Primary Practices in Underserved Areas: FQHCs and RHCs
Elizabeth Morgan Burrows, JDChief Executive Officer
Vermillion Parke Community Health CenterOctober 27th, 2010
What are all these “HCs?”
• FQHC – Federally Qualified Health Center– In hearing about the Affordable Care Act,
Community Health Centers are all FQHC• RHC – Rural Health Clinic• State-funded CHC – Community Health Center– Indiana provides tobacco settlement money to
fund state-funded CHCs. • FQHCs and RHCs can also be state-funded
CHCs but not all of them are.
Currently in Indiana…
• There are 47 state-funded Community Health Centers
• 19 of the 47 are Federally Qualified Health Centers
• 9 of the 47 are Rural Health Clinics
• 62 Rural Health Clinics (9 are state-funded CHCs)
MUA/MUP and HPSA
• To start an FQHC, the site must be located in a Medically Underserved Area or Population
• To start an RHC, the site must be in a MUA/MUP or Health Professions Shortage Area
Starting an FQHC
• FQHCs received funding under Section 330 of the Public Health Service Act. This funding is for operational expenses.
• Program Assistance Letter 98-23 spells out all the federal requirements.
• Must be located in an MUA or MUP.• New Access Point Funding is currently
available through HRSA.
FQHCs
• Non-profit entity• Governed by a consumer driven governing
board (51% of the board members must be patients of the clinic)
• Serve ALL patients regardless of their ability to pay through a Sliding Fee Scale
• Must provide primary, behavioral, and dental services either on-site or through an arrangement for ALL patients
Benefits of an FQHC
• Enhanced Medicaid and Medicare Reimbursement
• Medical Malpractice under the Federal Tort Claims Act
• 340B Drug Pricing• National Health Service Corps• Vaccines for Children
FQHC Look-Alike
• Organization meets all requirements of a Section 330 grant.
• No Grant funding for FHQC Look-Alikes.
• Receives all other FQHC “benefits.”
State-Funded CHCs
• Must meet a set of minimum standards outlined by the state
• These standards are less stringent than FQHC standards
• Must have a consumer-driven governing board
RHCs
• Special Medicaid and Medicare reimbursement
• Must be “certified” through CMS• Staffed at least 50% of the time with a
midlevel provider• Can be for-profit or non-profit• Can be provider-based• Must be in a rural area and in a HPSA OR
MUA/MUP
The Differences
FQHCs• Receive federal operational
grant funding• Subject to many more federal
regulations • Medicaid PPS Rate• Must be non-profit• Governed and owned by a
community governing board; cannot be owned by a hospital or health system (exception for public Entities
RHCs• Reimbursed at the
Medicare All-inclusive rate by Medicaid and Medicare
• Can be for-profit or non-profit
• Can be owned by a hospital or other health system
Lessons Learned since I started an FQHC 3 years ago.
If I knew then what I know now…
If I knew then what I know now – Community Support
• You need to have community support and the support from your medical community.
• You need individuals that are dedicated to making the health center a success.
• You also need patients!
If I knew then… - Governing Board
• The consumer-driven governing board is the integral foundation of the FQHC. Having board members that are committed to the health center’s mission is the key to success!
If I knew then… - Services
• You don’t have to do everything on your own from the beginning!
• Primary• Dental• Behavioral• Pharmacy• Outreach/Enabling Services
If I knew then… – Community Support
• Without the support of Union Hospital Clinton and the entire Union Hospital Organization, we would not be the success that we are now.
If I knew then… – Rapid Growth
• FQHCs are growing extremely quickly
• In 2008, we completed over 3,500 encounters.
• In 2009, over 8,000 encounters.
• In 2010, we are expected to complete over 14,000 encounters.
If I knew then… - Policies and Procedures
• FQHCs must have many policies and procedures established when they are started– QI plan– Credentialing Plan– After-hours Call Policy– Sliding Fee Scale implemented– Risk Management Plan– Recruitment and Retention Plan– And Many More
If I knew then… - The Deeming Process
• FQHCs received medical malpractice coverage under the Federal Tort Claims Act.
• Must be deemed for FTCA coverage.
• Deeming process reviews your QI plan and the staff and board’s efforts for continual improvement.
If I knew then… • FQHCs are hard work!• The feds are actually there to help!• There are always more people to
serve than the capacity that you have.
• Other FQHCs and associations are there to help.
• Serving members of my community is the most rewarding experience of my life.
Resources
• www.hrsa.gov• www.isdh.in.gov• www.raconline.org• www.indianapca.org• www.indianaruralhealth.org
Elizabeth Morgan Burrows, JDVermillion-Parke Community
Health [email protected]
765-828-1003 or 765-492-9042
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