provide primary, behavioral, and dental services either on-site or through an arrangement for ALL patients

6. Benefits of an FQHC Enhanced Medicaid and Medicare Reimbursement Medical Malpractice under the Federal Tort Claims Act – Medical Malpractice Insurance is free! 340B Drug Pricing National Health Service Corps – Student Loans are Repaid! Vaccines for Children

7. 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

8. 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

9. The Differences FQHCs 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 RHCs 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

10. Reimbursement FQHC Medicaid: $148 Medicare: $119 Commercial: Same (contracted rate) Must accept uninsured on a sliding fee scale! Private Practice Physician Medicaid: $30 Medicare: $50 Commercial: Same (contracted rate) Do not need to accept uninsured.

11. Lessons Learned: Services You don’t have to do everything on your own from the beginning! Primary Dental Behavioral Pharmacy Outreach/Enabling Services

12. Lessons Learned: 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.

13. How do we work together? Labs Ancillary Services ER Referrals In-patient services After-hours phone service Strong partnership for community activities

14. Strong Partnership = Rapid Growth FQHCs are growing extremely quickly In 2008, we completed over 3,500 encounters. In 2009, over 8,000 encounters. In 2010, over 13,800 encounters. In 2011, over 25,000 encounters.

15. Final Thoughts 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.

16. Conclusion In Vermillion and Parke Counties in Indiana, Union Hospital Clinton and Vermillion Parke Community Health Center are… BEST FRIENDS! But there are still constant challenges that require a lot of communication and commitment to the partnership!

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

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