Transcript Resource - Indiana Rural Health Association

Primary Practices in Underserved
Areas: FQHCs and RHCs
Elizabeth Morgan Burrows, JD
Chief Executive Officer
Vermillion Parke Community Health Center
October 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 nonprofit
• 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
•
•
•
•
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www.hrsa.gov
www.isdh.in.gov
www.raconline.org
www.indianapca.org
www.indianaruralhealth.org
Elizabeth Morgan Burrows, JD
Vermillion-Parke Community
Health Center
[email protected]
765-828-1003 or 765-492-9042