Introduction To Federally Qualified Health Centers (FQHCs)

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Introduction ToFederally Qualified
HealthCenters (FQHCs)
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What is an FQHC?

• Federally Qualified Health Center (FQHC) -
  umbrella term for a number of federally-supported
  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?

• Alcona
• Baldwin
• Jackson
• Detroit (3)
• Grand Rapids
• Algonac
• East Jordan
• Battle Creek (2)
• Kalamazoo
• Carleton
• Muskegon (2)
• Flint
• Saginaw
• Lansing
• Benton Harbor (2)
• Houghton Lake
• Shelby
• Sault St. Marie
• Sterling

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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 directors)
  a majority of which must be consumers of the
  centers 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 patients ability to pay (lt200 FPL nominal
  for lt100 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
  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 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? (contd)

• 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

• Kim Sibilsky, Executive Director
• Michigan Primary Care Association
• [phone]
• ksibilsky_at_mpca.net
• Neal Colburn, Technical Assistance Consultant
• Michigan Primary Care Association
• [phone] x220
• ncolburn_at_mpca.net