Federally Qualified Health Centers: - PowerPoint Presentation

Slide1

Federally Qualified Health Centers:

An Overview

August 13, 2014Slide2

2

Today’s AgendaLouisiana Primary Care Association

19 Key Requirements of FQHCsOverview of Louisiana’s FQHCs

2Slide3

3

MISSION: To serve as “the voice of Louisiana's Health Centers, who believe that all Louisianans deserve access to the highest quality healthcare.” 

3

Louisiana Primary Care AssociationSlide4

4

Louisiana Primary Care Association

MembershipResponsibilitiesStaffActivitiesRelationships

4Slide5

5

Private, nonprofit health centers located in medically underserved areas that provide comprehensive primary care, behavioral health and dental services to all individuals regardless of their ability to pay

Offer a sliding fee scale based on income for the uninsuredReceive a federal grant to finance the care for the uninsured

Receive a special rate for Medicaid services

Accept most forms of private insurance

Federally Qualified Health CentersSlide6

Governed by a community board composed of a majority (51% or more) of health center patients who represent the population served.

Meet other performance and accountability requirements regarding administrative, clinical, and financial operations.

6

Federally Qualified Health CentersSlide7

7

OverviewThere are 19 Key Health Center Program Requirements

(http://www.bphc.hrsa.gov/about/requirements.htm) Requirements are divided into four categories: NeedServices Management & Finance

Governance

7Slide8

8

1. Needs Assessment

Requirement:Health center demonstrates and documents the needs of its target population, updating its service area, when appropriate.

http://bphc.hrsa.gov/about/requirements/hcpreqs.pdf

8Slide9

9

2. Required and Additional Services

Requirement: Health center provides all required primary, preventive, enabling health services and additional health services as appropriate and necessary, either directly or through established written arrangements and referrals.

Note: Health centers requesting funding to serve homeless individuals and their families must provide substance abuse services among their required services (Section 330(h)(2) of the PHS Act)

9Slide10

10

3. Staffing Requirement

Requirement:Health center maintains a core staff as necessary to carry out all required primary, preventive, enabling health services and additional health services as appropriate and necessary, either directly or through established arrangements and referrals. Staff must be appropriately credentialed and licensed.

Staffing should be culturally and linguistically appropriate for the population being

served.

10Slide11

11

4. Accessible Hours of Operation/ Locations

Requirement:Health center provides services at times and locations that assure accessibility and meet the needs of the population to be served.

11Slide12

12

5. After Hours Coverage

Requirement:Health center provides professional coverage during hours when the center is closed. Includes the provision, through clearly defined arrangements, for access of health center patients to professional coverage for medical emergencies after the center's regularly scheduled hours

12Slide13

13

6. Hospital Admitting Privileges and Continuum of Care

Requirement:Health center physicians have admitting privileges at one or more referral hospitals, or other such arrangement to ensure continuity of care. In cases where hospital arrangements (including admitting privileges and membership) are not possible, health center must firmly establish arrangements for hospitalization, discharge planning, and patient tracking.

13Slide14

14

7. Sliding Fee Discounts

Requirement:Health center has a system in place to determine eligibility for patient discounts adjusted on the basis of the patient ability to pay.

Individuals at or below 100% FPL must receive a full discount on fees for services, however a nominal fee may be charged.

The fee schedule must slide/provide varying discount levels on charges to individuals between 101% and 200% of the FPL.The fee schedule must be based on the most recent Federal Poverty Level/Guidelines, available at

http://aspe.hhs.gov/poverty/

and must be updated annually.

14Slide15

15

8. Quality Improvement/Assurance Plan

Requirement:Health center has an ongoing Quality Improvement/Quality Assurance (QI/QA) program that includes clinical services and management, and that maintains the confidentiality of patient records.

(Section 330(k)(3)(C) of the PHS Act, 45 CFR Part 74.25 (c)(2), (3) and 42 CFR Part 51c.303(c)(1-2))

15Slide16

16

9. Key Management Staff

Requirement:Health center maintains a fully staffed health center management team as appropriate for the size and needs of the center. Prior review by HRSA of final candidates for Project Director/Executive Director/CEO position is required.

(Section 330(k)(3)(H)(ii) of the PHS Act and 45 CFR Part 74.25 (c)(2),(3))

16Slide17

17

10. Contractual/Affiliation Agreements

Requirement:Health center exercises appropriate oversight and authority over all contracted services, including assuring that any subrecipient(s) meets Health Center Program requirements.

(Section 330(k)(3)(I)(ii), 42 CFR Part 51c.303(n), (t)) and Section 1861(

aa)(4), Section 1905(l)(2)(B) of the Social Security Act, and 45 CFR Part 74.1(a)(2))

17Slide18

18

11. Collaborative Relationships

Requirement:Health center makes effort to establish and maintain collaborative relationships with other health care providers, including other health centers, in the service area of

the center. The health center secures letter(s) of support from existing health centers (section 330 grantees and FQHC Look-Alikes) in the service area or provides an explanation for why such letter(s)

of support cannot be obtained

18Slide19

19

12. Financial Management and Control Policies

Requirement:Health center maintains accounting and internal control systems appropriate to the size and complexity of the organization reflecting Generally Accepted Accounting Principles (GAAP) and separates functions appropriate to organizational size to safeguard assets and maintain financial stability.

(Section 330(k)(3)(D), Section 330(q) of the PHS Act and 45 CFR Parts 74.14, 74.21 and 74.26)

19Slide20

20

13. Billing and Collections

Requirement:Health center has systems in place to maximize collections and reimbursement for its costs in providing health services, including written billing, credit and collection policies and procedures. Health centers must bill Medicare, Medicaid, CHIP, and other applicable public or private third party payors

.(Section 330(k)(3)(F) and (G) of the PHS

Act)

20Slide21

21

14. Budget

Requirement:Health center has developed a budget that reflects the costs of operations, expenses, and revenues (including the Federal grant) necessary to accomplish the service delivery plan, including the number of patients to be served.

(Section 330(k)(3)(D), Section 330(k)(3)(I)(i), and 45 CFR Part 74.25)

21Slide22

22

15. Program Data Reporting Systems

Requirement:Health center has systems which accurately collect and organize data for program reporting and which support management decision making.

(Section 330(k)(3)(I)(ii) of the PHS Act)

22Slide23

23

16. Scope of Project

Requirement:Health center maintains its funded scope of project (sites, services, service area, target population, and providers), including any increases based on recent grant awards. (45 CFR

Part 74.25)

23Slide24

24

17. Board Authority

Requirement:Health center governing board maintains appropriate authority to oversee the operations of the center.

(Section 330(k)(3)(H) of the

PHS

Act and 42

CFR

Part

51c.304

)

24Slide25

25

18. Board Composition

Requirement:The health center governing board is composed of individuals, a majority (at least 51%) of whom are being served by the center and, who as a group, represent the individuals being served by the center in terms of demographic factors such as race, ethnicity, and sex.

No more than 50% of the non-consumer board members may derive more than 10% of their annual income from the health care industry.

25Slide26

26

19. Conflict of Interest Policy

Requirement:Health center bylaws or written corporate board approved policy include provisions that prohibit conflict of interest by board members, employees, consultants, and those who furnish goods or services to the health center.

26Slide27

27

FQHC EnvironmentHealth Reform

LegislationTechnical AssistanceCollaborationsExpansions and EnhancementsNational and State RelationshipsOutreach & Enrollment

27Slide28

28

How do FQHCs Benefit Communities?Provide comprehensive preventative and primary care

Reduce the need for ER visits and hospitalizations Improve the health of the local workforceProvide well paying jobs Purchase goods and services from other local businesses Slide29

FQHC Data & Accomplishments

Patient GrowthFacility ExpansionHealth Center Controlled Network

Health Information ExchangesQuality InitiativesQuality OutcomesPatient Access

29Slide30

30

National 2013 FQHC Grantee Statistics* 1,202 FQHC organizations

21.7 million patients85.6 million patient visits72% of these patients were < 100% of Poverty93% of these patients were < 200% of Poverty 35% were uninsured 41% had Medicaid

157,000 FTE staff

*excludes FQHC Look-AlikesSlide31

31Slide32

32

Louisiana 2013 FQHC Statistics*

31 FQHCs operating over 150 Service LocationsServed over 275,000 patientsProvided more than 960,000 visits79% of patients were < 100% of Poverty95% of patients were < 200% of Poverty

37% were uninsured 42% had MedicaidOver 1,640 staff

*LA currently has no Look-Alikes;

25 FQHC reporting in 2013Slide33

33Slide34

34Slide35

35Slide36

Economic Impact

36Slide37

Facility Expansion Initiative

37

2007 Legislative Appropriation of $41.5MSince 2008, over 90 capitol projects have been completedNew and Expanded facilities, Health IT$110M capitol pool

Last few projects remain under construction$180M economic impactSlide38

38

Facility Expansion InitiativeSlide39

39

Facility Expansion InitiativeSlide40

40

Facility Expansion InitiativeSlide41

41

Facility Expansion InitiativeSlide42

42

Facility Expansion InitiativeSlide43

43

Facility Expansion InitiativeSlide44

44

Facility Expansion InitiativeSlide45

InitiativesPatient Centered Medical Home

Meaningful UseClinical IndicatorsTelehealth

Health Center Controlled Network (HCCN)45Slide46

46

Clinical Aspects of Health Centers

Services (cont.):

Prescription Drugs

Immunizations

Well Child Services

Voluntary Family Planning

Prenatal, Perinatal, and Women’s Care

Cancer Screenings (Breast, Cervical, Prostate, etc.)

Diabetes Screening and

Care

High blood pressure and high cholesterol screening and care

Patient Self Management Education

Disease Prevention and Health Promotion

Case Management/Social ServicesSlide47

47

Clinical Aspects of Health Centers

Services (cont.):

Transportation Outreach and Enrollment

Interpreter ServicesSpecialty Referrals Other Services

Home visiting

Medicare Part D Counseling

Disability Determination

Financial Counseling

Legal Counseling

Job search assistance

Voter Registration

Telehealth

Integrated CareSlide48

What to bring for a visit:

All patients will be asked for the following information. In most cases, a health center will require written documentation that verifies the information the patient will provide:

Patient name, date of birth, social security number, phone number, proof of address/residency (utility bill, driver’s license) proof of insurance (insurance card), proof of income (paystub, tax return), number of people in householdAny medical records from a previous provider, if possible, should be brought to first visit. The health center should be able to request these records via fax or electronic transmission if new patient signs a release of information while at the health center.

48Slide49

What to bring for a visit:

All patients will be asked for the following information. In most cases, a health center will require written documentation that

verifies the information the patient will provide:

A complete list of all medications patient is currently prescribed and/or taking

A list of current immunizations (especially for a pediatric visit)

49Slide50

Sliding Fee Scale

According to Health Center Policy:One form of identification,

One form of proof of income, and One form of proof of age and family size.

50Slide51

Recognitions/Activities

Dr. Gary Wiltz, CEO of Teche Action Clinic, is currently serving as NACHC

board chairRoderick Campbell, CEO of Iberia Comprehensive CHC serves on Louisiana Health Care CommissionMultiple New Orleans FQHC CEOs participate in 504HealthNetJonathan Chapman, Director of LPCA, serves as board chair of Louisiana Rural Health Association

Annual Educational and Providers ConferencesRecognized by HRSA for outreach to special populations

51Slide52

52

52Slide53

53

Comments or Questions?

53

www.lpca.net

Louisiana

Primary Care

Association

LPCA1