FQHC Incubator Program Community Grants
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FQHC Incubator Program Community Grants






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  • The 330 exp/req apply to FQHCs
  • The 330 exp/req apply to FQHCs
  • Take uninsured patients as well as Medicaid, Medicare, and CHIP
  • If an organization intends to apply for 330 funding, then the applicant must demonstrate that it will be operational and compliant with all requirements within 120 days of receiving a federal award notice. Non-operational entities have four months to get things going. Operational sites have less of an issue with this requirement. If an organization intends to apply for look-alike status, it must demonstrate in its application that it is currently meeting all section 330 program requirements and serving predominantly the uninsured and underserved. To do this the entity will have to submit a minimum of one month of utilization information as part of application. In a collaboration with existing FQHC, the new location must become part of the existing FQHCs corporate structure Under any of these three paths it is critical that the community or organization seeking FQHC status understand and comply with the section 330 program expectations/requirements.
  • So hopefully by now you have gathered that the way to become an FQHC lies down a road of establishing compliance or meeting all of the FQHC program requirements. For this reason I will now discuss in some detail the program requirements.
  • As mentioned earlier, Board of Directors has to have at least a majority of members that are consumers of clinic services and the consumer members reflect the demographics of the service population Non-consumer members are to be selected for expertise and knowledge they can bring to Board and not more than half of the non-members can be health care professionals
  • The Board of directors has many responsibilities. These include The strategic plan guides the development of an initial organizational work plan, and this work plan is described in the grant application. Tied to the work plan is a operational budget. The work plan and budget are developed by the management team (CEO, CFO, grant writer, etc) and approved by the BOD. Aspects of clinical operations include: hire and dismissal of CEO, approving hours of operations, approving site expansions, approving mix of services, approving contracts, and others
  • Continuum of care Patients have access to all required services on the following slide, access to specialty and hospital services, and after-hours coverage Service Delivery Model Location ensures Accessibility Hours facilitate access to care, typically have some early morning, evening or weekend hours Mix of Services is Responsive to Needs Type of Service Provider Matches Mix of Services Contracting: Secure Services that Center Does Not Provide Written Agreements Required for Contractors Establish Health Care Goals and Objectives Address highest priority health care needs In planning to meet highest needs, consider role of center in community system and center specific actions Collaborate to achieve goals when possible Quality improvement Medical Director, Medical Staffing Board Certified or Residency Trained, Other clinicians licensed as appropriate, Employment is preferred, Fair Compensation and Benefits Package, Credentialing and Privileging – FTCA, Continuing Professional Education, Affiliation with Teaching Programs Clinical Systems: Patient flow and appointment systems Information system the utilization system is critical because the information from it will drive the strategic planning process and development of new services as well as the financial and capital development planning Policies and Procedures : Hours of Operation, Patient Referral & Tracking, Use of Clinical Protocols, Risk Management Procedures, Procedures for Assessing Patient Satisfaction, Consumer Bill of Rights / Patient Grievance Procedures
  • Remember that centers must strive to provide services in a culturally and linguistically appropriate manner
  • Management team is made up of the CEO, CFO, the medical director, and should include key department heads A strong management team is essential for success!!!!! The center must demonstrate the Relationship of Management Staff to Board with clear lines of authority between the Board, the CEO, and the staff CEO Has Authority to Manage day-to-day operations Accountable to Board of Directors Management Team The management team operationalizes the strategic goals and objectives of the organization and assures financial viability and cost competitiveness To do this the management team has to be supported by sound, interrelated systems Information on utilization, finances, and the clinical systems produce the data necessary for the management team to analyze and determine changes needed to adapt to a changing environment. A center has to demonstrate that these systems are in place or will be operational within 120 days of receiving a 330 grant. In addition the Financial System has to have or allow for the following components: Fund Accounting and Internal Controls Budget Billing and Collections Independent Financial Audit Facilities must meet health and safety code standards and ideally JCAHO standards Need room for growth or strategic plan for future growth and development, I.e. addition of social services
  • Grant support includes support for the costs of “enabling services” delivered to uninsured and underinsured populations at sites within the 330 scope of project Health care networks are established for the provision of health services and may include provision of services on a prepaid basis or other managed care arrangement Drug pricing program allows FQHCs to purchase covered outpatient prescription pharmaceuticals for HC patients at substantially reduced prices for distribution either directly by a health center pharmacy or thru contract with retail pharmacy PPS is predicated on cost-based reimbursement methodology that reimburses FQHCs for services on basis of reasonable costs rather than discounted fee-for-service or capitated reimbursement in managed care area
  • New Access Point grants have a one-time allowance to use up to $150,000 for minor capital improvements and equipment. 80% Loan guarantee on commercial loan available for large-scale capital projects. FQHCs can also contract with State Medicaid agencies for FQHC staff to carry out and be reimbursed for outstationing activities at FQHC sites First Dollar reimbursement under Medicare means that deductible is waived, so that is not a barrier for elderly VFC distributes to FQHCs at no charge for either the vaccine or its delivery to FQHCs to be provided by the FQHC to uninsured children.
  • FQHCs have an incredible opportunity to expand their scope of services and serve more uninsured and underserved persons due to ………….
  • Senate Bill provides $10 per year to meet Gov Perry’s $20 MM request for CHC development in state

FQHC Incubator Program Community Grants FQHC Incubator Program Community Grants Presentation Transcript

  • FQHC Incubator Program Community Grants Texas Department of Health Primary Care Office Reviewer Training January 8, 2004
  • In General
    • FQHC Essentials
    • Why We Are Here
      • President’s 5-Year Initiative to Increase FQHCs
    • How We Got Here
      • Senate Bill 610
    • FQHC Incubator Program Components
    • Evaluating the Applications
    • Details of the RFP
  • Introduction to Federally Qualified Health Centers (FQHCs)
  • FQHC 101 Topics
    • Benefits received from FQHC status
    • FQHC Essentials
      • Characteristics
      • BPHC Section 330 program expectations/requirements
    • BPHC funding priorities and application information
  • What is a Federally Qualified Health Center (FQHC)?
    • FQHC
      • Federal designation from Bureau of Primary Health Care (BPHC)
      • assigned to private non-profit or public health care organizations that serve predominantly uninsured or underserved populations
      • meet other service requirements
    • Also called
      • Community/Migrant Health Center (C/MHC)
      • Community Health Center (CHC)
      • 330 Funded Clinic
  • Characteristics of an 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
  • Characteristics of an 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 federal program expectations/requirements and all applicable federal and state regulations
  • Paths to Becoming an FQHC
    • Apply to Bureau of Primary Health Care for Section 330 funding
    • Apply to be an FQHC look-alike and then later apply for 330 funding
    • Collaborate with an existing FQHC to apply as an expansion site
  • Section 330 Program Requirements
    • Four components:
      • Governance
      • Mission and Strategy
      • Clinical program
      • Management and finance
  • Program Requirements: FQHC Governance
    • Board composition
      • Governed by community board
        • 51% consumers of the clinic services
      • Non-consumer requirements
      • 9-25 members
      • By-laws prescribe method for selecting board members
      • Employees and relatives are ineligible
  • Program Requirements: 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
  • Program Requirements: Clinical Program
    • Provides a continuum of care
    • Service Delivery Model
    • Contracting
    • Health Care Planning
    • Clinical Staff
    • Clinical Systems & Procedures
  • Required Services Directly or Through Contract
    • Primary care
    • Dental
    • Mental health
    • Substance Abuse
    • Diagnostic lab and x-ray
    • Prenatal and perinatal
    • Cancer and other disease screening
    • Blood level screenings
      • Lead levels
      • Communicable diseases
      • Cholesterol
    • Prenatal and perinatal
    • 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
  • Program Requirements: Management and Finance
    • Management Staff and Structure
    • Management Systems
      • Utilization
      • Financial
      • Clinical
    • Facilities
  • Benefits of FQHC Status
    • Access to federal grants to support costs of providing uncompensated care
    • Access to federal grants to support the costs of planning and developing a health care network or plan
    • Prospective Payment System reimbursement for services to Medicaid/Medicare patients
      • Reimbursement from Medicaid/Medicare based on actual cost of providing care
    • Access to free medical malpractice coverage under Federal Tort Claims Act (FTCA)
    • PHS Drug Pricing Discounts
  • Benefits of FQHC Status (cont’d)
    • Access to grant support and loan guarantees for capital improvements
    • Right to have out-stationed eligibility workers on-site
    • 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) Provider Placements
  • Public Entities & FQHC
    • (Re)Configure Board of Directors to include BPHC/330 Requirements- 51% consumer (user) majority
    • OR
    • Form a Co-Applicant Board-establishing a
    • subsidiary 501 (c) 3
      • Meets BPHC/330 requirements
      • Public entity cannot have authority over FQHC board with exception of general personnel and fiscal policies
  • FQHC Look-Alike Clinics
    • Meet all of the Section 330 program expectations/requirements, but…
      • Do NOT receive grant support
      • Do NOT receive coverage under Federal Tort Claims Act (FTCA)
  • FQHC Look-Alike Benefits
    • Prospective Payment System reimbursement
    • PHS Drug Pricing Discounts
    • Outstationed eligibility workers on-site
    • “ First Dollar” Medicare reimbursement
    • Vaccines for Children (VFC) Program
    • National Health Service Corps (NHSC) Provider Placements
  • FQHCs Recap
    • Community based clinic
    • Full scope primary care to underserved and uninsured populations
    • Care for all ages
    • Does not turn away people because of an inability to pay
    • Bureau of Primary Health Care Model
      • Applicants to this federal program have to meet the model of an FQHC, not just provide the services of an FQHC
  • President Bush’s New Access Point Initiative
  • President Bush’s New Access Point Initiative
    • 5-year initiative announced in August 2001
    • Plan to double the number of persons CHCs serve
      • Funding for 1,200 new or expanded health center sites
      • 6 million new patients served by health centers
    • $1.2 billion of additional funding to Section 330 program
      • $175 million additional in FY 2002
      • $114 million additional for FY 2003
    • All funding on nationally competitive basis
  • How Texas Is Doing
    • High levels of uninsured
    • High health disparities
    • Only 7% of uninsured served by FQHCs
    • Applications coming from non-operational clinics
    • Only operational clinics are getting funded
    • Lots of need, but not getting funded
  • Where the Money is Going by State (June 2003)
  • Status of FQHCs in Texas
    • 2 New Access Points FY 02
    • 6 New Access Points in FY 03
    • 33 Existing Prior to Incubator Program
    • Texas Association of Community Health Centers Strategic Plan Information
      • 50 new locations-132,663 new users
      • Capacity expansions-158,230 users
    • We are not meeting these projections
  • Barriers to FQHC Funding
    • Lack of technical assistance resources
    • Existing CHCs have not adjusted to “competitive” environment
    • Non-operational clinics
    • Simple mistakes in federal application
      • Narrative=>Healthcare/Business Plan=>Budget
      • Budget numbers don’t match
      • Not following evaluation criteria
      • Incorrectly filling out forms
  • FQHC Incubator Program Mission: Leverage additional federal funds through new and expanded FQHC and FQHC Look-Alike Clinics by helping organizations ramp-up to meet the federal requirements.
  • How We Got Here— Senate Bill 610
    • Part of Gov. Perry’s Campaign Platform 2002
    • Introduced by Senator Nelson and passed with bi-partisan support
      • $10 million per biennium
      • Including $150,000 RFP for additional technical support
    • Funds must be spent by TDH by March 1, 2004
    • Seed Money Only! Not Available after FY05
    • TDH Goal
      • 17 new or expanded FQHCs or FQHC-LAs
  • FQHC Incubator Program Components
    • Planning Grants
    • Development Grants
    • Transitional Operating Support
    • Capital Infrastructure Grants
  • Estimate of Dollar Breakdown $ 750,000 10 $100,000 Capital Improvement $3,125,000 17 $250,000 Transitional Operating Support (TOS) $ 907,000 17 $ 75,000 Development $ 67,500 18 $ 5,000 Planning Estimated Total Est. # Top Award Component
  • Incubator Plan Components
    • Component 1: Planning Grants are designed to support specific technical assistance activities that are key to successful applications.
      • Organizational feasibility studies
      • Board development & 501 (c) 3 application
      • Strategic planning & work plan development
      • Community involvement & collaborations
      • Needs and asset mapping
      • Basic training on FQHC requirements
  • Incubator Plan Components
    • Component 2: Development Grants provide support for development of the organizational and collaborative capacities required of FQHCs.
      • FQHC-Look Alike application development
      • Grant writing
      • Negotiating formal collaborations and memorandums of understanding (MOUs)
      • Staffing to develop collaborative & organizational capacities
      • Technical assistance on any of the above activities
  • Incubator Plan Components
    • Component 3: Transitional Operating Support intends to operationalize community based clinics which increases the likelihood of receiving FQHC & FQHC-LA designation. Funding for Direct Care.
      • Medical supplies
      • Salaries for staff (Physician, Nurse, CEO)
      • Contract
      • Rent
      • Information systems
    • Self-sustaining!
  • Incubator Plan Components
    • Component 4: Capital Improvement Grants are designed to increase the infrastructure of FQHCs and FQHC look-alikes.
      • Major equipment purchases
      • Management information systems, hard and software
      • Major renovations, configuring existing office space, central air conditioning,
      • Purchase or lease of mobile units or temporary facilities
  • FQHC Incubator Program RFP
  • Eligible Applicants
    • Any public or private non-profit entity investigating or developing or expanding a Federally Qualified Health Center (FQHC)
    • Development Grants, Transitional Operating Support, and Capital Infrastructure Grants have additional requirements
    • Includes existing FQHCs if they are planning to apply for Bureau of Primary Health Care (BPHC)
      • New Access Point (NAP)
      • Expanded Medical Capacity (EMC)
      • Service Expansion Grants (SExp)
  • Using the Funds
    • These funds may not replace other funds
    • All contracts will begin on March 1
      • Expenses incurred before March 1 will not be reimbursed
    • All grant related expenses must be incurred by August 31, 2004
    • 6 month budget
  • Performance Measures: Beginning of the Logical Plan
    • We provided them with the performance measures they needed to meet
    • The performance measures provide to you and the applicant are the required steps of developing an FQHC!
    • Performance Measures tables should be filled in
  • Performance Measures: Opportunity to Tailor
    • Applicant may have additional performance measures
    • Select key performance measures should/could be identified as budget deliverables
    • In-kind (internal and external) resources should be identified in leveraged box
  • Present a Logical Plan
    • Work plan should be a description of how they are going to achieve performance measures
    • Budget should reflect that they have adequate resources to accomplish the activities in the work plan
  • Development Grants Performance Measures
    • Correction: “Completed 330 funding application AND/OR FQHC-LA application”
    • A 330 funding application can be prepared after the last federal deadline (June, 2004) so that it is ready for FY 05 funding cycles
    • Identify technical assistance performance measures if applicant is a young organization
  • Transitional Operating Support (TOS) Performance Measures
    • Expectation is, regardless of success in obtaining 330 grant dollars, a new clinic or expanded services will be sustainable after FQHC Incubator Program funds end in FY 05.
    • If applicant also is requesting Development Grant, the timeline measures provided by TOS may dictate application completion dates the Development Grant performance measures section.
    • This is a 6-month budget.
  • Capital Infrastructure Performance Measures
    • Service delivery plan refers to the plan developed under FQHC Incubator Program Development Component OR applicant’s current service delivery plan.
    • Identify additional performance measures that pertain to applicant’s particular project
  • Work Plan
    • Planning grant only applicants:
      • Do not make this more complicated than it is
      • Max of 3 pages where 5 questions answered
    • Identified areas technical assistance and how applicant will go about obtaining
    • Applicants instructed to refer back to the Evaluation Criteria in writing their work plan
    • Applicants for Development Grants in combination with TOS and/or Capital Infrastructure
      • May not have all of the details worked out for TOS and/or Capital Infrastructure work plans and budgets
      • Should indicate what remains to be developed
  • Budget
    • Deliverables based
      • Applicant will be paid when deliverable is completed and documentation provided to the Texas Primary Care Office
      • If deliverables not completed, will not be paid
    • Categorical information will be tracked
      • Salaries, travel, equipment, etc.
      • If in the development process may not have details. Should have provided what is known.
  • Program Income
    • If it is TOS Component, patient revenue should be identified in Program Income.
    • The percentage of total budget that comes from the FQHC Incubator Program is the percentage of Program Income that belongs to the FQHC Incubator Program
    • TOS = 10% of total budget then
    • 10% of program income must be applied to project
  • Total Budget
    • If TOS Component, total cost of operating your clinic/satellite site should be documented (Budget Summary page 51).
    • Include in-kind, other grants
  • Request for Proposal (RFP) Evaluations
  • RFP Evaluation Process
    • TDH review
    • Panel Review
    • Final Selections
    • Contract Negotiations with Applicants
    • Contract Start Date March 1, 2004
  • Why A Panel Review?
    • Opportunity for stakeholder participation
    • Imitates federal process
    • Brings a variety of experiences and perspectives to the table to review applications
    • Creates a transparent process
  • What to Look For in RFP
    • Grant writing and reviewing is not rocket science
    • Logical plan on how they are going to develop an FQHC and when they will apply for additional federal funding
    • Grant budget should be reasonable & logical
    • Applications should reflect community support
    • TDH/PCO wants applicants to succeed!
  • What TDH Does
    • Reviews all applications
    • Screens for eligibility
    • Make sure all of the required attachments are in place
    • Provides staff person to each review committee
    • Provides technical assistance to reviewers on RFP and federal requirements
    • Compiles scores and advisory comments
    • Scrutinizes the budget
    • Makes funding decisions
  • Overall Evaluation Criteria 5
    • Assessment Narrative
    • Description of socio-economic and demographic indicators
    • Other safety net sites, Medicaid/Medicare providers in the community
    • Analysis of barriers to securing FQHC funding or FQHC-LA designation
    • Applicant Background
    • Involvement in healthcare
    • Focused on community primary care needs
    • Cultural competency
    • Work thus far on developing an FQHC including board training from Texas Association of Community Health Centers or the Texas Primary Care Office
    Value Criteria
  • …Overall Evaluation Criteria 20
    • Overall FQHC funding feasibility
    • Commitment of organization to develop safety net clinic
    • Target area will support expanded services
    • Ability and commitment to meeting all FQHC requirements
    • Governing board educated on FQHC requirements and committed to meeting requirements of new or expanded funding
    • Collaborative Efforts
    • Partnerships to increase access to health care specific to this project
    • Current coordination with other FQHCs or potential applicants on this project. If not, then a reasonable explanation for lack of collaboration on this project.
    • Significant history of coordination with the Texas Association of Community Health Centers and/or the Texas Primary Care Office
    Value Criteria
  • Evaluation Criteria Per Component 10
    • Performance Measures and Workplan and Timeline
    • For each of the performance measures listed in Section L, how well does the applicant plan to accomplish each of these measures.
    • Timelines are reasonable; yet show diligent commitment to securing FQHC funding and/or FQHC-LA designation
    • Able to complete in 6 months
    • Does the applicant plan to secure technical expertise and user input at appropriate junctures?
    Value Criteria
  • …Evaluation Criteria Per Component 10
    • Deliverables and Budget
    • Reasonableness of budget
    • Deliverables reflect significant development milestones
    • Deliverables are sufficiently specific
    • Applicants with well-developed internal resources (i.e. existing FQHCs, hospitals, local health departments) demonstrate that significant internal resources are leveraged
    Value Criteria
  • …Evaluation Criteria Per Component 10
    • Readiness for this Component
    • Reasonable preparation thus far for this component
    • Amount of work to complete between award and beginning the activities of this component minimal
    • Likelihood that applicant will not be able to or might choose not to complete some of the performance measures
    30 TOTAL PER COMPONENT Value Criteria
  • Final Score Percentage of Total Points Possible Received Final Score 185 4 Components Applied for Total Possible Points 155 3 Components Applied for Total Possible Points 125 2 Components Applied for Total Possible Points 95 1 Component Applied for Total Possible Points 30 per component Per Component Total Possible 65 Overall Criteria Total Possible
  • Review Process
    • Each application assigned to 3 reviewers
      • Primary Reviewer
      • Secondary Reviewer
      • Reader
    • Reviewers read and score applications
      • Reviewer Tool (purple form and on disk)
    • Present strengths and weaknesses of applications during committee meeting
  • Primary Reviewer Duties
    • Read the application and be the lead presenter during the committee meeting
    • Fully complete the Reviewer Tool on the disk provided before the committee meeting
    • Bring the completed Reviewer Tool on disk and a printed copy to committee meeting
    • Add comments from other committee members to Reviewer Tool during the meeting
  • Secondary Reviewer Duties
    • Read the application and be prepared to augment the presentation of the Primary Reviewer or bring up points of disagreement
    • Complete a written copy of the Reviewer Tool
      • You may choose to complete on disk, but are not required to.
      • If you choose to complete on disk, bring a printed copy to the committee meeting.
    • Be prepared to step in as Primary Reviewer if the assigned Primary Reviewer is unable to complete his/her duties
  • Reader Duties
    • Read the application and be prepared to augment the presentation of the other Reviewers or bring up points of disagreement
    • Complete a written copy of the Reviewer Tool
      • You may choose to complete on disk, but are not required to.
      • If you choose to complete on disk, bring a printed copy to the committee meeting.
  • Reviewer Tips
    • Draw on your area expertise in evaluating the application
    • Be internally consistent on your scoring and the review in general
    • You can agree to disagree with other reviewers
    • Do not ding applicants for listing their barriers to completing the federal process instead…
      • Evaluate if they have given sufficient consideration to what barriers exist
      • Evaluate their plan to address their barriers
    • Use the Texas Primary Care Staff as resources on the RFP and federal requirements
  • Reviewer Essentials
    • 4 Components
      • Planning Grants
      • Development Grants
      • Transitional Operating Support
      • Capital Development Funds
    • Logical Plan
      • Describe in work plan how they will be performance measures and budget enough money to get it done
    • You are not responsible for knowing every detail of the RFP
    • Use Advisory Comments to address areas of concern
    • Bring your area of expertise to the review committee
    • Be internally consistent
  • Concerns
    • If you have concerns about being able to complete your reviews, please contact someone in the Primary Care Office immediately.
    • It is much easier to find a substitute reviewer now than the day before the committee meetings.
    • We know you are all doing this without any additional compensation and we are eternally grateful.
    • We want to make this as easy as possible so please call us if there is something that we can do.
  • Questions?
    • Program or RFP Questions:
      • Jennifer Jones, Kate Martin, Cliff McSparran
      • 512-458-7518
      • [email_address]
      • [email_address]
      • [email_address]
    • Logistics Questions:
      • Vickie Hamilton or Mike Lens
      • 512-458-7518
      • [email_address]
      • [email_address]