Becoming a Community Health Center. Mar 14, 2017 Stacey Moody, John Snow Inc. Laura Gerard,

Transcription

1 Becoming a Community Health Center Mar 14, 2017 Stacey Moody, John Snow Inc. Laura Gerard, CBA@JSI

2 Goal - To provide information on the basic requirements needed to become a Federally Qualified Health Center (FQHC) Objectives - At the end of this webinar participants will: Know the basic requirements for an FQHC Be able to make informed decisions for their organization

3 Quick Poll Are you planning to become a health center? a. No, I just want to learn about what a health center is b. We are just starting the conversation c. We think we want to apply but need to have some more discussion d. We are going to apply to become a health center

4 What Is an FQHC? Community health centers (also called FQHCs) are non-profit private or public entities that serve designated medically underserved populations/areas or special medically underserved populations (e.g., migrant and seasonal farmworkers, the homeless or residents of public housing)

5 FQHCs Include: Program Community Health Center Section 330 (e) Migrant Health Program Center - Section 330 (g) Health Care for the Homeless Program - Section 330 (h) Public Housing Program Primary Care Section 330 (i)

6 Why Would You Consider This? 330 grant funding of up to $650,000 Enhanced Medicare and Medicaid reimbursement Medical malpractice coverage through the Federal Tort Claims Act Reduced cost prescriptions through the 340(b) Federal Drug Pricing Program Access to National Health Service Corps Access to the Vaccine for Children program Eligibility for various other federal grants and programs

7 Case Study Apicha Community Health Center

8 Case Study Apicha Community Health Center

9 Case Study Apicha Community Health Center

10 Case Study Apicha Community Health Center

11 Case Study Apicha Community Health Center

12 19 Specific Requirements: Need, Services, Management and Finance, and Governance

13 Need

14 1. Needs Assessment Demonstrate and document the needs of its target population, updating its service area, when appropriate

15 Services

16 2. Required and Additional Services Provide all required primary, preventive, enabling health services and additional health services as appropriate and necessary, either directly or through established written arrangements and referrals

17 3. Staffing Requirement Core staff to carry out all required primary, preventive, enabling health services and additional health services as appropriate and necessary, either directly or through established arrangements and referrals

18 4. Accessible Hours of Operation and Locations Provide services at times and locations that assure accessibility and meet the needs of the population to be served

19 5. After Hours Coverage Professional coverage for medical emergencies during hours when the center is closed

20 6. Hospital Admitting Privileges and Continuum of Care Physicians have admitting privileges at one or more referral hospitals, or other such arrangement to ensure continuity of care

21 Sliding Fee Discounts System in place to determine eligibility for patient discounts adjusted on the basis of the patient s ability to pay. No discounts may be provided to patients with incomes over 200% of the Federal poverty guidelines

22 7. Sliding Fee Discounts No patient will be denied health care services due to an individual s inability to pay for such services by the health center, assuring that any fees or payments required by the center for such services will be reduced or waived.

23 8. Quality Improvement/ Assurance Plan Periodic assessment of the appropriateness of the utilization of services and the quality of services provided/ proposed

24 How Did Apicha Do? Case Study: Implementing requirements under Services

25 Quick Poll Select which requirement listed below is NOT a requirement to become an FQHC: a. Must provide all required primary, preventive and enabling health care services b. Must have core staff on site because patient referrals through established arrangements are not allowed c. Must provide services at locations and during times that meet the needs of the population being served d. Must not deny services because patients are unable to pay

26 Management and Finance

27 9. Key Management Staff Maintain fully staffed health center management team as appropriate for the size and needs of the center

28 10. Contractual/Affiliation Agreements Exercise appropriate oversight and authority over all contracted services, including assuring that any sub-recipient(s) meet health center program requirements

29 11. Collaborative Relationships Establish and maintain collaborative relationships with other health care providers, including other health centers, in the service area of the center Letter(s) of support from existing health centers in the service area

30 12. Financial Management and Control Policies Maintain accounting and internal control systems reflecting Generally Accepted Accounting Principles (GAAP) Assure an annual independent financial audit is performed in accordance with Federal audit requirements

31 13. Billing and Collections Systems in place to maximize collections and reimbursement for its costs in providing health services, including written billing, credit, and collection policies and procedures

32 14. Budget Budget that reflects the costs of operations, expenses, and revenues (including the Federal grant) necessary to accomplish the service delivery plan, including the number of patients to be served

33 15. Program Data Reporting Systems Systems that accurately collect and organize data for program reporting and which support management decision making

34 16. Scope of Project Maintain funded scope of project (sites, services, service area, target population, and providers), including any increases based on recent grant awards

35 How Did Apicha Do? Case Study: Implementing requirements under Management and Finance

36 Quick Poll Which one of these is NOT correct. FQHCs must: a. Obtain independent financial audits on a regular basis b. Maintain an accurate data reporting system c. Have billing and collecting systems in place d. Maintain a collaborative relationship with the local Medicaid department

37 Governance

38 17. Board Authority Monthly meetings Approval of grant application and budget Selection/dismissal and performance evaluation of the CEO Selection of services to be provided and hours of operations Measuring and evaluating progress in meeting annual and long-term programmatic and financial goals; and Establishment of general policies

39 18. Board Composition Majority are individuals being served by the health center and representative according to race, ethnicity, and sex 9-25 members Non-consumer members of the board shall be representative of the community in which the center's service area is located and shall be selected for their expertise No more than one half of the non-consumer board members may derive more than 10% of their annual income from the health care industry

40 19. Conflict of Interest Policy Bylaws or written corporate board approved policy include provisions that prohibit conflict of interest No board member shall be an employee of the health center or an immediate family member of an employee The Chief Executive may serve only as a non-voting ex-officio member of the board

41 How Did Apicha Do? Case Study: Implementing requirements under Governance

42 In Summary We have reviewed the 19 requirements to become an FQHC You can discuss with your organization to make informed decisions for going forward

43 Next Steps Determine if pursuing the FQHC designation is feasible for your organization: Is it aligned with your mission? What steps do you need to take to meet the 19 requirements? Does your organization want to first become an FQHC look-alike?

44 Need more assistance? is funded by the Centers for Disease Control and Prevention (CDC) to provide capacity building assistance to communitybased organizations across the U.S. to support CDC s high-impact approach to HIV prevention under grant number 1U65PS