Federally Qualified Health Centers 101What is a Community Health Center?
Key Characteristics of Health CentersCommunity Health Centers (CHCs), aka Federally QualifiedHealth Centers (FQHCs) and FQHC-Look Alikes Not-for-profit (Public or private) Provide a Comprehensive Scope of Services Located in or serve a high need community - Medically Underserved Area (MUA) or a Medically Underserved Population (MUP) Govern with community involvement (51%-user Board of Directors) Treat patients regardless of ability to pay
Who are health center patients?Collectively, health centers are the Health Care Home for 24 Million Americans• 1 of 7 Uninsured Persons, including – 1 of 5 Low-income Uninsured Persons• 1 of 7 Medicaid Beneficiaries• 1 of 3 Individuals Living in Poverty – 1 out of 4 Minority Individuals Living in Poverty• 1 of 7 Rural Americans Source: NACHC, 2012. Includes patients of federally-funded health• 923,400 Farmworkers centers, non-federally funded health centers, and expected patient growth• 1.1 Million Homeless Persons for 2012.
Who are health center patients? Over 200% 7% 151-200% 0% Health Center Patients 7% Are Predominately Low Income101-150% Source: Federally-funded health centers only. 14% 2010 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Federal Poverty Level (FPL) for a family of three in 2010 was $17,600. (See http://aspe.hhs.gov/poverty/08poverty.shtml.) Based on percent known. Percents may not total 100% due to rounding. 100% and below 72%
Who are health center patients? Private Other 14% Most Health Center Patients Public are Uninsured or Publicly 3% InsuredMedicare Uninsured 7% 38% Other public may include non-Medicaid SCHIP and state-funded insurance programs. Source: Federally-funded health centers only. 2010 Uniform Data Medicaid/ System, Bureau of Primary Health Care, HRSA, DHHS. SCHIP Note: Percents may not total 100% due to rounding. 38%
Where are health centers located?There are more than 1,200 health centerorganizations serving more than 24 millionpatients in over 8,000 rural and urbancommunities.>>Locate a Community Health Center<<
Why support health centers?Proud History: 45+ years of bringing high-quality health care tounderserved communities, giving people served ownership & controlof delivery systemLargest National Primary Care Network: 24+ million people servedRecord of Achievement: cited by IOM, OMB, and GAO for excellencein care, disparities reduction, cost-effectiveness, and communitybenefitBipartisan Support: Congressional majority and two Presidents praisework, mission of health centers, call for continuation & growth
Health Center Program RequirementsA. NeedB. ServicesC. Management and FinanceD. Governance
Health Center Program RequirementsA) Patient Need• Needs Assessment: Health center demonstrates and documents the needs of its target population, update its service area when appropriate.• Required and Additional Services: 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 referralsNote: CHCs requesting funding to serve homeless individuals and theirfamilies must provide substance abuse services among their required services.
Health Center Program RequirementsB) Services• After Hours Coverage: Health center provides professional coverage during hours when the center is closed.• Hospital Admitting Privileges & Continuum of Care: Health center physicians have admitting privileges at one or more referral hospitals, or other such arrangements to ensure continuity of care. In cases where hospital arrangements (including admitting privileges and membership) are not possible, the health center must firmly establish arrangements for hospitalization, discharge planning, and patient tracking.
Health Center Program RequirementsB) Services• Sliding Fee Discounts: Health center has a system in place to determine eligibility for patient discounts adjusted on the basis of the patient’s ability to pay.System must provide a full discount to individuals and families with annualincomes at or below 100% of the Federal Poverty guidelines (only nominalfees may be charged) and for those with incomes between 100% and 200% ofpoverty, fees must be charged in accordance with a sliding discount policybased on family and income.
Health Center Program RequirementsB) Services• Quality Improvement/Assurance Plan: Health centerhas an ongoing qualityimprovement/assurance programthat includes clinical services andmanagement, and that maintainsthe confidentiality of patient records.
Health Center Program RequirementsC) Management and Finance• Program and Reporting Requirements: Health center has systems that accurately collect and organize data for program reporting.• Financial Management & Control Policies: Health center maintains accounting and internal controls systems. Health center ensures that an annual independent financial audit is performed in accordance with federal audit requirements.
Health Centers’ Revenue Sources Do Not Resemble Those of Private Physicians 10.0% Self-Pay/Uninsured 11.6% Private Insurance 4.5% 9.9% 64.0% Other Public Medicare 6.8% 64.0% Medicaid/SCHIP 25.3% Source: Private Physician data: 2009 National Ambulatory Medical Care Survey (visits). NACHC, 2012. Based on Bureau of Primary Health Care, HRSA, DHHS, 2010 Uniform Data System. Note: Private 15.5% Physicians does not equal 100% due to reporting in NAMCS. Health Center Private Physicians
Health Center Program RequirementsD) Governance• Board Authority: CHC governing board maintains appropriate authority to oversee the operations of the center.• Board Composition: CHC has a governing board of between 9 and 25 members. A majority (51%) of the governing board members MUST BE patients of the center and they represent the individuals served by the center in terms of demographic factors such as race, ethnicity, and gender. The non-consumer members of the board must be representative of the community, and no more than half of them may derive more than 10% of their annual income from the health care industry.
Interested in Becoming a FederallyQualified Health Center? Follow this link to our guide http://tiny.cc/NewStartFQHC
PartnersThere are several state and national partnerorganizations who support health centersthrough training and technical assistance:NACHCPCAsPCOsHRSA/BPHC
What is NACHC?• National Association of Community Health Centers is a membership-supported organization, providing training, technical assistance, group purchasing programs, leadership and professional development, lobbying/advocacy, and group purchasing programs.• NACHC provides strong advocacy before Congress and with federal administrative and regulatory bodies on all major issues that affect health centers and our mission.
What is HRSA?Health Resources and Services Administration (HRSA)HRSA, an agency of the U.S. Department of Health and HumanServices, is the primary Federal agency for improving access tohealth care services for people who are uninsured, isolated ormedically vulnerable.Within HRSA, the Health Centers Program is managed andfunded through the Bureau of Primary Health Care (BPHC)>>Learn more about HRSA and BPHC<<
What are PCAs?State/Regional Primary Care Associations (PCAs)• PCAs are private, non-profit organizations that provide a wide spectrum of services individualized to state needs and may include: – Training and technical assistance to health centers – Support for the development of health centers in their state – Operational diagnostics and support – Leadership Development – Group Purchasing Programs – Workforce Retention and Recruitment – Lobbying and Advocacy with state regulatory and legislative entities – And More….! >>Complete listing of the PCA organizations<<
What are PCOs?Primary Care Offices (PCOs)PCOs are state-based offices that provide assistance tocommunities seeking Health Professional Shortage Area (HPSA)designations and funding for health centers such as Communityand Migrant Health Centers and Health Care for the Homelesshealth centers. PCOs work collaboratively with Primary CareAssociations, relevant HRSA programs and offices and otherorganizations to increase access to primary and preventivehealth care and improve the status of underserved andvulnerable populations.>>Complete listing of the PCOs<<
America’s Voice for Community Health CareNational Association of Community HealthCenters Mission: To promote the provision ofhigh quality, comprehensive and affordablehealth care that is coordinated, culturally andlinguistically competent, and communitydirected for all medically underserved people.Learn more about NACHC: www.NACHC.org
CFAHC, a project of NACHCCampaign For America’s Health Centers Mission:To do everything we can to stop threats to healthcenters and health center patients! We want to providea way for every health center, every patient and everycommunity that has or needs a health center to act topreserve, strengthen and expand America’s HealthCenters.Join us! http://www.saveourchcs.org/join-the-campaign.cfm