Vermont Primary Care Sourcebook

Vermont Primary Care Sourcebook Prepared by Bi-State Primary Care Association January 2018 7 th Edition Bi-State Primary Care Association 61 Elm Street, Montpelier, Vermont 05602 (802) 229-0002 www.bistatepca.org Printed on January 30, 2018

Mission and Vision 3 FQHCs Collaborate Across Health Sectors 18 Public Policy Principles, Priorities and Strategies 4 FQHCs Partner to Achieve the Best Care 19 Ten Critical Points to Transform Vermont s Health System 5 20 Bi-State s Recruitment Center 6 Rural Health Clinics Overview 21 Bi-State s Members 8 Grace Cottage Family Health & Hospital 22 Member Map 9 Vermont Area Health Education Centers 23 Member Directory 10 Vermont Coalition of Clinics for the Uninsured 26 FQHCs Strengthen Communities 12 FQHC Federal Requirements 29 FQHCs Ensure Access in Their Communities 13 FQHC Sliding Fee Scale 30 FQHC Patients by Payer 14 Member Site Directory by Organization 31 FQHC Funding and Reimbursement Structure 15 Member Site Directory by County 32 FQHCs Exceed National Average for Quality Measures 16 Vermont Legislative Representative Directory 34 FQHCs Use Data to Drive Improvement 17 Acknowledgement and Contact Information 40 2

Bi-State Primary Care Association Mission and Vision Mission Promote access to effective and affordable primary care and preventive services for all, with special emphasis on underserved populations in Vermont and New Hampshire. Vision Healthy individuals and communities with quality health care for all. Who We Are Bi-State Primary Care Association was established in 1986 to serve Vermont and New Hampshire. Bi-State is a nonprofit, 501(c)(3) charitable organization that promotes access to effective and affordable primary care and preventive services for all, with special emphasis on underserved populations in New Hampshire and Vermont. Bi-State members include federally qualified health centers (FQHCs), community health centers (CHCs), rural health clinics (RHCs), private and hospital-supported primary care practices, community action programs, area health education centers (AHEC), clinics for the uninsured, Planned Parenthood and social service agencies. What We Do Bi-State works with federal, state, and regional health policy organizations, foundations, and payers to develop strategies, policies, and programs that provide and support community-based primary health care services in medically underserved areas. Bi-State s nonprofit recruitment center provides workforce assistance and candidate referrals to FQHCs, RHCs, and private and hospital-sponsored physician practices throughout Vermont and New Hampshire. The recruitment center focuses on recruiting and retaining primary care providers including physicians, dentists, nurse practitioners, and physician assistants. For more information, please contact: Georgia Maheras, Esq., Director of Vermont Public Policy gmaheras@bistatepca.org, (802) 229-0002 ext. 218 3

Bi-State s 2018 Vermont Public Policy Principles, Priorities and Strategies Public Policy Principles Bi-State is committed to improving the health status of Vermonters and ensuring that all individuals have access to affordable and highquality primary medical, mental health, substance abuse, and oral health care, regardless of insurance status or ability to pay. We support the state s efforts to move to a universal and unified health care delivery system and ensure universally available health access and insurance coverage. We support investments in public health and primary and preventive care. Our work aims to preserve, strengthen and expand Vermont s community-based primary care safety-net providers, recognizing that these organizations are integral to the lives of one in three Vermonters and are the foundation of healthy communities statewide. Public Policy Priorities Bi-State works through effective partnerships and robust engagement with the Governor and the Administration, State Legislature, Green Mountain Care Board, and other partners to: Ensure every Vermonter has access to a primary care medical home with particular attention to underserved Vermonters. Advocate for delivery system and payment models that invest in, build upon, and prioritize community-based primary care, specifically that sustain and enhance the FQHC and RHC models of care delivery and reimbursement. Build on the successes of Blueprint for Health, ensuring substantial investment in patient-centered medical homes and empowering local care communities. Close coverage gaps for uninsured Vermonters and affordability gaps for under-insured Vermonters. Promote population health and well-being through support of public health goals and population health initiatives. Establish strong community-based partnerships that support patients through transitions across care settings. Increase investments to integrate mental health/substance abuse and primary care. Integrate coverage for and expand access to oral health. Invest in preventive services, early intervention, wellness initiatives, and health education. Support primary care practitioners in care management and patient engagement for patients with chronic conditions. Sustain the 340B pharmacy program to ensure continued access to low cost pharmaceuticals. Increase funding for Vermont Medicaid, and ensure continued investment in primary care. Invest in comprehensive workforce development strategies including increased federal and state loan repayment for health care professionals and funding for national marketing and outreach. Increase access to and funding for telemedicine services to improve access to services for Vermont s rural and underserved populations. Sustain federal payment floors and framework for FQHC and RHC infrastructure, initiatives, and services to improve access to comprehensive primary care for the uninsured and underinsured. Sustain state funding for the Vermont Coalition of Clinics for the Uninsured. 4

Ten Critical Points to Transform Vermont s Health System Vermont s federally qualified health centers (FQHCs) recognize and value the work of the past year on payment reform. However, Vermonters will be healthier and better off only if the system transforms to address social determinants as a priority, commits to comprehensive primary care, invests in strong community-based care systems, and builds capacity to accomplish these goals. A successfully transformed health system has the following characteristics: 1. Primary care practices are strong and well-supported patient-centered medical homes, with the resources they need to prevent chronic disease, promote wellness, and manage patient care outside the hospital setting. 2. Primary care practitioners have the time they need to address the issues underlying chronic disease and mental health and the resources to maximize primary care practitioner time in direct patient care. 3. Mental health, behavioral health, and primary care work together to provide seamless care to patients. 4. Home health services and primary care practices work together to provide seamless care to patients, and home health is available without regard to Medicare or Medicaid legacy rules around coverage for home health services. 5. Community-based social service agencies are fully-integrated or tightly coordinated with primary care practices, including: Area Agencies on Aging who serve as the eyes and ears of the system, working to keep vulnerable elders housed and out of impoverished living conditions. Mental Health Centers who offer integrated services and supports to Vermonters affected by developmental disabilities, mental health conditions and substance use disorders. The Vermont Food Bank and local food shelves with a pulse on food insecurity in the community, working to feed low-income and underserved Vermonters. Parent Child Centers, shaping solutions to meet the needs of working families. 6. Primary care practices work with community partners to offer a health coach option to help patients in making better health decisions and following a healthy lifestyle. 7. Communities integrate wellness-initiatives with schools, employers, community centers, etc.; i.e. meet people where they are. 8. Hospitals are stable and positioned to meet the acute inpatient and outpatient needs of the community, and participate as equals in the delivery system. 9. Systems of care are focused on the local and regional levels, with resources deployed efficiently to meet the needs of the community, and with local strategic and project plans that roll up to a statewide plan. 10. Vermont s Blueprint team retains independence and neutrality to lead the transformation effort, using community collaboration boards (e.g. Blueprint UCCs) with broad community representation to shape and drive the transformation at the local level. Adopted by Bi-State s Member FQHC CEOs December 2015 5

Bi-State s Recruitment Center: Addressing Primary Care Workforce The Recruitment Center is the only nonprofit organization in Vermont that conducts national marketing and outreach to physicians, nurse practitioners, physician assistants, dentists, and mental health and substance use disorder treatment professionals specifically to attract and recruit them to Vermont. Dedicated to recruiting these providers to rural and underserved areas of the state where their services are most needed, the Recruitment Center screens providers to determine which communities and practices will best meet their personal and professional needs to support long-term retention. The Recruitment Center manages the Vermont state page and regularly posts vacancies on the National Rural Recruitment and Retention Network (3RNet). Due to its familiarity with the health care business, culture, educational, and recreational environment in the state, the Recruitment Center is able to support the transition of newly-recruited providers and their families to Vermont. The Recruitment Center also provides technical assistance on programs that support recruitment such as the National Health Service Corps, which offers loan repayment for clinicians who agree to practice in federally-designated medically underserved areas. The Recruitment Center regularly collaborates with organizations across Vermont to maximize resources and avoid duplication. The national marketing and outreach complements the pipeline and workforce development activities conducted by Vermont s Area Health Education Centers and the Vermont Dental and Medical Societies. The Recruitment Center regularly engages with the Vermont Office of Rural Health and the Vermont Department of Health on workforce initiatives in the state. For information on the Recruitment Center, please contact Stephanie Pagliuca, Director, at spagliuca@bistatepca.org. For assistance with recruitment, please contact Mandi Gingras, Recruitment and Retention Coordinator, at mgingras@bistatepca.org. 6

OUR MEMBERS 7

Bi-State s Member Health Centers and Clinics Provide Care to 1 in 3 Vermonters Our Members Our Member Average Coverage Mix Federally Qualified Health Centers (FQHCs) 12 Vermont FQHCs encompassing 64 sites in all 14 counties 12 clinics A Rural Health Clinic (RHC) 1 site Vermont Area Health Education Center (AHEC) A Network of Partners Vermont Coalition of Clinics for the Uninsured 9 clinics Vermont s health centers and clinics have served as medical homes for more than 200,000 patients, with more than 720,000 visits in 2016. Our members serve: 43% of Vermont Medicaid enrollees 35% of Vermont Medicare enrollees The majority of uninsured Vermonters Third Party 41% Uninsured 12% Medicare 19% Medicaid 28% Source(s): FQHC self-reported 2016 UDS data, self-reported data for non-fqhcs, the 2014 DFR Vermont Household Health Insurance Survey 8

Bi-State Primary Care Association Member Map Our members provide care to Vermonters at 86 sites across every county of the State. 9

Bi-State Primary Care Association s Vermont Members Battenkill Valley Health Center 9 Church Street, PO Box 61, Arlington, VT 05250 (802) 375-6566 www.battenkillvalleyhealthcenter.org Alison Calderara, CEO 617 Riverside Avenue, Burlington, VT 05401 (802) 264-8190, acalderara@chcb.org www.chcb.org Grant Whitmer, Executive Director 71 Allen Pond Street, Suite 101, Rutland, VT 05701 (802) 855-2083, gwhitmer@chcrr.org www.chcrr.org Community Health Services of Lamoille Valley Kevin Kelley, President/CEO 66 Morrisville Plaza, PO Box 749, Morrisville, VT 05661 (802) 851-8607, kkelley@chslv.org www.chslv.org Gifford Health Care Daniel Bennett, CEO 44 S. Main Street, PO Box 2000, Randolph, VT 05060 (802) 728-2304, dbennett@giffordmed.org www.giffordhealthcare.org Grace Cottage Family Health & Hospital Douglas F. DiVello, CEO 185 Grafton Road (Route 35), Townshend, VT 05353 802-365-7357, ddivello@gracecottage.org www.gracecottage.org The Health Center John Matthew, MD, CEO 157 Towne Avenue, PO Box 320, Plainfield, VT 05667 (802) 454-8336, jmatthew@together.net www.the-health-center.org Indian Stream Health Center Gregory Culley, Interim CEO 253 Gale Street, Canaan, VT 05903 (603) 388-2473, gculley@indianstream.org www.indianstream.org Little Rivers Health Care Gail Auclair, CEO 146 Mill Street, PO Box 338, Bradford, VT 05033 (802) 222-4637 ext. 104, gauclair@littlerivers.org www.littlerivers.org Mountain Health Center Martha Halnon, Executive Director 74 Munsill Avenue, Suite 100, Bristol, VT 05443 (802) 453-5028 ext. 7214 mhalnon@mountainhealthcenter.com www.mountainhealthcenter.com Shawn Tester, CEO 165 Sherman Drive, St. Johnsbury, VT 05819 (802) 748-9405 ext. 1519, shawnt@nchvt.org www.nchcvt.org Northern Tier Center for Health Pamela Parsons, Executive Director 44 Main Street, Richford, VT 05476 (802) 255-5560, pparsons@notchvt.com www.notchvt.org Meagan Gallagher, CEO and President 784 Hercules Drive, Suite 110, Colchester, VT 05446 (802) 448-9778, meagan.gallagher@ppnne.org www.plannedparenthood.org Springfield Medical Care Systems Timothy Ford, CEO 25 Ridgewood Road, Springfield, VT 05156 (802) 885-2151, tford@springfieldmed.org www.springfieldmed.org UVM Larner College of Medicine Office of Primary Care and AHEC Program Elizabeth Cote, Director 1 South Prospect Street, Arnold 5, Burlington, VT 05401 (802) 656-0030, elizabeth.cote@uvm.edu www.med.uvm.edu/ahec Vermont Coalition of Clinics for the Uninsured Steve Maier, Executive Director 122 Green Mountain Place, Middlebury, VT 05753 (802) 448-4280, vtcoalitionofclinics@gmail.com www.vtccu.org 10

CARING FOR VERMONT S COMMUNITIES 11

FQHCs Strengthen Communities Making high quality services available to patients, regardless of ability to pay. Creating sustainable jobs and offering top-tier training to their 1,300+ direct employees. Dr. Anje Van Berckelaer from Battenkill Valley Health Center Communities within federallydesignated medically underserved areas are provided integrated services. Through expansions and community investment, spurring local economic development, with an estimated 500+ additional indirect/induced jobs.* Extending hours to include early mornings, evenings and weekends. Responding to the unique needs of their communities with holistic approaches to health and wellness. Maintaining healthier communities makes for a safer places to raise families. Meeting patients where they are by providing interpretation, transportation, and other services. Dr. Jeffrey Wulfman from Mountain Health Center *Capital Link 2016 Report, The Economic Impact of Vermont s Community Health Centers based on CY2014 data. 12

FQHCs Ensure Access in Their Communities Federally qualified health centers (FQHCs) offer services to all residents in their service areas and determine charges using a sliding fee scale, which is based upon the resident s ability to pay. FQHCs leverage federal dollars to expand services and construct or renovate facilities. FQHCs are automatically eligible for National Health Service Corps (NHSC) loan repayments and scholarship recipients.* In many communities, FQHCs are the only comprehensive, patient-centered medical home open to all patients without restrictions, especially underinsured and Medicaid patients. 1 in 3 Medicaid Enrollees FQHCs provide care to 1 in 4 Vermonters 1 in 3 Medicare Enrollees 1 in 5 Commercially Insured Vermonters Over half of Uninsured Vermonters Source(s): FQHC self-reported 2016 UDS data, self-reported data for non-fqhcs, the 2014 DFR Vermont Household Health Insurance Survey *NHSC loan repayment and scholarships are obtained through a competitive HRSA process. 13

FQHCs Provided Primary Care to Over 170,000 Vermonters in 2016 Vermont s FQHCs saw 171,828 individual patients in 2016. Collectively, those patients made 677,293 visits to the FQHCs. Uninsured 7% 10,125 FQHC Patients by Payer in 2016 Medicare 21% 32,669 Types of Health Insurance in Vermont 2014 Medicaid 21% 132,829 Uninsured 4% 23,231 Third Party 40% 62,784 Medicaid 32% 50,046 Medicare 18% 110,916 Third Party 57% 359,655 Source(s): FQHC self-reported 2016 UDS data, self-reported data for non-fqhcs, the 2014 DFR Vermont Household Health Insurance Survey 14

FQHC Funding and Reimbursement Structure Minimizes Cost Shifting FQHCs are eligible to receive federal appropriations for allowable costs that are not reimbursed by Medicaid, Medicare, commercial payers, and patient self-pay. Some of these costs may include care provided to uninsured and underinsured low-income patients and enabling services such as care management, outreach, transportation, and interpretation. Federal FQHC grants are awarded based upon a very competitive national application process. When FQHCs are awarded federal funds, they must meet strict program, performance, and accountability standards. Federal Grant: Capital 1% 2016 Sources of Revenue for Vermont FQHCs Other Grants State Grant 1% 3% Other Revenue 5% Federal Grant: Operating 13% Patient Revenue: Medicaid 28% Federal FQHC appropriations are not transferable to any other entity. Medicare and Medicaid FQHC reimbursement is a prospective, capped encounter rate. FQHCs bill commercial insurers just like any other primary care practice. No payer reimburses FQHCs for their full costs. Patient Revenue: Commercial/ Other Public 19% Patient Revenue: Uninsured/ Self Pay 12% Patient Revenue: Medicare 17% Source(s): FQHC self-reported 2016 UDS data 15

Vermont s FQHCs Exceed National Average for Many Clinical Quality Measures Vermont FQHC Average vs. National Health Center Data Average Selected UDS Clinical Quality Measures 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Cervical Cancer Screening Adolescent Weight Screening Colorectal Cancer Screening Childhood Immunizations Adult Weight Screening Depression Asthma Treatment Hypertension Controlled Diabetes VT FQHC Average National FQHC Average Source(s): FQHC self-reported 2016 UDS data, HRSA 16

Vermont s FQHCs Use Data to Drive Improvement Patients Screened for Depression and Appropriate Follow-up 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 2014 2015 2016 Source(s): FQHC UDS data 17

FQHCs Collaborate Across Health Sectors FQHCs collaborate with other health care and social services organizations in their communities to strengthen the health system as a whole. ACOs An integrated system of care across the state Mental Health & Substance Use Treatment Centers Integration into Primary Care Vermont Department of Health Public Health Initiatives FQHC Network 340B Pharmacy Program, Pediatric Mobile Dental Program, telemedicine, and transportation Collaboration Universities, Technical Schools, High Schools Education & Workforce Pipeline Hospitals ER Diversion & Transitions in Care Free Clinics for the Uninsured Outreach to all Vermonters 18

FQHCs Partner to Achieve the Best Care Each FQHC is unique. They tailor programs and services based on demographics, geography, availability of acute and sub-acute providers, and other needs of their communities. Collaborations with community partners allow them to go above and beyond in delivering high quality primary care. Initiatives and Partnerships Northern Tier Center for Health runs an annual free summer day camp for children in Richford. Little Rivers Health Care sends a dental van to local schools to provide oral health and dental care at least twice a year for over 350 students. has a physician solely dedicated to running a transgender clinic. Battenkill Valley Health Center has a partnership with the local food shelf to provide low-cost or free food to patients with financial needs. partners with a CSA farm that provides at-risk children with prescriptions for healthy food available for a weekly pick-up at their doctor s office. Community Health Services of Lamoille Valley provides bus service to patients in the Stowe mountain area for families who may not have access otherwise. 19

(PPNNE) Founded in 1965, PPNNE serves patients at 21 health centers across Vermont, New Hampshire, and Maine. These health centers provide the highest quality care through a wide range of services for women and men, including cancer screening, birth control, LGBTQ services, well person check-ups, and STD testing and treatment. PPNNE offers a sliding fee scale, making care accessible and affordable to anyone who walks through their doors. In 2016, PPNNE Operated 12 health centers in Vermont These centers provided care to 18,836 Vermonters And conducted a total of 28,438 patient visits, including 2,471 Pap Tests 3,436 Breast Exams 34,291 STI Tests At the close of 2016, my insurance changed unexpectedly and I learned that my PCP and most local agencies do not accept my new insurance My husband and I are not in a position to start a family quite yet; I am graduating with my Master's and we are in the middle of purchasing a 'fixer upper' home. I initially thought I had nowhere to turn, until I remembered that Planned Parenthood is accessible, affordable, and completely available to me. I was offered an appointment as a new patient within ONE week of calling, and offered Saturday appointments! The Nurse Practitioner educated me on all of my options, counseled me on proper contraceptive use, and assured me that they would be there for me for whatever needs that arise in the future The entire staff made for a pleasant and anxiety-free experience, and I could not be more grateful. Even if I found a primary care or gynecology office that will take my insurance, I will still go back for all of my care. PPNNE patient For more information, contact Meagan Gallagher, President & CEO, at (802) 448-9778 or meagan.gallagher@ppnne.org. 20

Rural Health Clinics The Rural Health Clinic Services Act of 1977 (Public Law 95-210) was enacted to address an inadequate supply of physicians serving Medicare patients in rural areas and to increase the use of non-physician practitioners such as nurse practitioners and physician assistants in rural areas. 1 Rural health clinics (RHC) can be public, nonprofit, or for-profit health care facilities. They must be located in rural, underserved areas. They are required to use a team approach of physicians working with non-physician practitioners such as nurse practitioners, physician assistants, and certified nurse midwives to provide services. RHCs are required to provide outpatient primary care services and basic laboratory services. 2 Vermont s Nine Rural Health Clinics 1. Grace Cottage Family Health & Hospital* 2. North Country Pediatrics & Adolescent Medicine 3. North Country Primary Care Barton/Orleans 4. North Country Primary Care Newport 5. North Country Obstetrics & Gynecology 6. NVRH Corner Medical 7. NVRH Kingdom Internal Medicine 8. NVRH St. Johnsbury Pediatrics 9. NVRH Women's Wellness Center *Bi-State PCA Member 1 www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/ruralhlthclinfctsht.pdf, as of 1/4/17 2 www.ruralhealthinfo.org/topics/rural-health-clinics, as of 1/4/17 21

Grace Cottage Family Health & Hospital Serving health care needs of its patients since 1949, Grace Cottage Family Health and Hospital provides acute and rehabilitative care in Windham County. Grace Cottage includes a federally certified rural health clinic offering family medicine, pediatrics, geriatrics, podiatry, and mental health services. It is supported by a Community Health Team offering care coordination, nutrition and exercise coaching, resource advocacy, and short-term counseling. Community Wellness is an important component of Grace Cottage s outreach to the community. One of Grace Cottage s buildings houses a Community Wellness Center with a beautiful exercise room built by community volunteers. This room hosts regular yoga classes, as well as four twice-weekly classes of Strong Bones exercise for seniors, and two levels of Tai Chi balance classes for seniors each week. In addition, the Community Wellness Center hosts a wide variety of other wellness classes and support groups, as well as providing space for non-profit groups to meet. For more information, contact Douglas DiVello, CEO, at (802) 365-7357 or ddivello@gracecottage.org. 22

Vermont Area Health Education Centers (AHEC) Vermont AHEC is a network of academic and community partners working together to improve the distribution, diversity, supply, and education of the health workforce in Vermont. Established in 1996, Vermont AHEC has a statewide infrastructure with a program office at the University of Vermont, Larner College of Medicine, and two regional centers. Vermont AHEC focuses on achieving a well-trained workforce so that all Vermonters have access to quality care, especially those who live in Vermont s most rural and underserved areas. During FY17, the UVM Office of Primary Care and the Vermont AHEC Network Provided 2,290 Vermont youth with health careers experiences, Worked with 238 providers precepting health professions students, Delivered continuing education to 2,088 health professionals, and Placed 16 physicians in Vermont communities. 23

AHEC Health Care Workforce Development Education and Career Pipeline 24

AHEC s Impact on Careers in Health Care For more information, contact Elizabeth Cote, Director at (802) 656-0030 or elizabeth.cote@uvm.edu. 25

Vermont Coalition of Clinics for the Uninsured The Vermont Coalition of Clinics for the Uninsured (VCCU) is an association of nine free clinic programs and four dental programs that provide care (on site or by referral) and assistance free of charge to patients without adequate medical and dental insurance. The clinics are located throughout the state and are supported by the work of volunteers, community hospitals, local fund-raising, and an annual grant from the State of Vermont. All patients are assessed for eligibility in a number of federal, state, and local health care programs. The VCCU provides outreach and enrollment as well as assistance with medical care, prescriptions, dental care, and other health needs, along with providing case management for each patient. Since 1997, VCCU has served over 55,000 Vermonters. Each year approximately 45% of their patients are NEW to the clinic system. The typical VCCU patient is employed, is a high school graduate, and has a wide range of health access needs. In 2017, VCCU Assisted 7,831 Vermonters, which is a 35% increase since 2010. Provided 4,584 medical and dental visits, worth $610,000. Equivalent ER care would have totaled more than $3.3 million. Provided over 26,000 services overall to Vermonters, an increase of 30% since 2010. Success story about a patient, Bridget Open Door Clinic, Middlebury, Vermont Upon her very first visit to the clinic, Bridget did not have health insurance and her health issues were very time sensitive. Within 48 hours, Bridget was enrolled in a health insurance plan, had chosen a primary care provider, AND had set up the necessary appointments to help manage her physical and mental health issues going forward. Bridget s referrals, transfer of records, Medicaid eligibility, and treatment plan were all orchestrated by the coalition s volunteers and staff members. For more information, contact Steve Maier, Executive Director, at (802) 448-4280 or vtcoalitionofclinics@gmail.com. www.vtccu.org 26

Vermont Coalition of Clinics for the Uninsured Bennington Free Clinic Sue Andrews 121 Depot Street, Bennington, VT 05201 (802) 447-3700 Good Neighbor Health Clinic & Red Logan Dental Clinic Dana Michalovis 70 North Main Street, White River Junction, VT 05001 (802) 295-1868 Health Assistance Program at UVM* Erin Armstrong 128 Lakeside Avenue, Suite 106 Burlington, VT 05401 (802) 847-6984 Health Connections at Gifford Medical Center* Michele Packard 38 South Main Street Randolph, VT 05060 (802) 728-2323 People s Health & Wellness Clinic Peter Youngbaer 553 North Main Street, Barre, VT 05641 (802) 479-1229 Rutland Free Clinic Tony Morgan 145 State Street, Rutland, VT 05701 (802) 775-1360 Valley Health Connections* Lynn Raymond-Empey 268 River Street, Springfield, VT 05156 (802) 885-1616 Windsor Community Clinic at Mt. Ascutney Hospital* Samantha Abrahamsen 289 County Road, Windsor, VT 05089 (802) 674-7213 Provides on-site dental care *Provides referral services only Open Door Clinic Heidi Sulis 100 Porter Drive, Middlebury, VT 05753 (802) 388-0137 27

RESOURCES 28

FQHC Federal Requirements Federally qualified health centers (FQHCs) are health care practices that have a mission to provide high quality, comprehensive primary care and preventive services regardless of their patients' ability to pay or insurance coverage. FQHCs must successfully compete in a national competition for FQHC designation and funding. Additionally, they must be located in federally-designated medically underserved areas and/or serve federally-designated medically underserved populations. Per Federal Requirements, FQHCs must: 1. Demonstrate and document the needs of their target populations, updating their service areas, when appropriate. including assuring that any subrecipient(s) meets Health Center Program Requirements. 2. 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. 11. Make efforts to establish and maintain collaborative relationships with other health care providers, including other health centers in the service area of the health center. 3. Maintain a core staff as necessary to carry out all required primary, preventive, enabling, and additional health services as appropriate and necessary, either directly or through established arrangements and referrals. Staff must be appropriately credentialed and licensed. 12. Maintain accounting and internal control systems appropriate to the size and complexity of the organization to safeguard assets and maintain financial stability. 13. Have systems in place to maximize collections and reimbursement for 4. Provide services at times and locations that assure accessibility and meet the needs of the population to be served. costs in providing health services, including written billing, credit, and collection policies and procedures. 5. Provide professional coverage during hours when the health center is closed. 14. Develop annual budgets that reflect the cost of operations, expenses, and revenues (including the federal grant) necessary to accomplish the service 6. Ensure their physicians have admitting privileges at one or more referral hospitals, or other such arrangement to ensure continuity of care. In cases where hospital arrangements (including admitting privileges and membership) are not possible, health centers must firmly establish arrangements for hospitalization, discharge planning, and patient tracking. delivery plans. 15. Have systems which accurately collect and organize data for program reporting and which support management decision-making. 16. Maintain their funded scope of project (sites, services, service area, target population, and providers). 17. Ensure governing boards maintain appropriate authority to oversee 7. Have a system in place to determine eligibility for patient discounts adjusted on the basis of the patient s ability to pay. No patient will be denied services based on an inability to pay. operations. 18. Ensure a majority of board members for each health center are patients of the health center. The board, as a whole, must represent the 8. Have an ongoing Quality Improvement/Quality Assurance (QI/QA) program that includes clinical services and management, and maintains the confidentiality of patient records. individuals being served by the health center in terms of demographic factors such as race, ethnicity, and sex. 19. Ensure bylaws and/or policies are in place that prohibit conflict of interest 9. Maintain a fully staffed management team as appropriate for the size and needs of the center. by board members, employees, consultants, and those who furnish goods or services to the health center. 10. Exercise appropriate oversight and authority over all contracted services, Source: Summary of Health Center Program Requirements. (February 2014) from Bureau of Primary Health Care, Health Resources and Services Administration, http://bphc.hrsa.gov/about/requirements/hcpreqs.pdf 29

FQHC Sliding Fee Scale FQHCs that receive Health Resources and Services Administration (HRSA) funding must provide access to services without regard for each patient's ability to pay. FQHCs must develop a schedule of fees or payments (often called a sliding fee scale) for the services they provide to ensure that the cost of services not covered by insurance are discounted on the basis of each patient's ability to pay, for incomes below 200% of the Federal Poverty Level (FPL). Ability to pay is determined by a patient's annual income and family size according to the most recent U.S. Department of Health & Human Services Federal Poverty Guidelines. Household Size Discount Applied 1 2 3 4 5 6 7 8 Additional people Below 100% FPL $5 flat fee Under $12,060 Under $16,240 Under $20,420 Under $24,600 Under $28,780 Under $32,960 Under $37,140 Under $41,320 Add $4,180 per person SAMPLE Vermont FQHC Sliding Fee Scale Annual Family Income Range 101 125% 126 150% 151 175% FPL FPL FPL 80% discount 60% discount 40% discount $12,061 $15,076 $18,091 15,075 18,090 21,105 $16,240 $20,301 $24,361 20,300 24,360 28,240 $20,421 $25,526 $30,631 25,525 30,630 35,735 $24,601 $30,751 $36,901 30,750 36,900 43,050 $28,781 $35,976 $43,171 35,975 43,170 50,365 $32,961 $41,201 $49,441 41,200 49,440 57,680 $37,141 $46,426 $55,711 46,425 55,710 64,995 $41,321 $51,651 $61,981 51,650 61,980 72,310 Add $5,225 Add $6,270 Add $7,315 per person per person per person 176 200% FPL 20% discount $21,106 24,120 $28,421 32,480 $35,736 40,840 $43,051 49,200 $50,365 57,560 $57,681 65,920 $64,996 74,280 $72,311 82,640 Add $8,360 per person Over 200% FPL 0% discount Over $24,121 Over $32,481 Over $40,841 Over $49,201 Over $57,561 Over $65,921 Over $74,281 Over $82,641 Add $8,360 per person Source: Health Resources and Services Administration, http://nhsc.hrsa.gov/downloads/discountfeeschedule.pdf, as of April 2017. 30

Bi-State Primary Care Association s Vermont Member Sites By Organization Battenkill Valley Health Center (FQHC) 1. Battenkill Valley Health Center* (FQHC) 1. Champlain Islands Health Center 2. GoodHEALTH Internal Medicine 3. Pearl Street Youth Health Center 4. Riverside Health Center* 5. Safe Harbor Health Center* 6. School-Based Dental Clinic 7. South End Health Center 8. Winooski Family Health (FQHC) 1. Allen Pond Community Health Center 2. Brandon Medical Center 3. Castleton Family Health Center 4. CHCRR Pediatrics 5. Community Dental Clinic* 6. Mettowee Valley Health Center 7. Rutland Community Health Center 8. Shorewell Community Health Center Community Health Services of Lamoille Valley (FQHC) 1. Appleseed Pediatrics 2. Behavioral Health & Wellness Center 3. Community Dental Clinic* 4. Morrisville Family Health Care 5. Stowe Family Practice Gifford Health Care (FQHC) 1. Bethel Health Center 2. Chelsea Health Center 3. Gifford Health Center at Berlin 4. Gifford Primary Care 5. Rochester Health Center 6. Twin River Health Center Grace Cottage Family Health & Hospital (RHC) 1. Grace Cottage Family Health & Hospital The Health Center (FQHC) 1. Cabot Health Services (school-based) 2. The Health Center Main Site* 3. Ronald McDonald Dental Care Mobile* Indian Stream Health Center (FQHC) 1. Indian Stream Health Center Little Rivers Health Care (FQHC) 1. Clara Martin Center 2. LRHC at Bradford 3. LRHC at East Corinth 4. LRHC at Wells River 5. Valley Vista Mountain Health Center (FQHC) 1. Mountain Health Center* 2. Mountain Health Center Annex 3. Mountain Health Dental Care* (FQHC) 1. Concord Health Center 2. Danville Health Center 3. Hardwick Area Health Center 4. Island Pond Health & Dental Center* 5. Northern Counties Dental Center* 6. Orleans Dental Center* 7. The St. Johnsbury Community Health Center Northern Tier Center for Health (FQHC) 1. Alburg Health Center 2. Enosburg Health Center 3. Fairfax Health Center 4. Fairfield Street Health Center 5. NCSS Health Center 6. Richford Health Center 7. Richford Dental Clinic* 8. St. Albans Health Center 9. Swanton Health Center* 1. Barre Health Center 2. Bennington Health Center 3. Brattleboro Health Center 4. Burlington Health Center 5. Hyde Park Health Center 6. Middlebury Health Center 7. Newport Health Center 8. Rutland Health Center 9. St. Albans Health Center 10. St. Johnsbury Health Center 11. White River Junction 12. Williston Health Center Springfield Medical Care Systems (FQHC) 1. Charlestown Family Medicine (NH) 2. Chester Family Medicine* 3. The Ludlow Dental Center* 4. The Ludlow Health Center 5. Mountain Valley Medical Center 6. Rockingham Medical Group 7. Springfield Health Center 8. The Women s Health Center of Springfield Vermont Coalition of Clinics for the Uninsured 1. Bennington Free Health Clinic 2. Good Neighbor Health Clinic & Red Logan Dental Clinic* 3. Health Assistance Program at UVM Medical Center 4. Health Connections at Gifford Medical Center 5. Open Door Clinic* 6. People s Health & Wellness Clinic* 7. Rutland Free Clinic* 8. Valley Health Connections 9. Windsor Community Clinic at Mt. Ascutney *site provides dental services FQHC Federally Qualified Health Center RHC Rural Health Clinic 31

Bi-State s Vermont Member Sites by County Addison County Middlebury Health Center (PPNNE) Mountain Health Center (FQHC)* Mountain Health Center Annex (FQHC) Mountain Health Dental Care (FQHC)* The Open Door Clinic (VCCU) Bennington County Battenkill Valley Health Center (FQHC)* Bennington Free Health Clinic (VCCU) Bennington Health Center (PPNNE) Caledonia County (FQHC) Danville Health Center Hardwick Area Health Center Northern Counties Dental Center* St. Johnsbury Community Health Center St. Johnsbury Health Center (PPNNE) Chittenden County Burlington Health Center (PPNNE) (FQHC) Riverside Health Center* Safe Harbor Health Center* Pearl Street Youth Health Center H.O. Wheeler School (school-based)* South End Health Center GoodHEALTH Internal Medicine Health Assistance Program at UVMMC (VCCU) Williston Health Center (PPNNE) *site provides dental services (FQHC) Federally Qualified Health Center (PPNNE) (RHC) Rural Health Clinic (VCCU) Vermont Coalition of Clinics for the Uninsured Essex County Indian Stream Health Center (FQHC) (FQHC) Concord Health Center Island Pond Health and Dental Center* Franklin County Northern Tier Center for Health (FQHC) Alburg Health Center Enosburg Health Center Fairfax Health Center Fairfield Street Health Center NCSS Health Center Richford Dental Clinic* Richford Health Center St. Albans Health Center Swanton Health Center* St. Albans Health Center (PPNNE) Grand Isle County (FQHC) Champlain Islands Health Center Northern Tier Center for Health (FQHC) Alburg Health Center Lamoille County Community Health Services of Lamoille Valley (FQHC) Appleseed Pediatrics Behavioral Health & Wellness Center Community Dental Clinic* Morrisville Family Health Care Stowe Family Practice Hyde Park Health Center (PPNNE) Orange County Gifford Health Care (FQHC) Chelsea Health Center Gifford Primary Care Health Connections at Gifford Health Care (VCCU) Little Rivers Health Care (FQHC) Clara Martin Center LRHC at Bradford LRHC at Wells River LRHC at East Corinth Valley Vista Orleans County Newport Health Center (PPNNE) Orleans Dental Clinic (FQHC) 32

Bi-State s Vermont Member Sites by County Rutland County Community Health Centers of the Rutland Region (FQHC) Allen Pond Family Health Center Brandon Medical Center Castleton Family Health Center CHCRR Pediatrics Community Dental Clinic* Mettowee Valley Health Center Rutland Community Health Center Shorewell Community Health Center Rutland Free Clinic* (VCCU) Rutland Health Center (PPNNE) Washington Barre Health Center (PPNNE) Gifford Health Care (FQHC) Gifford Health Center at Berlin People s Health & Wellness Clinic (VCCU) The Health Center (FQHC) Cabot Health Services (school-based) Ronald McDonald Dental Care Mobile* The Health Center Main Site* Windsor Gifford Health Care (FQHC) Bethel Health Center Rochester Health Center Twin River Health Center Good Neighbor Health Clinic & Red Logan Dental Clinic*(VCCU) Springfield Medical Care Systems (FQHC) Chester Family Medicine* Mountain Valley Medical Center The Ludlow Health Center The Ludlow Dental Center* The Women s Health Center of Springfield Springfield Health Center Valley Health Connections (VCCU) Windsor Community Clinic (VCCU) Sullivan County in New Hampshire Springfield Medical Care Systems (FQHC) Charlestown Family Medicine Windham Brattleboro Health Center (PPNNE) Grace Cottage Family Health & Hospital (RHC) Springfield Medical Care Systems (FQHC) Rockingham Medical Group *site provides dental services (FQHC) Federally Qualified Health Center (PPNNE) (RHC) Rural Health Clinic (VCCU) Vermont Coalition of Clinics for the Uninsured 33

Bi-State s Vermont Member Legislative Representation List Biennium 2017-2018 Rep. David Ainsworth (R) Windsor-Orange-1 Gifford Health Care Rep. Janet Ancel (D) Washington-6 The Health Center Sen. Timothy Ashe (D)/(P) Chittenden District Sen. Claire Ayer (D) Addison District Mountain Health Center Sen. Becca Balint (D) Windham District Springfield Medical Care Systems Rep. Robert Bancroft (R) Chittenden-8-3 Rep. John Bartholomew (D) Windsor-1 Springfield Medical Care Systems Vermont Coalition of Clinics for the Uninsured Sen. Philip Baruth (D)/(P) Chittenden District Rep. Fred Baser (R) Addison-4 Mountain Health Center Rep. Lynn Batchelor (R) Orleans-1 Rep. Scott Beck (R) Caledonia-3 Rep. Paul Belaski (D) Windsor-1 Springfield Medical Care Systems Vermont Coalition of Clinics for the Uninsured Sen. Joseph Benning (R) Caledonia District Little Rivers Health Care Rep. Steve Beyor (R) Franklin-5 Northern Tier Center for Health Rep. Clement Bissonnette (D) Chittenden-6-7 Rep. Thomas Bock (D) Windsor-3-1 Grace Cottage Family Health & Hospital Springfield Medical Care Systems Rep. William Botzow (D) Bennington-1 Battenkill Valley Health Center Sen. Carolyn Branagan (R) Franklin District Northern Tier Center for Health Sen. Christopher Bray (D) Addison District Mountain Health Center Rep. Patrick Brennan (R) Chittenden-9-2 Rep. Timothy Briglin (D) Windsor-Orange-2 Gifford Health Care Sen. Randy Brock (R) Franklin District Northern Tier Center for Health Sen. Francis Brooks (D) Washington District Gifford Health Care The Health Center Rep. Cynthia Browning (D) Bennington-4 Battenkill Valley Health Center Rep. Jessica Brumsted (D) Chittenden-5-2 Rep. Susan Buckholz (D) Windsor-4-1 Gifford Health Care Rep. Tom Burditt (R) Rutland-2 Rep. Mollie Burke (P) Windham-2-2 Grace Cottage Family Health & Hospital Closest FQHC is Springfield Medical Care Systems Sen. Brian Campion (D) Bennington District Battenkill Valley Health Center Rep. William Canfield (R) Rutland-3 Rep. Stephen Carr (D) Rutland-6 Rep. Robin Chesnut-Tangerman (P) Rutland- Bennington 34

Bi-State s Vermont Member Legislative Representation List Biennium 2017-2018 Rep. Annmarie Christensen (D) Windsor-2 Springfield Medical Care Systems Rep. Kevin Christie (D) Windsor-4-2 Vermont Coalition of Clinics for the Uninsured Closest FQHC is Little Rivers Health Care Rep. Brian Cina (P) Chittenden-6-4 Sen. Alison Clarkson (D) Windsor District Closest FQHC is Springfield Medical Care Systems Rep. Selene Colburn (P) Chittenden-6-4 Sen. Brian Collamore (R) Rutland District Rep. James Condon (D) Chittenden-9-1 Rep. Peter Conlon (D) Addison-2 Gifford Health Care Rep. Daniel Connor (D) Franklin-6 Northern Tier Center for Health Rep. Charles Conquest (D) Orange-Caledonia Little Rivers Health Care Rep. Sarah Copeland Hanzas (D) Orange-2 Little Rivers Health Care Rep. Timothy Corcoran (D) Bennington-2-1 Battenkill Valley Health Center Sen. Ann Cummings (D) Washington District Gifford Health Care The Health Center Rep. Larry Cupoli (R) Rutland-5-2 Rep. Maureen Dakin (D) Chittenden-9-2 Rep. David Deen (D) Windham-4 Grace Cottage Family Health & Hospital Springfield Medical Care Systems Vermont Coalition of Clinics for the Uninsured Rep. Dennis Devereux (R) Rutland-Windsor-2 Springfield Medical Care Systems Rep. Eileen Dickinson (R) Franklin-3-2 Northern Tier Center for Health Rep. Anne Donahue (R) Washington-1 The Health Center Rep. Johannah Donovan (D) Chittenden-6-5 Rep. Betsy Dunn (D) Chittenden-8-1 Rep. Alice Emmons (D) Windsor-3-2 Springfield Medical Care Systems Vermont Coalition of Clinics for the Uninsured Rep. Peter Fagan (R) Rutland-5-1 Rep. Martha Feltus (R) Caledonia-4 Rep. Rachael Fields (D) Bennington-2-1 Battenkill Valley Health Center Sen. Margaret Peg Flory (R) Rutland District Rep. Robert Forguites (D) Windsor-3-2 Springfield Medical Care Systems Vermont Coalition of Clinics for the Uninsured Rep. Bob Frenier (R) Orange-1 Gifford Health Care Little Rivers Health Care Rep. Douglas Gage (R) Rutland-5-4 Rep. Marianna Gamache (R) Franklin-4 Northern Tier Center for Health Rep. John Gannon (D) Windham-6 Closest FQHC is Battenkill Valley Health Center 35

Bi-State s Vermont Member Legislative Representation List Biennium 2017-2018 Rep. Marcia Gardner (D) Chittenden-1 Rep. Dylan Giambatista (D) Chittenden-8-2 Rep. Diana Gonzalez (P) Chittenden-6-7 Rep. Maxine Grad (D) Washington-7 The Health Center Rep. Rodney Graham (R) Orange-1 Gifford Health Care Little Rivers Health Care Rep. Sandy Haas (P) Windsor-Rutland Gifford Health Care Rep. James Harrison (R) Rutland-Windsor-1 Rep. Helen Head (D) Chittenden-7-3 Rep. Michael Hebert (R) Windham-1 Closest FQHC is Springfield Medical Care Systems Rep. Robert Helm (R) Rutland-3 Rep. Mark Higley (R) Orleans-Lamoille Community Health Services of the Lamoille Valley Rep. Matt Hill (D) Lamoille-2 Community Health Services of the Lamoille Valley Rep. Jay Hooper (D) Washington-4 The Health Center Rep. Mary Hooper (D) Orange-Washington-Addison Gifford Health Care Vermont Coalition of Clinics for the Uninsured Rep. Lori Houghton (D) Chittenden-8-2 Rep. Mary Howard (D) Rutland-5-3 Vermont Coalition of Clinics for the Uninsured Sen. Debbie Ingram (D) Chittenden District Rep. Kimberly Jessup (D) Washington-5 The Health Center Rep. Ben Jickling (I) Orange-Washington-Addison Gifford Health Care Vermont Coalition of Clinics for the Uninsured Rep. Mitzi Johnson (D) Grand Isle-Chittenden Northern Tier Center for Health Rep. Ben Joseph (D) Grand Isle-Chittenden Northern Tier Center for Health Rep. Bernie Juskiewicz (R) Lamoille-3 Community Health Services of the Lamoille Valley Rep. Brian Keefe (R) Bennington-4 Battenkill Valley Health Center Rep. Kathleen Keenan (D) Franklin-3-1 Northern Tier Center for Health Rep. Charlie Kimbell (D) Windsor-5 Closest FQHC is Springfield Medical Care Systems Sen. Jane Kitchel (D) Caledonia District Little Rivers Health Care Rep. Warren Kitzmiller (D) Washington-4 The Health Center Rep. Jill Krowinski (D) Chittenden-6-3 Rep. Robert LaClair (R) Washington-2 The Health Center Rep. Martin LaLonde (D) Chittenden-7-1 Rep. Diane Lanpher (D) Addison-3 Mountain Health Center 36

Bi-State s Vermont Member Legislative Representation List Biennium 2017-2018 Rep. Richard Lawrence (R) Caledonia-4 Rep. Paul Lefebvre (R) Essex-Caledonia-Orleans Indian Stream Health Center Rep. Patti Lewis (R) Washington-1 The Health Center Rep. William Lippert (D) Chittenden-4-2 Rep. Emily Long (D) Windham-5 Grace Cottage Family Health & Hospital Closest FQHC is Springfield Medical Care Systems Rep. Gabrielle Lucke (D) Windsor-4-2 Vermont Coalition of Clinics for the Uninsured Closest FQHC is Little Rivers Health Care Sen. Virginia Lyons (D) Chittenden District Rep. Terry Macaig (D) Chittenden-2 Sen. Mark MacDonald (D) Orange District Gifford Health Care Little Rivers Health Care Rep. Marcia Martel (R) Caledonia-1 Little Rivers Health Care Rep. James Masland (D) Windsor-Orange-2 Gifford Health Care Rep. Christopher Mattos (R) Chittenden-10 Sen. Richard Mazza (D) Grand Isle District Northern Tier Center for Health Rep. Curt McCormack (D) Chittenden-6-3 Sen. Richard McCormack (D) Windsor District Closest FQHC is Springfield Medical Care Systems Rep. Patricia McCoy (R) Rutland-1 Rep. James McCullough (D) Chittenden-2 Rep. Francis McFaun (R) Washington-2 The Health Center Rep. Alice Miller (D) Bennington-3 Battenkill Valley Health Center Rep. Ruqaiyah Morris (D) Bennington-2-2 Battenkill Valley Health Center Vermont Coalition of Clinics for the Uninsured Rep. Mary Morrissey (R) Bennington-2-2 Battenkill Valley Health Center Vermont Coalition of Clinics for the Uninsured Rep. Michael Mrowicki (D) Windham-4 Grace Cottage Family Health & Hospital Springfield Medical Care Systems Vermont Coalition of Clinics for the Uninsured Rep. Linda Myers (R) Chittenden-8-1 Sen. Alice Nitka (D) Windsor District Closest FQHC is Springfield Medical Care Systems Rep. Gary Nolan (R) Lamoille-Washington Community Health Services of the Lamoille Valley Rep. Terry Norris (I) Addison-Rutland Mountain Health Center Rep. Daniel Noyes (D) Lamoille-2 Community Health Services of the Lamoille Valley Rep. Michael Marcotte (R) Orleans-2 Rep. Carol Ode (D) Chittenden-6-1 37