CROSSROADS CONFERENCELUBBOCK, TEXASJUNE 5, 2013

Building An Effective Coalition &

Basic Requirements of the Federally Qualified Health Centers Program

“FQHC 101”

West Texas Area Health Education Center – Big Country RegionTexas Association of Community Health Centers

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Specific Problem Addressed

Identify if there is a problem Identify if there is a problem

regarding access to care in Abileneregarding access to care in Abilene

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Steps to Create Our Coalition• AHEC – Responded to community need (neutral)

• Recruiting the Right People

• Formed the Coalition

• Devise a Set of Preliminary Objectives/Activities

• Process Begins

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Who is Our Coalition?• Facilitator – AHEC Office

• Representatives from the Hospitals

• Mayor/Other City Officials

• County Officials

• Community Foundations/Leaders

• Medical Society

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Steps Taken with the Coalition

• Additional Resources• Nonprofit Luncheon/Workshop• Data Collection

• Physician Survey• Dental Survey

• What did the data indicate?• Patterns• Strengths of Taylor County• Barriers to Care

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Community Needs Assessment

• Gaps in Health Services

• Access to Care and Barriers to Care

• Health Disparities of the Community

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Service Provider Workshop

• Primary Health Care

• Dental Care

• Medical Specialists

• Mental Health Treatment

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Primary Care Provider SurveyResults

• 30 Primary Care Providers Responded

• 14 Accept Medicare

• 16 Accept Medicaid

• 14 Accept Uninsured Patients

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Next Steps of the Coalition

• Explore Expansion Opportunities with Existing Clinics

• Establish a FQHC

• Other

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Topics of Discussion

• FQHC characteristics • BPHC Section 330 program expectations/requirements

• Benefits received from FQHC status• How FQHC addresses needs assessment components

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Characteristics of a FQHC

• Community based non-profit or public primary health care clinics

• Located in or serving a designated Medically Underserved Area/Population (MUA or MUP)

• Consumer Board governance structure• Provide health services to persons in all stages of the life cycle

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Characteristics of a FQHC (cont’d)

• Provide services to all persons regardless of ability to pay

• Charge for services on a sliding-fee scale based on patients’ family income and size

• Comply with Section 330 program expectations/requirements and all applicable federal and state regulations

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Paths to Becoming a FQHC

Collaborate with an existing FQHC to apply for HRSA New Access Point (NAP) grant

Create new not-for-profit that will/does meet all program requirements to apply or HRSA NAP grant

Extremely competitive grant application – less than 10% success rate

Apply to be an FQHC Look-Alike (FQHCLA) Not-for-profit that meets all program requirements at the time of

application No grant support when designated as a FQHCLA More competitive when applying for 330 funding

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Section 330 Program Requirements

• Four components:

• Governance

• Mission and Strategy

• Clinical program

• Management and finance

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FQHC Governance

• Board composition • Governed by community board• Non-consumer requirements• 9-25 members• By-laws prescribe method for selecting board

members• Employees and relatives are ineligible

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FQHC Governance

• Board of Directors responsibilities• Carries legal and fiduciary responsibility for clinic

operations and grants• Strategic planning and evaluation of progress toward

organizational goals• Approve Annual Budget & Grant Application• Meet At Least Monthly / Keep Minutes• Full authority over all aspects of clinic operations• No other entity/individual can have the ability to

override or veto governing board decisions

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Mission and StrategyMission: improve health status of underserved

populationsStrategy:

Needs assessment - starting point but can be based on specific parameters in grant application guidance

Design culturally and linguistically appropriate programsMeasure effectiveness through health and financial

outcomesOperate efficiently – maximize revenue and grow net

assetsCollaborate with other health care and social service

providers

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Why Demonstrating Need for FQHC is Important

HRSA NAP guidance (HRSA 11-017)“Information provided on need should serve as the basis

for, and align with, the proposed activities and goals described in the clinical and performance measures and throughout the application.”

“Response” section of NAP application should propose activities that address health care and other needs in community

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Clinical ProgramProvides a continuum of care

Primary, secondary and tertiary Relies on collaboration with system providers to prevent duplication of

servicesService Delivery Model

Must have direct control of majority of health care servicesContracting

Only to secure services not provided by center Written agreements are required

Health Care Planning Develop goals to impact health care needs and monitor via

health outcomes performance Clinical Staff Clinical Systems & Procedures

Focus on electronic health and dental records implementation and meaningful use

Others tied to operations and patient satisfaction

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Required Services

• Primary care• Dental• Mental health• Substance Abuse• Diagnostic lab and x-ray• Prenatal and perinatal services• Cancer and other disease

screening• Blood level screenings

• Lead levels• Communicable diseases• Cholesterol

• Well child services

• Child and adult immunizations• Eye and ear screening for

children• Family planning services• Emergency medical• Pharmaceutical• Case management• Outreach and education• Eligibility/Enrollment services• Transportation and

interpretation• Referrals

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FQHC must provide directly or through written agreement

Management and Finance Systems

Systems must ensure that CEO and Board of Directors have access to timely information that is critical to sustainability

MIS combines financial and utilization data for informed decision-making Implementation and meaningful use of electronic

health/dental recordsUtilization is reported to federal authorities annually in the

Uniform Data System reportFinancial system must provide for: Accounting and Internal controls Budget Billing and Collections Independent Financial Audit

Facilities

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Benefits of FQHC StatusCENTER

• Federal grants to support costs of uncompensated care*

• Prospective Payment System reimbursement for services to Medicaid and Medicare patients

• Medical malpractice coverage under Federal Tort Claims Act *

• PHS Drug Pricing Discounts• Grant support and loan

guarantees for capital improvements

• Right to have outstationed eligibility workers on-site

COMMUNITYCommunity-based organizationMedical home for underserved Improved access to

comprehensive health servicesReduction of use of Emergency

Rooms for non-emergent careEconomic impact of federal and

state investmentsPotential for additional federal

investment

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*FQHC look-alikes do not get federal grant or FTCA coverage

Benefits of FQHC Status (cont’d)

CENTER• Reimbursement by Medicare

for “first dollar” of services (deductible is waived)

• Access to Vaccines for Children (VFC) Program

• Access to National Health Service Corps (NHSC) Placements

• Closely align with definition of Essential Community Providers for participation in Health Insurance Exchanges

COMMUNITY• Assistance with streamlined

Medicaid and CHIP enrollment

• Less financial strain on Medicare patients

• Free immunizations for uninsured children

• Additional sources of primary care and other health providers

• Access to comprehensive primary care and additional services for newly insured

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How FQHC Addresses Taylor County Needs Assessment Components• Required to serve Medically Underserved Area and target

services to persons under 200% of Federal Poverty Level• Mission is to increase access to care for uninsured and

underinsured• Required to provide linguistically and culturally

appropriate care• History of reducing health disparities• Dental and behavioral health services• Eligibility assistance for public insurance• Need for clinic that will accept uninsured, Medicaid, and

Medicare• Sliding fee discount for services

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Contact Information Kelly Cheek Center Director West Texas Area Health Education Center Big Country Region 325-672-0495 kcheek@bcahec.org Daniel Diaz Director of Community Development

Texas Association of Community Health Centers512-329-5959

ddiaz@tachc.org

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