Michigan Primary Care Association and Federally Qualified Health Centers

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Michigan Primary Care Association and Federally
Qualified Health Centers

• Kim Sibilsky, Executive Director, Michigan
  Primary Care Association
• November 2005

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Who is MPCA?

• Michigan Primary Care Association is a non-profit
  membership organization of community based
  primary health care providers.
• Our mission is to promote, support and develop
  comprehensive, accessible and affordable quality
  primary health care services to everyone in
  Michigan.

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Who is MPCA?

• Contractually partners with US Department of
  Health and Human Services and the Michigan
  Department of Community Health
• Informally partners with advocates, other
  associations and providers, and state and
  national policymakers to improve access to health
  care for all persons regardless of their ability
  to pay.
• MPCA operates through a Board of Directors. Each
  active member may appoint one representative to
  the Board for a one-year term representatives
  are eligible to serve successive terms without
  limitation. Board members have the ability to
  impact actions, policies, and procedures put
  forth by MPCA through their vote

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What is an FQHC?

• A community health center that receives federal
  funding under section 330 of the Public Health
  Service Act to provide comprehensive primary care
  services to uninsured and underinsured
  populations.

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Where did FQHCs come from?

• Economic Opportunity Act of 1964 established the
  Neighborhood Health Centers.
• Models were designed to combine the resources of
  local communities with federal funds to establish
  neighborhood clinics in poverty-stricken and
  rural areas.
• A 1966 Amendment included language emphasizing
  the necessity of encouraging the participation
  and employment of local community residents.

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Why are we suddenly hearing more about FQHCs?

• Unprecedented programmatic growth period combined
  with ever increasing number of uninsured persons.
• President Bushs intent to enhance the quality of
  life in underserved communities by expanding the
  safety net through the community health center
  program.
• The Presidents Initiative to create 630 new
  access points and expand 570 existing centers
  with the goal of serving an additional 6 millions
  people by fiscal year 2006.

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Basic Eligibility Requirements

• Must be located in (or serve) a medically
  underserved area (MUA) or serve a medically
  underserved population (MUP)
• Must be a public or private nonprofit entity,
  including tribal, faith-based and community based
  organization.
• Must have a governing board (board of directors),
  a majority of which must be consumers of the
  centers health services
• Must have a management team that works with the
  governing board to achieve the mission of the
  center

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Requirements Continued

• Must provide comprehensive primary care either
  directly or through contract
• Must offer a sliding fee scale, accept Medicare,
  Medicaid and provide culturally competent
  services regardless of ability to pay

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FQHC Benefits

• Receive Section 330 funds which significantly
  support expanded access to health care services
  to underserved populations
• Receive cost based reimbursement for services
  provided to Medicare patients and enhanced
  (cost-derived prospective) payments for services
  to Medicaid patients

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Benefits Continued

• Ability to participate in the Public Health
  Service Act Section 340B Drug Pricing Program
• Ability to access free medical malpractice
  insurance under the Federal Tort Claims Act
  (FTCA)
• Access to Bureau of Primary Health Care technical
  assistance
• Access to the federal Vaccines for Children
  Program

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FQHC Look-Alike

• Meets all the Section 330 program requirements
  but does not receive grant support
• Must be fully operational and meeting all Section
  330 program requirements for at least one month
  to be eligible to apply
• Can apply for both Look-Alike status and federal
  grant funding simultaneously
• Look-alike status application process is
  non-competitive

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FQHC Look-Alike Benefits

• Enhanced revenue due to the Prospective Payment
  System reimbursement for services to Medicaid and
  Medicare patients
• PHS Drug Pricing Discounts for pharmaceutical
  products
• Access to on-site Department of Health and Human
  Services out stationed eligibility workers to
  provide Medicaid and CHIP enrollment services

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FQHC Look-Alike Benefits

• Reimbursement by Medicare for first dollars of
  services because deductible is waived if FQHC is
  providing services
• Access to Vaccines for Children (VFC)
• Access to National Health Service Corps (NHSC)
  Placements to provide medical, dental and mental
  health provider staff

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What makes FQHCs different from other providers?

• Our mission is to improve access to primary
  health care for all persons regardless of
• - Insurance status
• - Location
• - Age
• - Sex
• - Race
• - Sexual Orientation
• - Disease Status

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What makes FQHCs different than other providers?

• We provide primary health care services to
  federally designated medically underserved areas
  populations
• We provide a comprehensive set of primary care
  services and enabling services to all persons
  regardless of their ability to pay
• We offer a sliding fee scale to the uninsured and
  underinsured

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What makes FQHCs different than other providers?

• Local governance- Health centers are governed by
  a volunteer Board of Directors. The majority of
  Board Members must be patients of the center.
• Responsive to community needs Health Centers
  tailor their services to fit the special needs
  and priorities of their communities.

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What makes FQHCs different than other providers?

• We report regularly to the Bureau of Primary
  Health Care, Department of Health and Human
  Services, information on revenue, cost, services
  provided, and the needs of our community (service
  area. We must meet high uniform practice
  standards for cost effectiveness and quality of
  care.
• We participate in a number of federal initiatives
  designed to improve the quality of health care.

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What is NACHC?

• The National Association of Community Health
  Centers, Inc. (NACHC) is a non-profit
  organization whose mission is to enhance and
  expand access to quality, community-responsive
  health care for Americas medically underserved
  and uninsured.

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NACHC continued

• NACHC represents the nations network of over
  1,000 Federally Qualified Health Centers (FQHCs)
  which serve 15 million people through 5,000 sites
  located in all of the 50 states, Puerto Rico, the
  District of Columbia, the U.S. Virgin Islands and
  Guam.

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NACHC continued

• In fulfilling its mission NACHC
• Serves as the major source for information, data,
  research and advocacy on key issues affecting
  community-based health centers and the delivery
  of health care for the medically underserved and
  uninsured in America
• Provides education, training, technical
  assistance and leadership development to health
  center staff, boards and others to promote
  excellence and cost-effectiveness in health
  delivery practice and community board governance
• Builds partnerships and linkages that stimulate
  public and private sector investment in the
  delivery of quality health care services to
  medically underserved communities

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NACHC continued

• By becoming a member of NACHC you work in unison
  with other key players in the industry to ensure
  that health centers continue to play a prominent
  role in Americas health care delivery system.
  As a member you have direct access to a host of
  benefits and services tailored specifically to
  health care organizations and their partners.

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Challenges

• Highly competitive grant application process
• Competitive grant reapplication every 3-5 years
• Annual Financial Status Report (FSR) required
• Comprehensive data reporting required annually
  (Uniform Data Set, or UDS)
• Higher level of staffing, both clinical and
  administrative/management, necessary to meet
  requirments

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For More Information

• www.mpca.net
• www.nachc.com
• www.hrsa.gov
• Kim Siblisky, Executive Director, MPCA
• (517) 381-800 ext. 211
• ksibilsky_at_mpca.net
• Jennifer Mora, Community Health Planning Mgr.
• [phone] ext. 221
• jmora_at_mpca.net