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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Application Components

• Program Narrative• Forms• Attachments

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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: FQHCLAL@hrsa.gov

Look-Alike Program TA Webpage: – http://bphc.hrsa.gov/about/lookalike/index.htm

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Question & Answer Session

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