How to leverage state funding to bring federal dollars into Nevada

Transcription

1 How to leverage state funding to bring federal dollars into Nevada EXHIBIT F Senate Committee on Health and Human Services Date: Page: 1 of 38

2 FQHC Opportunities for Federal Funding FQHC 101 FQHCs: Its Impact Opportunities for Federal Funding Nevada: The Need Incubator Program F 2

3 FQHC 101 Federal designation from Bureau of Primary Health Care (BPHC) Assigned to private non-profit or public Health care organizations that serve uninsured or underserved populations Meets all service requirements 330 Grantee F 3

4 FQHC 101 Characteristics of an FQHC Located in or serving a designated Medically Underserved Area/Population (MUA or MUP) Governed by community member Board Provide comprehensive preventive, primary health care and supportive services F 4

5 FQHC 101 Characteristics of an FQHC Provides access to health care for all regardless of ability to pay Charges for services on a sliding fee scale Meets all federal performance and accountability requirements F 5

6 FQHC 101 Requirements Components: Governance Mission and strategy Management and Finance Clinical Program F 6

7 Program Requirements FQHC Governance Community member board Carries legal and fiduciary responsibility for clinic operations Strategic planning and evaluation of progress towards organization goals Approve annual budget, policies and procedures, sliding scale Decides on hiring and evaluating of CEO F 7

8 Program Requirements Clinical Program Provides continuum of care Service delivery model Contracting/collaborative relationships Adequate clinical staff Clinical systems and procedures F 8

9 Program Requirements Management and Finance Management staff and structure Patient Management Systems Financial policies Facilities F 9

10 Benefits of FQHC status Access to federal grants to support costs of providing uncompensated care Access to federal grants to support costs of planning and developing a health care network or plan Prospective payment system reimbursement for Medicare/Medicaid patients (based on actual cost of providing care) Access to free medical malpractice coverage under Federal Tort Claims Act (FTCA) F 10

11 Benefits of FQHC Status (cont d) Access to 340B Drug Program Access to grant support and loan guarantees for capital improvements Right to have out-stationed eligibility workers on site Reimbursement by Medicare for first dollar of services (deductible is waived) Access to Vaccine for Children (VFC) Program Access to National Health Service Corp Provider Placements F 11

12 FQHC Look-Alike Clinics Meet all Section 330 program requirements Do NOT receive grant support Do NOT receive coverage under FTCA F 12

13 FQHC National Impact In 2011, 1100 FQHC with 8500 sites provided care to 20.2 Million patients 2/3 ethnic, minority 40% uninsured 1/3 children Reduction in healthcare disparities and improvement of patient outcomes despite serving a high risk population F 13

14 FQHC Economic Impact Integral source of employment and economic growth Total employment 138,000 Employs 9,900 Physicians and 6,900 mid-level providers In 2010, generated $20 Billion in economic activity for low income areas by providing employment and indirectly by purchasing goods and services F 14

15 FQHC Economic Impact Patients served by FQHC had 5.8/1000 fewer hospitalizations Provides high quality care at cost of $1.64/ patient/day Lowers utilization of ER visits and in-patient stays, hospitals save $1600/patient/day Expansion of FQHC under ACA will save $122 B in total health care costs between of which $55 B is savings for Medicaid F 15

16 Opportunities for Federal Funding FQHCs Affordable Care Act established a FQHC fund that provides $11 Billion over 5 years $9.5 Billion to support ongoing FQHC operations, create new FQHC sites, expand delivery of oral, behavioral health, pharmacy and/or enabling services at existing sites $1.5 Billion for major construction and renovation at existing sites F 16

17 Affordable Care Act Funding FQHC 2011: $1.7 Billion awarded $732 M for 144 FQHC Capital development $900 M for ongoing FQHC programs $40 M for 67 new FQHC sites and 129 Planning grants $40 M for Quality improvement activities in 900 FQHCs F 17

18 Affordable Care Act Funding FQHCs 2012 : $129 M for 219 new FQHCs to provide care to 1.29 M patients $629 M for Capital development to 171 FQHCs for renovation, expansion and construction to serve an additional 860,000 patients $99 M for facility improvements F 18

19 Affordable Care Act Funding FQHC 2013 Budget appropriated $3.061 Billion to include $19 M for 25 new FQHC sites to serve an additional 21 M patients F 19

20 Opportunities for Federal Funding FQHC FY 2013 New Access Point Funding Opportunity Announcement HRSA Applications due February 27, 2013 April 3, 2013 F 20

21 Nevada: The Need High levels of uninsured 592,600 (22%) High level of uninsured children 134,300 (19%) Medicaid under enrolled 10% vs. 20% US Few attempts at application Lots of need but not getting funded F 21

22 Status of FQHCs in Nevada No awardees in 2011, FQHC, 33 sites serving 57,987 patients Percent of Vulnerable Nevada residents served by FQHC Low income uninsured % Medicaid beneficiaries % Poverty level 100% and below 4% F 22

23 F 23

24 Capital Development Program Grants Per State F 24

25 F 25

26 Barriers to FQHC Funding Lack of technical assistance resources Existing FQHCs have not adjusted to competitive environment Lack of understanding of value of FQHC Clinics that have interest lack budget to afford indirect costs of care F 26

27 Firstmed Health and Wellness Center Structured around FQHC model Committed to providing access to healthcare to all regardless of ability to pay Served over 6,000 patients in 2012 Only clinic awarded Planning Grant in the South Worked with PCO to designate service area as MUP F 27

28 Firstmed Health and Wellness Center Leads in education and advocacy to address healthcare issues of those that have no ready access to care Worked with State Senator Copening in advocacy and collaborative efforts to develop more FQHCs Worked with Assemblywoman Bustamante Adams to sponsor an Incubator Program F 28

29 Incubator Program Nevada Goal: Leverage additional federal funds through new and expanded FQHC and FQHC Look-Alike clinics by helping organizations ramp-up to meet the federal requirements F 29

30 FQHC Incubator Program Components Planning Grants Development Grants Transitional Operating Support Capital Infrastructure Grants F 30

31 FQHC Incubator Program Component: Planning Grant To support specific technical assistance activities key to successful applications -Organizational feasibility studies -Board development & 501c3 app -Strategic Planning and work plan development -Needs and asset mapping Basic training on FQHC requirements F 31

32 FQHC Incubator Program Component: Development To provide support for development of organizational and collaborative capacities FQHC Look alike application development Grant writing Negotiating formal collaborations and MOU Staffing to develop collaboration and organizational capacity Technical assistance on any of above F 32

33 FQHC Incubator Program Component: Transitional Support To operationalize clinics to increase likelihood of obtaining FQHC designation (funding costs of services) Medical supplies Salaries of key staff (physicians, nurses, CEO) Rent Informational systems SELF SUSTAINING! F 33

34 FQHC Incubator Program Component: Capital Improvement To increase the infrastructure of FQHC and FQHC-LA Major equipment purchase Management information systems Major renovations Purchase or lease of mobile units or temporary facilities F 34

35 FQHC Incubator Program The Texas Story In 2003, the state legislation budget included $5M/year for Incubator Program Results: - FQHCs doubled from 32 to 69, of which 28 became FQHC through Incubator Grant funding - Brought $40 M/year in renewable, ongoing federal funds to Texas F 35

36 FQHC Incubator Program Lessons Learned Consider support of funds that will increase capacities of clinics to apply for FQHC successfully Consider resources for PCA to increase capacity to provide technical assistance Consider working with PCA to establish policies and guidelines PCA to address service area overlaps in urban areas F 36

37 How Can You Help? Firstmed hopes to collaborate with local hospitals to decrease ER utilization and decrease hospital costs of uncompensated care and re-admissions Firstmed requests a letter of support in its application for the NAP Firstmed asks for your support in the passage of Incubator Program F 37

38 Federally Qualified Health Centers Thank you for the opportunity. Dr. Lynn Quisumbing CEO and Provider Firstmed Health and Wellness Center 3343 S. Eastern Ave, LV, NV Off (702) Cell (702) F 38