Federally Qualified Health Center Look-Alike Application Instructions for Calendar Year
2011/2012
Renewal of Designation and Annual Certification Applications
Call Overview
• FQHC Definition, Benefits, and Eligibility• Application Types, Components, and Content
Overview• Application Submission Information• Review Timelines• Tips for Preparing a Successful Application• Technical Assistance Resources
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What is an FQHC?
Medicare and Medicaid statutes define a provider type: “Federally Qualified Health
Center” (FQHC) – Respectively, Social Security Act §1861(aa)(4) and §1905(l)(2)(B)
• Entity that receives a grant under section 330 of the Public Health Service Act – Health Center Program.
• Entity that is determined by DHHS to meet requirements to receive funding without actually receiving a grant (i.e., FQHC Look-Alike).
• Entities that are outpatient health programs or facilities operated by a tribe or tribal organization under the Indian Self-Determination Act or by an Indian organization receiving funds under Title V of the Indian Health Care Improvement Act. 3
Fundamental Principles
• Private non-profit or public entities that serve a high-need community or population
• Governed by a community board of which at least a majority are health center patients who represent the patient population served
• Provide comprehensive primary care and enabling and supporting services
• Services are available to all, with fees adjusted based upon ability to pay
• Meet all performance and accountability requirements for administrative, clinical, and financial operations
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Benefits
Benefit Health Center Grantees
FQHC Look-Alikes
Grant funding YES NO
Eligible for Medicaid Prospective Payment System (PPS)
YES YES
Eligible for Medicare cost-based reimbursement
YES YES
Access to 340B drug pricing YES YES
Eligible for Federal Tort Claims Act medical malpractice insurance
YES NO
Automatic Health Professional Shortage Area (HPSA) Designation
YES YES
Vaccines for Children YES YES
Eligible for supplemental HRSA funding (PCMH, capital investments, HIT incentive payments)
YES NO
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Eligibility
• Must be a private, charitable, tax-exempt nonprofit organization, OR public entity
• Must serve a medically underserved area (MUA) or medically underserved population (MUP) designated by DHHS
• Must NOT be owned, controlled, or operated by another entity
• Must be operational and providing primary care services at the time of application submission
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FQHC Look-Alike Application Types
Application Type Description
Initial Designation Comprehensive application required for organizations seeking initial FQHC Look-Alike designation
Renewal of Designation
Comprehensive application required for existing Look-Alike organizations to renew their FQHC Look-Alike designation after an initial two-year designation period, and thereafter, typically every five-years
Annual Certification An annual program update submitted by existing FQHC Look-Alikes
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Program Narrative
• Need• Response • Collaboration (New!)
• Evaluative Measures• Impact (Annual Certification application only)
• Resources/Capabilities• Governance
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Forms
Renewal of Designation Application Content Type
Cover Page Form
Form 1A: General Information Worksheet Form
Table of Contents Document
Project Abstract Document
Project Narrative Document
Clinical Performance Measures Form
Financial Performance Measures Form
Form 2: Staffing Profile Form
Form 3: Income Analysis Form Document
Form 3A: FQHC Look-Alike Budget (New!) Form
Form 4: Community Characteristics Form
Form 5A: Services Provided Form
Form 5B: Service Sites Form
Form 5C: Other Activities/Locations (As Applicable) Form
Form 6A: Current Board Member Characteristics Form
Form 6B: Request for Waiver of Governance Requirements Form
Form 8: Health Center Agreements Form
Form 9: Need for Assistance (New!) Form
Form 10: Annual Emergency Preparedness and Management Report Form
Form 12: Contacts Information Form
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Forms
Annual Certification Application Content Type
Cover Page (Required) Form
Project Abstract (Required) Document
Project Narrative (Required) Document
Clinical Performance Measures (Required) Form
Financial Performance Measures (Required) Form
Form 1A: General Information Worksheet (Required) Form
Form 2: Staffing Profile (Required) Form
Form 3: Income Analysis Form (Required Document
Form 3A: FQHC Look-Alike Budget (New!) Form
Form 5A: Services Provided (Read Only) Form
Form 5B: Service Sites (Read Only) Form
Form 5C: Other Activities/Locations (Read Only) Form
Form 6A: Current Board Member Characteristics (Required) Form
Form 8: Health Center Agreements (As Applicable) Form
Form 10: Annual Emergency Preparedness and Management Report (Required) Form
Form 12: Contacts Information (Required) Form
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Attachments
Renewal of Designation Application Content Type
Attachment 1: Service Area Map Document
Attachment 2: Current or Requested MUA/MUP Designation Document
Attachment 3: Governing Board Bylaws Document
Attachment 4: Co-Applicant Agreement for Public Centers (As Applicable) Document
Attachment 5: Affiliation, Contract, and/or Referral Agreements (As Applicable) Document
Attachment 6: Articles of Incorporation Document
Attachment 7: Evidence of Non-Profit or Public Agency Status Document
Attachment 8: Medicare and Medicaid Provider Documentation Document
Attachment 9: Organizational Chart Document
Attachment 10: Position Descriptions for Key Personnel Document
Attachment 11: Resumes for Key Personnel Document
Attachment 12: Schedule of Discounts/Sliding Fee Scale Document
Attachment 13: Most Recent Independent Financial Audit Document
Attachment 14: Letters of Support Document
Attachment 15: Floor Plans Document
Attachment 16: Other Information Document
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Attachments
Annual Certification Application Content Type
Attachment 1: Service Area Map Document
Attachment 2: Governing Board Bylaws (As Applicable) Document
Attachment 3: Affiliation, Contract, and/or Referral Agreements (As Applicable)
Document
Attachment 4: Organizational Chart (As Applicable) Document
Attachment 5: Position Descriptions for Key Personnel (As Applicable)
Document
Attachment 6: Resumes for Key Personnel (As Applicable) Document
Attachment 7: Other Information (As Applicable) Document
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Key Differences Between PIN 2009-06 & the New Instructions
• All applications must be submitted through HRSA Electronic Handbooks (EHB). Renewal of Designation and Annual Certification applications will be submitted according to existing designation periods.
• Data will now be reported separately from the Annual Certification application through the Uniform Data System (UDS) in the EHB. This data will be reported on a calendar year (CY) basis. Data reported in the EHB will no longer be included in the Annual Certification application.
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Key Differences Between PIN 2009-06 & the New Instructions
• Contracts for required services will be summarized in an attachment rather than attached in full, except for contracts that constitute a substantial scope of the project.
• A budget form (Form 3A) has been added to the application requirements.
• The Change in Scope process is unchanged from and can still be found in PIN 2009-06.
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Application Submission
RENEWAL OF DESIGNATION
• Applications must be submitted through the HRSA EHB
– Refer to HRSA’s Electronic Submission User Guide, available online at http://bphc.hrsa.gov/about/lookalike/index.html for detailed application and submission instructions.
• Once the Renewal of Designation application process is started in the EHB system, it must be completed and submitted in a maximum of 90 calendar days.
• Applications that are ineligible or not completed within 90 days will not be considered for designation. Failure to submit the Renewal of Designation application could result in termination of the FQHC Look-Alike designation and all corresponding benefits.
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Application Submission
ANNUAL CERTIFICATION
• Applications must be submitted through the HRSA EHB
– Refer to HRSA’s Electronic Submission User Guide, available online at http://bphc.hrsa.gov/about/lookalike/index.html for detailed application and submission instructions.
• Once the Annual Certification application process is started in the EHB system, it must be completed and submitted in a maximum of 60 calendar days.
• Applications that are ineligible or not completed within 60 days will not be considered for designation. Failure to submit the application could result in termination of the FQHC Look-Alike designation and all corresponding benefits.
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Estimated Timelines
Responsible Entity Step in Process Number of
Days
ApplicantDevelopment and submission of application once the application process has been initiated in the EHB.
90
HRSA Initial review of the application once received in EHB. 75
Applicant Response to any follow-up information requested by HRSA.
30(unless
otherwise specified by
PO)
HRSA HRSA review of applicant response to requested follow-up information. 30
CMS CMS review and approval process 30
RENEWAL OF DESIGNATION APPLICATION
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Estimated Timelines
ANNUAL CERTIFICATION APPLICATION
Responsible Entity Step in Process Number of
Days
ApplicantDevelopment and submission of application once the application process has been initiated in the EHB.
90
HRSA Initial review of the application once received in EHB. 75
Applicant Response to any follow-up information requested by HRSA.
30(unless
otherwise specified by
PO)
HRSA HRSA review of applicant response to requested follow-up information. 30
CMS CMS review and approval process 30
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Preparing for a Successful Application
• Perform a thorough needs assessment early• Request technical assistance from your PCA/PCO
or other experienced health centers• Ensure that the organization is operating in full
compliance with each program requirement, including active involvement and oversight of a governing board
• Ensure that all application forms, attachments, and program narrative provide consistent information
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Key Resources for Application Development
• FQHC Look-Alike Application Instructions 2011-2012 and EHB System User Guides: http://bphc.hrsa.gov/about/lookalike/index.html
• Service Area Overlap: Policy and Process (PIN 2007-09) for guidance on preparing a service area overlap analysis
• Health Center Program Requirements: http://bphc.hrsa.gov/about/requirements/index.html
• FQHC Look-Alike Application Resources document under “Application Help” on the TA page
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Technical Assistance
Program Contacts:– Jennifer Joseph; Chief, Strategic Operations
Branch– Nicole Amado; Public Health Analyst– Telephone: 301-594-4300– Email: [email protected]
Look-Alike Program TA Webpage: – http://bphc.hrsa.gov/about/lookalike/index.htm
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