Transcript Where is rural Michigan now? - Free clinics of michigan

Introduction To
Federally Qualified Health
Centers (FQHCs)
What is an FQHC?
• Federally Qualified Health Center (FQHC) -
umbrella term for a number of federallysupported safety-net programs. The term also
determines how the programs will be
reimbursed by Medicaid. These programs
include:
– Community/Migrant Health Centers
– Health Care for the Homeless
– Public Housing Health Centers
– School-based, School-linked Health Centers
There are also FQHC ‘Look-Alikes’ (These meet all FQHC
requirements but receive no grant)
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FQHCs in Michigan
Thirty one (31) Michigan Community
Health Centers provide quality,
comprehensive, community-oriented
primary health care for nearly 600,000
patients annually at 160 sites across the
state. Of those 31 Community Health
Centers, 28 are Federally Qualified
Health Centers (FQHCs), 2 are FQHC
'Look-Alikes’, and 1 is both a FQHC and a
FQHC ‘Look-Alike’.
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Where are the FQHC
Organizations?
1.
Alcona
2.
Baldwin
3.
Jackson
4.
Detroit (3)
5.
Grand Rapids
6.
Algonac
7.
East Jordan
8.
Battle Creek (2)
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Kalamazoo
10.
Carleton
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Muskegon (2)
12.
Flint
13.
Saginaw
14.
Lansing
15.
Benton Harbor (2)
16.
Houghton Lake
17.
Shelby
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Sault St. Marie
19.
Sterling
20.
Thunder Bay
21.
Marquette
This list does not include
all access points.
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FQHC Eligibility Requirements
• Must be located in (or serve) a medically
underserved area (MUA) or serve a
medically underserved population (MUP)
• Must be a private nonprofit entity or a
public entity with a compliant co-applicant
board, including tribal, faith-based and
community based organizations
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FQHC Requirements
• Must have a governing board (board of
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directors) a majority of which must be
consumers of the center’s health services and as
a group represent those being served.
No more than half of non-consumer members
may derive 10% or more of their income from
the health care industry.
Must have a management team that works with
the governing board to achieve the mission of
the center.
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FQHC Requirements
• Must be accessible, having extended
hours, and having arrangements for off
hour coverage (24/7)
• Must offer a sliding fee scale to adjust fees
to a patient’s ability to pay (<200% FPL;
nominal for <100% FPL)
• Must accept Medicare & Medicaid
• Must provide culturally competent services
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FQHC Requirements
• Must provide comprehensive system of
care (either directly or by contract)
available & accessible promptly and in a
manner that assures continuity of care,
including required services:
– Basic primary and preventive services
– Referrals to other providers (specialists when
medically indicated) and health related
services and agencies (substance abuse;
mental health)
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FQHC Requirements
– Case management services (counseling;
referral & follow-up) and services to
assist patients establishing eligibility for
financial assistance programs
– Enabling services: outreach,
transportation and translation
–Health Education: availability &
proper use of health services
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FQHC Requirements
–Additional health services as
appropriate
• Behavioral Health
• Comprehensive oral health
• Linguistic and cultural competence
• Special populations services (migrant,
homeless, public housing etc.)
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FQHC Benefits
• Receive Section 330 funds which significantly
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support expanded access to health care services
to underserved populations (Except Look-Alikes)
Receive Medicaid Agency payment rates under
the Prospective Payment System (PPS) or other
State approved alternative payment
methodology (PAL 2001-09; Sec 1902(bb) SSA)
Receive an FQHC Medicare All-Inclusive Rate
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FQHC Benefits
• Ability to participate in the Public Health Service
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Act Sections 340B Drug Pricing Program
Automatic HPSA Designation/access to National
Health Service Corps
Ability to access free medical malpractice
insurance under the Federal Tort Claims Act
(FTCA) Note: This does not apply to Look-Alikes.
Access to the federal Vaccines for Children
Program
Access to Bureau of Primary Health Care
technical assistance
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How do FQHCs make a difference?
• Their mission is to improve access to primary
health care for all persons regardless of –
– Insurance status
– Location
– Age
– Sex
– Race
– Disease Status
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How do FQHCs make a difference?
• They offer a sliding fee scale to the uninsured and
underinsured.
• Local governance – Health centers are governed by
a volunteer Board of Directors. The majority of
Board Members must be patients of the center.
Boards must be able to hire/fire executive director
(When owned by public entity, have authority
delegated to them to be able to do so.)
• Responsive to community needs – Health centers
tailor their services to fit the special needs and
priorities of their communities.
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How do FQHCs make a difference?
• Create jobs and stimulate economic growth.
• The Institute of Medicine recognized health
centers for reducing and eliminating the health
gaps for racial and ethnic minorities.
• Cost-effective care – A recent study in Michigan
demonstrated that health centers provide $44.87
per member per month savings to Michigan
Medicaid as compared to other Medicaid
providers.
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How do FQHCs make a difference?
(cont’d)
• Health centers meet or exceed nationally
accepted practice standards for treatment
of chronic conditions. All health centers
must have a clinical quality program and
submit reports on their clinical outcomes
(clinical measures).
• Quality of care provided at health centers
is equal to or greater than care provided
elsewhere.
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Web Resources
• Michigan Primary Care Association
www.mpca.net
• National Association of Communty Health
Centers www.nachc.com
• US HHS HRSA Bureau of Primary Health
Care http://bphc.hrsa.gov/
– http://bphc.hrsa.gov/about/
– http://bphc.hrsa.gov/policy/default.htm
– http://bhpr.hrsa.gov/shortage/
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For more information
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Kim Sibilsky, Executive Director
Michigan Primary Care Association
(517) 381-8000
[email protected]
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Neal Colburn, Technical Assistance Consultant
Michigan Primary Care Association
(517) 381-8000 x220
[email protected]
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