Federally Qualified Health Centers:An Overview

August 13, 2014

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Today’s Agenda

• Louisiana Primary Care Association• 19 Key Requirements of FQHCs• Overview of Louisiana’s FQHCs

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MISSION: To serve as “the voice of Louisiana's Health Centers, who believe that all Louisianans deserve access to the highest quality healthcare.”

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Louisiana Primary Care Association

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Louisiana Primary Care Association

• Membership• Responsibilities• Staff• Activities• Relationships

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• Private, nonprofit health centers located in medically underserved areas that provide comprehensive primary care, behavioral health and dental services to all individuals regardless of their ability to pay

• Offer a sliding fee scale based on income for the uninsured

• Receive a federal grant to finance the care for the uninsured

• Receive a special rate for Medicaid services • Accept most forms of private insurance

Federally Qualified Health Centers

• Governed by a community board composed of a majority (51% or more) of health center patients who represent the population served.

• Meet other performance and accountability requirements regarding administrative, clinical, and financial operations.

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Federally Qualified Health Centers

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Overview

• There are 19 Key Health Center Program Requirements (http://www.bphc.hrsa.gov/about/requirements.htm)

• Requirements are divided into four categories: – Need

– Services

– Management & Finance

– Governance

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1. Needs Assessment

Requirement:

– Health center demonstrates and documents the needs of its target population, updating its service area, when appropriate.

http://bphc.hrsa.gov/about/requirements/hcpreqs.pdf

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2. Required and Additional Services

Requirement:

– Health center provides all required primary, preventive, enabling health services and additional health services as appropriate and necessary, either directly or through established written arrangements and referrals.

Note: Health centers requesting funding to serve homeless individuals and their families must provide substance abuse services among their required services (Section 330(h)(2) of the PHS Act)

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3. Staffing RequirementRequirement:

– Health center maintains a core staff as necessary to carry out all required primary, preventive, enabling health services and additional health services as appropriate and necessary, either directly or through established arrangements and referrals. Staff must be appropriately credentialed and licensed.

– Staffing should be culturally and linguistically appropriate for the population being served.

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4. Accessible Hours of Operation/ Locations

Requirement:

– Health center provides services at times and locations that assure accessibility and meet the needs of the population to be served.

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5. After Hours Coverage

Requirement:

– Health center provides professional coverage during hours when the center is closed.

• Includes the provision, through clearly defined arrangements, for access of health center patients to professional coverage for medical emergencies after the center's regularly scheduled hours

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6. Hospital Admitting Privileges and Continuum of Care

Requirement:

– Health center physicians have admitting privileges at one or more referral hospitals, or other such arrangement to ensure continuity of care. In cases where hospital arrangements (including admitting privileges and membership) are not possible, health center must firmly establish arrangements for hospitalization, discharge planning, and patient tracking.

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7. Sliding Fee DiscountsRequirement:

• Health center has a system in place to determine eligibility for patient discounts adjusted on the basis of the patient ability to pay.

• Individuals at or below 100% FPL must receive a full discount on fees for services, however a nominal fee may be charged.

• The fee schedule must slide/provide varying discount levels on charges to individuals between 101% and 200% of the FPL.

• The fee schedule must be based on the most recent Federal Poverty Level/Guidelines, available at http://aspe.hhs.gov/poverty/ and must be updated annually.

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8. Quality Improvement/Assurance Plan

Requirement:

• Health center has an ongoing Quality Improvement/Quality Assurance (QI/QA) program that includes clinical services and management, and that maintains the confidentiality of patient records.

(Section 330(k)(3)(C) of the PHS Act, 45 CFR Part 74.25 (c)(2), (3) and 42 CFR Part 51c.303(c)

(1-2))

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9. Key Management Staff

Requirement:

– Health center maintains a fully staffed health center management team as appropriate for the size and needs of the center. Prior review by HRSA of final candidates for Project Director/Executive Director/CEO position is required.

(Section 330(k)(3)(H)(ii) of the PHS Act and 45 CFR Part 74.25 (c)(2),(3))

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10. Contractual/Affiliation Agreements

Requirement:

– Health center exercises appropriate oversight and authority over all contracted services, including assuring that any subrecipient(s) meets Health Center Program requirements.

(Section 330(k)(3)(I)(ii), 42 CFR Part 51c.303(n), (t)) and Section 1861(aa)(4), Section 1905(l)(2)(B) of the Social Security Act, and 45 CFR Part 74.1(a)(2))

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11. Collaborative Relationships

Requirement:

– Health center makes effort to establish and maintain collaborative relationships with other health care providers, including other health centers, in the service area of the center. The health center secures letter(s) of support from existing health centers (section 330 grantees and FQHC Look-Alikes) in the service area or provides an explanation for why such letter(s) of support cannot be obtained

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12. Financial Management and Control Policies

Requirement:

– Health center maintains accounting and internal control systems appropriate to the size and complexity of the organization reflecting Generally Accepted Accounting Principles (GAAP) and separates functions appropriate to organizational size to safeguard assets and maintain financial stability.

(Section 330(k)(3)(D), Section 330(q) of the PHS Act and 45 CFR Parts 74.14, 74.21 and 74.26)

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13. Billing and Collections

Requirement:

– Health center has systems in place to maximize collections and reimbursement for its costs in providing health services, including written billing, credit and collection policies and procedures.

– Health centers must bill Medicare, Medicaid, CHIP, and other applicable public or private third party payors.

(Section 330(k)(3)(F) and (G) of the PHS Act)

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14. Budget

Requirement:

– Health center has developed a budget that reflects the costs of operations, expenses, and revenues (including the Federal grant) necessary to accomplish the service delivery plan, including the number of patients to be served.

(Section 330(k)(3)(D), Section 330(k)(3)(I)(i), and 45 CFR Part 74.25)

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15. Program Data Reporting Systems

Requirement:

– Health center has systems which accurately collect and organize data for program reporting and which support management decision making.

(Section 330(k)(3)(I)(ii) of the PHS Act)

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16. Scope of Project

Requirement:

– Health center maintains its funded scope of project (sites, services, service area, target population, and providers), including any increases based on recent grant awards.

(45 CFR Part 74.25)

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17. Board Authority

Requirement:

– Health center governing board maintains appropriate authority to oversee the operations of the center.

(Section 330(k)(3)(H) of the PHS Act and 42 CFR Part 51c.304)

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18. Board Composition

Requirement:

– The health center governing board is composed of individuals, a majority (at least 51%) of whom are being served by the center and, who as a group, represent the individuals being served by the center in terms of demographic factors such as race, ethnicity, and sex.

– No more than 50% of the non-consumer board members may derive more than 10% of their annual income from the health care industry.

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19. Conflict of Interest Policy

Requirement:

– Health center bylaws or written corporate board approved policy include provisions that prohibit conflict of interest by board members, employees, consultants, and those who furnish goods or services to the health center.

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FQHC Environment

• Health Reform• Legislation• Technical Assistance• Collaborations• Expansions and Enhancements• National and State Relationships• Outreach & Enrollment

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How do FQHCs Benefit Communities?

• Provide comprehensive preventative and primary care

• Reduce the need for ER visits and hospitalizations

• Improve the health of the local workforce• Provide well paying jobs • Purchase goods and services from other local

businesses

FQHC Data & Accomplishments

• Patient Growth• Facility Expansion• Health Center Controlled Network• Health Information Exchanges• Quality Initiatives• Quality Outcomes• Patient Access

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National 2013 FQHC Grantee Statistics*

• 1,202 FQHC organizations • 21.7 million patients• 85.6 million patient visits• 72% of these patients were < 100% of Poverty• 93% of these patients were < 200% of Poverty • 35% were uninsured • 41% had Medicaid • 157,000 FTE staff

*excludes FQHC Look-Alikes

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Louisiana 2013 FQHC Statistics*

• 31 FQHCs operating over 150 Service Locations• Served over 275,000 patients• Provided more than 960,000 visits• 79% of patients were < 100% of Poverty• 95% of patients were < 200% of Poverty• 37% were uninsured • 42% had Medicaid• Over 1,640 staff

*LA currently has no Look-Alikes; 25 FQHC reporting in 2013

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3420062007

20082009

20102011

20122013

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50,000

100,000

150,000

200,000

250,000

300,000

Unduplicated Pa-tientsPrimary CareDentalBehavioral HealthOther Services

3520062007

20082009

20102011

20122013

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100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

1,000,000

Other VisitsBehavioral Health Vis-itsDental VisitsPrimary Care Visits

Economic Impact

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Facility Expansion Initiative

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• 2007 Legislative Appropriation of $41.5M• Since 2008, over 90 capitol projects have been

completed– New and Expanded facilities, Health IT

• $110M capitol pool• Last few projects remain under construction• $180M economic impact

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Facility Expansion Initiative

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Facility Expansion Initiative

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Facility Expansion Initiative

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Facility Expansion Initiative

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Facility Expansion Initiative

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Facility Expansion Initiative

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Facility Expansion Initiative

Initiatives

• Patient Centered Medical Home• Meaningful Use• Clinical Indicators• Telehealth• Health Center Controlled Network (HCCN)

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Clinical Aspects of Health Centers

• Services (cont.):– Prescription Drugs– Immunizations– Well Child Services– Voluntary Family

Planning– Prenatal, Perinatal, and

Women’s Care– Cancer Screenings

(Breast, Cervical, Prostate, etc.)

– Diabetes Screening and Care

– High blood pressure and high cholesterol screening and care

– Patient Self Management Education

– Disease Prevention and Health Promotion

– Case Management/Social Services

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Clinical Aspects of Health Centers

• Services (cont.): – Transportation – Outreach and

Enrollment– Interpreter Services– Specialty Referrals

• Other Services – Home visiting– Medicare Part D

Counseling

– Disability Determination – Financial Counseling– Legal Counseling– Job search assistance– Voter Registration – Telehealth – Integrated Care

What to bring for a visit:All patients will be asked for the following information. In most

cases, a health center will require written documentation that verifies the information the patient will provide:

1. Patient name, date of birth, social security number, phone number, proof of address/residency (utility bill, driver’s license) proof of insurance (insurance card), proof of income (paystub, tax return), number of people in household

2. Any medical records from a previous provider, if possible, should be brought to first visit. The health center should be able to request these records via fax or electronic transmission if new patient signs a release of information while at the health center.

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What to bring for a visit:

All patients will be asked for the following information. In most cases, a health center will require written documentation that verifies the information the patient will provide:

3. A complete list of all medications patient is currently prescribed and/or taking

4. A list of current immunizations (especially for a pediatric visit)

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Sliding Fee Scale

According to Health Center Policy:1.One form of identification, 2.One form of proof of income, and 3.One form of proof of age and family size.

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Recognitions/Activities• Dr. Gary Wiltz, CEO of Teche Action Clinic, is currently

serving as NACHC board chair• Roderick Campbell, CEO of Iberia Comprehensive CHC

serves on Louisiana Health Care Commission• Multiple New Orleans FQHC CEOs participate in

504HealthNet• Jonathan Chapman, Director of LPCA, serves as board

chair of Louisiana Rural Health Association• Annual Educational and Providers Conferences• Recognized by HRSA for outreach to special

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Comments or Questions?

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www.lpca.net

Louisiana Primary Care Association LPCA1