Transcript The Federally Qualified Health Center: Past, Present, and

Health Resources and Services Administration
2008 Primary Health Care All-Grantee Meeting
The Federally Qualified Health Center
Look-Alike Program:
Past, Present, and Future
Tonya Bowers, Interim Director
Twyla Adams, Branch Chief
U.S. Department of Health and Human Services
Health Resources and Services Administration
Bureau of Primary Health Care
June 23, 2008
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Workshop Objectives

This workshop will:
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June 23, 2008
Cover the basics of the FQHC LookAlike Program.
Exam the recent trends under the
FQHC Look-Alike Program.
Present the challenges and
opportunities for the FQHC Look-Alike
Program.
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Basics of the
FQHC Look-Alike Program
June 23, 2008
3
Background

Medicare and Medicaid statutes
define the provider type
“Federally Qualified Health
Center” (FQHC):
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June 23, 2008
Social Security Act §1861(aa)(4) and
§1905(l)(2)(B) respectively.
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Definition of an FQHC
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June 23, 2008
An entity that receives a grant under section 330
of the Public Health Service Act (PHSA) – Health
Center Program:

Community Health Center Program – Section 330(e).

Migrant Health Center Program – Section 330(g).

Health Care for the Homeless Program – Section 330(h).

Public Housing Primary Care Program – Section 330(i).
An entity that is determined by DHHS to meet
requirements to receive funding without actually
receiving a grant (i.e., requirements for an FQHC
“Look-Alike” entity are found in PINs #2003-21 &
#2005-17).
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FQHC Look-Alike
Eligibility Requirements
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June 23, 2008
Must be a private, charitable, tax-exempt
nonprofit organization OR public entity
(direct or co-applicant arrangement).
Must serve a medically underserved area
(MUA) or medically underserved population
(MUP) designated by DHHS.
Must not be owned, controlled or operated
by another entity.
Must be operational and providing primary
care services at the time of application
submission.
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Benefits of
FQHC Look-Alike Status
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Eligible for:
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June 23, 2008
Enhanced reimbursement under Prospective
Payment System (PPS) or other stateapproved alternative payment methodology
for services provided under Medicaid.
Cost-based reimbursement for services
provided under Medicare.
Have access to favorable drug pricing
under Section 340B of the PHSA.
Have the right to have “outstationed”
Medicaid eligibility workers.
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Benefits of
FQHC Look-Alike Status
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June 23, 2008
Safe harbor under the Federal anti-kickback
statute for waiver of co-payments to the extent
a patient is below 200% of Federal income
poverty guidelines.
Reimbursement by Medicare for "first dollar" of
services rendered to beneficiaries, i.e.,
deductible is waived.
Access to providers through the National Health
Service Corps if the health center's service area
is designated a Health Professional Shortage
Area (HPSA).
Access to the Federal Vaccine For Children
program and eligibility to participate in the
Pfizer Sharing the Care Program.
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FQHC Look-Alike
Program Administration
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The FQHC Look-Alike Program is operated
under an intra-agency agreement between
HRSA and CMS.
HRSA is responsible for:
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June 23, 2008
Assuring compliance with requirements under
section 330 of the PHSA.
Making a recommendation to CMS for
designation as an FQHC Look-Alike.
CMS has final authority to designate
applicants as an FQHC Look-Alike.
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FQHC Look-Alike
Program Administration
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HRSA staff are responsible for:
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Developing the application guidance.
Providing technical assistance to
applicants and existing FQHC Look-Alikes.
Reviewing applications.
Coordinating site visits.
Monitoring continued compliance.
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Recent Trends under the
FQHC Look-Alike Program
June 23, 2008
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FQHC Look-Alike
Project Officers
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Twyla Adams (301-594-4439)
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Cristina Petruccelli (301-594-4118)
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NY, NJ, MD, WV, VA, SD, ND, CO, MT, UT, ID, WA, OR, WY, PR, DE, PA,
DC, AR
Bette Darling (301-594-4342)
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June 23, 2008
OH, MI, WI, MN, IL, IN, MO, IA, NE, KS
Valerie Bowers (301-443-7364)
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AR, LA, NM, OK, TX
Blanca Fuertes (301-443-0612) and Michelle Parker (301-5944285)
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CT, ME, NH, RI, VT, AL, FL, GA, KY, MS, NC, SC, TN
Cicely Nelson (301-594-4496)
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Branch Chief
CA, NV, AZ, HI
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FQHC Look-Alike Program Growth
1991-2007
140
124
120
111
112
100
121
122
107
90
80
60
40
28
20
0
1991
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2001
2002
2003
2004
2005
2006
2007
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Number of Applications and New Designations
2004-2007
45
39
39
40
35
30
25
25
20
21
21
17
17
Applications Received
Designations
15
8
10
5
0
2004
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2005
2006
2007
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Trend Revenue Per Payor Type
100%
90%
25%
32%
80%
27%
19%
70%
60%
50%
9%
23%
13%
14%
25%
23%
13%
13%
19%
17%
40%
30%
20%
19%
40%
39%
32%
27%
34%
10%
0%
Medicare
June 23, 2008
6%
7%
6%
9%
7%
2003
2004
2005
2006
2007
Medicaid
Other Public Payer
Third Party
Self Pay
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Success Rates for NAP Funding
2002-2007
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June 23, 2008
Of the FQHC Look-Alikes that
applied for NAP new start funding:
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FY 2002: 43% (24/56) were successful.
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FY 2003: 33% (17/51) were successful.
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FY 2004: 7% (4/58) were successful.
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FY 2005: 33% (12/36) were successful.
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FY 2006: 59% (22/37) were successful.
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FY 2007: 48% (23/48) were successful.
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Success Rates for NAP Funding
2002-2007
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June 23, 2008
Of the organizations that received
NAP new start grants:
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FY 2002: 27% (24/88) were FQHC Look-Alikes.
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FY 2003: 32% (17/53) were FQHC Look-Alikes.
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FY 2004: 15% (4/27) were FQHC Look-Alikes.
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FY 2005: 28% (12/45) were FQHC Look-Alikes.
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FY 2006: 40% (22/55) were FQHC Look-Alikes.
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FY 2007: 47% (23/49) were FQHC Look-Alikes.
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Challenges and Opportunities
for the FQHC Look-Alike
Program
June 23, 2008
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Challenges
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Challenge #1: Reviewing initial
submissions of FQHC Look-Alike new
designation applications in which 9095% are non-compliant.
Challenge #2: Having partners who
are not knowledgeable about the FQHC
Look-Alike Program.
Challenge #3: Streamlining data
collection for increased program
analysis.
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Opportunities:
Assure Compliance
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Revise the FQHC Look-Alike
application guidance.
The goals of the revised guidance
are to:
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June 23, 2008
Enhance clarity in conveying HRSA’s
expectations to applicants.
Better align FQHC Look-Alike
application requirements to those in
the section 330 grant program.
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Opportunities:
Assure Compliance
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Proposed revisions to the existing
application guidance include:
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June 23, 2008
Creation of designation periods up to 5 years.
Adoption of application forms used in the
section 330 grant applications.
Submission of 5-year health care and business
plans.
Allowance of governance waivers for
organizations that serve special populations as
defined in section 330 of the PHSA.
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Opportunities:
Assure Compliance
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Status of revised application guidance:
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June 23, 2008
Draft guidance was released for a 60-day
public comment in the fall of 2007.
Draft guidance will be released for a second
60-day public comment in the summer of 2008
as a result of the comments received and
resulting changes.
HRSA projects releasing the revised application
guidance in final in the fall of 2008.
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Opportunities:
Assure Compliance
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Conduct compliance site visits to verify compliance with
requirements under section 330 of the PHSA.
Description of compliance site visits:
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June 23, 2008
10 pre-designation and 10 post-designation compliance
site visits will be conducted in FY 2008.
An organization may receive a compliance site visit if its
paper application for new designation or recertification is
approvable.
To ensure diversity, selection factors will include
geographic region, urban/rural, private/public, and single
site/multiple sites.
If areas of non-compliance are identified during the site
visit, HRSA will provide the organization with technical
assistance in order to come into compliance.
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Opportunities:
Assure Compliance
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Status of the compliance site visits:
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June 23, 2008
HRSA will disseminate a Program
Assistance Letter that provides more
specific information about the
compliance site visits in the summer of
2008.
HRSA will implement the compliance
site visits in the summer of 2008.
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Opportunities:
Strengthen Partnerships
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Develop and strengthen relationships
with partners to increase their
knowledge and understanding of the
FQHC Look-Alike Program by:
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June 23, 2008
Convening brown bag sessions for HRSA
staff.
Defining roles for partners.
Developing additional educational
materials.
Convening national conference calls.
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Opportunities:
Streamline Data Collection
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June 23, 2008
HRSA anticipates integrating the FQHC
Look-Alike Program into the HRSA-wide
EHB System in 2009.
At that time, new applicants and
existing FQHC Look-Alikes will be able
to submit applications electronically.
It will facilitate data extraction in order
to analyze data trends.
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Questions?
June 23, 2008
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Contact Information
Tonya Bowers
Interim Director
U.S. Department of Health and Human Services
Health Resources and Services Administration
Bureau of Primary Health Care
5600 Fishers Lane Room 17C-26
Rockville, MD 20857
Telephone: 301.594.4300
Fax: 301.594-4984
E-mail: [email protected]
June 23, 2008
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Contact Information
Twyla Adams
Branch Chief
U.S. Department of Health and Human Services
Health Resources and Services Administration
Bureau of Primary Health Care
5600 Fishers Lane Room 17C-26
Rockville, MD 20857
Telephone: 301.594.4300
Fax: 301.480.7225
E-mail: [email protected]
June 23, 2008
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