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

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

6. 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

7. 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

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

9. 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

10. 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

11. 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

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

13. 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!

14. 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!

15. 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

16. 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.

17. 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.

18. 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

19. 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.

20. 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.

21. Resources www.hrsa.gov www.isdh.in.gov www.raconline.org

22. Elizabeth Morgan Burrows, JD Vermillion-Parke Community Health Center or