Pathways to Becoming an FQHC

American Muslim Health Conference

May 9, 2015

Pamela Xichel Cairns, MHAPresident

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Topics

• What are Federally Qualified Health Centers

• Pathways: FQHC and FQHC Look Alike

• Decision Points

What are FQHCs?

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Health Center Program: History and National Context

• Started in 1965; War on Poverty– Dr. Jack Geiger: Boston MA, Mound Bayou, MI– Combine federal funds with community resources – Empower communities to establish and direct health services at the

local level• Largest system of primary care in the U.S.

– Serve 23 million people• Low income. Uninsured, publically insured, under-insured

– Instrumental in the implementation of ACA• Access to services for newly insured

– Training centers: primary care, nursing, behavioral health– Proven to be cost-effective, high-quality– Save $24 billion annually in reduced hospitalization and emergency

room visits

From the National Association of Community Health Centers

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Defining Characteristics All Section 330 Health Centers

• Defined in Section 330 of Public Health Service Act • Non-profit, Community-directed• Serve low-income, medically underserved

communities• Provide comprehensive high quality health services• Ensure access regardless of ability to pay• 19 rigorous requirements.

– Governing board– Required services– Sliding fee scale; billing Medicare and Medicaid– Clinical and operational performance expectations

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FQHC – Financial Basics

Revenues

• Federal Grant*– Usually 20% of total revenue

• Enhanced Medicaid Reimbursement

• “Wrap-around” – protection in risk-based Medicaid contracts

Expenses

• Access to National Health Service Corps Trainees

• Reduced-cost prescription medicine – 340B

• Most professional liability exposure is covered through Federal Tort Claims Act*

• Probable increase in costs associated with compliance• Staff roles• Clinical Services

* Does not apply to Look Alikes

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FQHCs – Financial Basics

Opportunities

• Many previously uninsured now covered by Medicaid

• Significant increase of low income patients covered by Exchange-based insurance products

• Federal grant opportunities specifically for FQHCs, in addition to base awards

• State grant programs and private foundations tend to understand and support FQHCs

Risks and Challenges

• Access to specialty care• Medicaid is increasingly complex

in expansion States – Churning eligibility and enrollment

• Competing on open market – Previously uninsured can choose private providers

• Federal funding not “guaranteed”• Must communicate effectively

with individual donors and private foundations – may perceive no longer need their support

Pathways into the Health Center Program

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Two Paths into Health Center Program

Health Center Program Funding

• Become an “FQHC”• Highly Competitive

Grant Applications– New Access Point (NAP)– Service Area Competition

(SAC)

Health Center Program Look Alike Designation (No federal grant)

• Become an “FQHC Look Alike”• Apply at any time, if eligible

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Two Paths into Health Center Program

Health Center Program Funding

• Key eligibility for New Access Point– Independent, nonprofit; cannot apply

on behalf of another organization – Propose new access point:

• Primary medical care is main purpose• Provide all required services without

regard to ability to pay• Ensures access to all individuals in

target population or service area• At least one permanent site, not

already in the health center program– If new start:

• Medically underserved area

• Ensure fulfillment of 19 requirements within 120 days of award

Health Center Program Look Alike Designation

• Eligibility Requirements– Independent, nonprofit; cannot apply on

behalf of another organization – Serve

• general underserved population,• OR special population: Homeless,

migrant farmworkers, public housing residents

– Fully operational and compliant for 6 months before submission … “the operational period”

• Board• Audit • All required services• Primary medical = main service• Billing Medicaid and Medicare• Medically underserved area

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Two Paths into Health Center Program

Health Center Program Funding

• Key eligibility requirements Service Area Competition– Nonprofit; cannot apply on

behalf of another organization – Current grantee, Current OR

Expanded Service Area;OR Health center seeking to serve existing grantee’s service area through 1+ sites

– Propose to serve defined service area and at least 75% currently served patients

– Propose appropriate use of grant funds; within defined maximum

• Relatively uncommon as a pathway into the Health Center Program, compared to NAP and Look-Alike Designations

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Milestones to FQHC

• Needs Assessment• Plan Services; Budgets• Define Collaborations• Get External Support

Planning

3 – 6 months 2 – 3 months Several months

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Milestones to FQHC Look Alike

• Needs Assessment• Plan Services; Budgets• Define Collaborations• Get External Support

Planning3 – 6 months 6 months Can be 6 months

Decision Points

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Decision Points

• Strategic– Why pursue FQHC status? What are the alternatives?– Where are your starting? Free clinic, behavioral

health provider, private practice, residency clinic…?• Financial

– Costs of preparation– Budget during operational period (Look Alike)– Multiple sources of financial support

• Organizational culture– Board of Directors, Providers, Staff

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Additional Resources

• http://bphc.hrsa.gov/programopportunities/howtoapply/index.html

• http://bphc.hrsa.gov/about/requirements/ • http://chchistory.nachc.org/ - Five-minute video

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Thank you!

Pamela Xichel Cairns, MHAPresident, Leading Healthy Futures

708-927-8121pam@leadinghealthyfutures.comwww.leadinghealthyfutuyres.com