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Federally Qualified Health Centers
              101
What is a Community Health Center?
Key Characteristics of Health Centers
Community Health Centers (CHCs), aka Federally Qualified
Health Centers (FQHCs) and FQHC-Look Alikes
 Not-for-profit (Public or private)
 Provide a Comprehensive Scope of Services
 Located in or serve a high need community - Medically
  Underserved Area (MUA) or a Medically Underserved Population (MUP)

 Govern with community involvement (51%-user
  Board of Directors)
 Treat patients regardless of ability to pay
Who are health center patients?
Collectively, health centers are the Health Care
  Home for 24 Million Americans
• 1 of 7 Uninsured Persons, including
   – 1 of 5 Low-income Uninsured Persons
• 1 of 7 Medicaid Beneficiaries
• 1 of 3 Individuals Living in Poverty
   – 1 out of 4 Minority Individuals Living in Poverty
• 1 of 7 Rural Americans                   Source: NACHC, 2012. Includes patients
                                           of federally-funded health
• 923,400 Farmworkers                      centers, non-federally funded health
                                           centers, and expected patient growth
• 1.1 Million Homeless Persons             for 2012.
Who are health center patients?
              Over 200%
                 7%
      151-200%
                        0%
                              Health Center Patients
         7%
                              Are Predominately Low
                              Income
101-150%                          Source: Federally-funded health centers only.
  14%                             2010 Uniform Data System, Bureau of Primary
                                  Health Care, HRSA, DHHS.
                                  Note: Federal Poverty Level (FPL) for a family of
                                  three in 2010 was $17,600. (See
                                  http://aspe.hhs.gov/poverty/08poverty.shtml.)
                                  Based on percent known. Percents may not total
                                  100% due to rounding.




                             100% and
                               below
                                72%
Who are health center patients?
               Private
    Other       14%      Most Health Center Patients
    Public               are Uninsured or Publicly
     3%                  Insured
Medicare                 Uninsured
  7%                         38%



                          Other public may include non-Medicaid SCHIP and state-funded
                          insurance programs.
                          Source: Federally-funded health centers only. 2010 Uniform Data
   Medicaid/              System, Bureau of Primary Health Care, HRSA, DHHS.
    SCHIP                 Note: Percents may not total 100% due to rounding.

     38%
Where are health centers located?
There are more than 1,200 health center
organizations serving more than 24 million
patients in over 8,000 rural and urban
communities.

>>Locate a Community Health Center<<
Why support health centers?
Proud History: 45+ years of bringing high-quality health care to
underserved communities, giving people served ownership & control
of delivery system

Largest National Primary Care Network: 24+ million people served

Record of Achievement: cited by IOM, OMB, and GAO for excellence
in care, disparities reduction, cost-effectiveness, and community
benefit

Bipartisan Support: Congressional majority and two Presidents praise
work, mission of health centers, call for continuation & growth
Why support health centers?
Health Center Program Requirements
A. Need
B. Services
C. Management and Finance
D. Governance
Health Center Program Requirements
A) Patient Need
• Needs Assessment: Health center demonstrates and documents the
  needs of its target population, update its service area when appropriate.

• Required and Additional Services: 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: CHCs requesting funding to serve homeless individuals and their
families must provide substance abuse services among their required services.
Health Center Program Requirements
B) Services
• After Hours Coverage: Health center provides professional coverage
  during hours when the center is closed.

• Hospital Admitting Privileges & Continuum of Care: Health center
  physicians have admitting privileges at one or more referral hospitals, or
  other such arrangements to ensure continuity of care.

   In cases where hospital arrangements (including admitting privileges and
   membership) are not possible, the health center must firmly establish
   arrangements for hospitalization, discharge planning, and patient
   tracking.
Health Center Program Requirements
B) Services
• Sliding Fee Discounts: Health center has a system in place to determine
  eligibility for patient discounts adjusted on the basis of the patient’s ability
  to pay.

System must provide a full discount to individuals and families with annual
incomes at or below 100% of the Federal Poverty guidelines (only nominal
fees may be charged) and for those with incomes between 100% and 200% of
poverty, fees must be charged in accordance with a sliding discount policy
based on family and income.
Health Center Program Requirements
B) Services
• Quality Improvement/
Assurance Plan: Health center
has an ongoing quality
improvement/assurance program
that includes clinical services and
management, and that maintains
the confidentiality of patient records.
Health Center Program Requirements
C) Management and Finance
• Program and Reporting Requirements: Health center has
  systems that accurately collect and organize data for program
  reporting.


• Financial Management & Control Policies: Health center
  maintains accounting and internal controls systems. Health
  center ensures that an annual independent financial audit is
  performed in accordance with federal audit requirements.
Health Centers’ Revenue Sources Do Not
 Resemble Those of Private Physicians
      10.0%                             Self-Pay/Uninsured
      11.6%
                                        Private Insurance
       4.5%
       9.9%             64.0%
                                        Other Public

                                        Medicare
                         6.8%
      64.0%                             Medicaid/SCHIP
                        25.3%               Source: Private Physician data: 2009
                                            National Ambulatory Medical Care Survey
                                            (visits). NACHC, 2012. Based on Bureau of
                                            Primary Health Care, HRSA, DHHS, 2010
                                            Uniform Data System. Note: Private
                        15.5%               Physicians does not equal 100% due to
                                            reporting in NAMCS.



   Health Center   Private Physicians
Income Sources for Health Centers
Health Center Program Requirements
D) Governance

• Board Authority: CHC governing board maintains appropriate authority to
  oversee the operations of the center.

• Board Composition: CHC has a governing board of between 9 and 25
  members. A majority (51%) of the governing board members MUST BE
  patients of the center and they represent the individuals served by the
  center in terms of demographic factors such as race, ethnicity, and
  gender. The non-consumer members of the board must be
  representative of the community, and no more than half of them may
  derive more than 10% of their annual income from the health care
  industry.
Interested in Becoming a Federally
Qualified Health Center?

  Follow this link to our guide
 http://tiny.cc/NewStartFQHC
Partners
There are several state and national partner
organizations who support health centers
through training and technical assistance:
NACHC
PCAs
PCOs
HRSA/BPHC
What is NACHC?
• National Association of Community Health Centers is
  a membership-supported organization, providing
  training, technical assistance, group purchasing
  programs, leadership and professional
  development, lobbying/advocacy, and group
  purchasing programs.

• NACHC provides strong advocacy before Congress
  and with federal administrative and regulatory
  bodies on all major issues that affect health centers
  and our mission.
What is HRSA?
Health Resources and Services Administration (HRSA)
HRSA, an agency of the U.S. Department of Health and Human
Services, is the primary Federal agency for improving access to
health care services for people who are uninsured, isolated or
medically vulnerable.

Within HRSA, the Health Centers Program is managed and
funded through the Bureau of Primary Health Care (BPHC)
>>Learn more about HRSA and BPHC<<
What are PCAs?
State/Regional Primary Care Associations (PCAs)
• PCAs are private, non-profit organizations that provide a wide
   spectrum of services individualized to state needs and may
   include:
   –   Training and technical assistance to health centers
   –   Support for the development of health centers in their state
   –   Operational diagnostics and support
   –   Leadership Development
   –   Group Purchasing Programs
   –   Workforce Retention and Recruitment
   –   Lobbying and Advocacy with state regulatory and legislative entities
   –   And More….! >>Complete listing of the PCA organizations<<
What are PCOs?
Primary Care Offices (PCOs)
PCOs are state-based offices that provide assistance to
communities seeking Health Professional Shortage Area (HPSA)
designations and funding for health centers such as Community
and Migrant Health Centers and Health Care for the Homeless
health centers. PCOs work collaboratively with Primary Care
Associations, relevant HRSA programs and offices and other
organizations to increase access to primary and preventive
health care and improve the status of underserved and
vulnerable populations.
>>Complete listing of the PCOs<<
America’s Voice for Community Health Care
National Association of Community Health
Centers Mission: To promote the provision of
high quality, comprehensive and affordable
health care that is coordinated, culturally and
linguistically competent, and community
directed for all medically underserved people.

Learn more about NACHC: www.NACHC.org
CFAHC, a project of NACHC
Campaign For America’s Health Centers Mission:
To do everything we can to stop threats to health
centers and health center patients! We want to provide
a way for every health center, every patient and every
community that has or needs a health center to act to
preserve, strengthen and expand America’s Health
Centers.
Join us! http://www.saveourchcs.org/join-the-campaign.cfm

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FQHC 101 What is a Community Health Center?

  • 1. Federally Qualified Health Centers 101 What is a Community Health Center?
  • 2. Key Characteristics of Health Centers Community Health Centers (CHCs), aka Federally Qualified Health Centers (FQHCs) and FQHC-Look Alikes  Not-for-profit (Public or private)  Provide a Comprehensive Scope of Services  Located in or serve a high need community - Medically Underserved Area (MUA) or a Medically Underserved Population (MUP)  Govern with community involvement (51%-user Board of Directors)  Treat patients regardless of ability to pay
  • 3. Who are health center patients? Collectively, health centers are the Health Care Home for 24 Million Americans • 1 of 7 Uninsured Persons, including – 1 of 5 Low-income Uninsured Persons • 1 of 7 Medicaid Beneficiaries • 1 of 3 Individuals Living in Poverty – 1 out of 4 Minority Individuals Living in Poverty • 1 of 7 Rural Americans Source: NACHC, 2012. Includes patients of federally-funded health • 923,400 Farmworkers centers, non-federally funded health centers, and expected patient growth • 1.1 Million Homeless Persons for 2012.
  • 4. Who are health center patients? Over 200% 7% 151-200% 0% Health Center Patients 7% Are Predominately Low Income 101-150% Source: Federally-funded health centers only. 14% 2010 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Federal Poverty Level (FPL) for a family of three in 2010 was $17,600. (See http://aspe.hhs.gov/poverty/08poverty.shtml.) Based on percent known. Percents may not total 100% due to rounding. 100% and below 72%
  • 5. Who are health center patients? Private Other 14% Most Health Center Patients Public are Uninsured or Publicly 3% Insured Medicare Uninsured 7% 38% Other public may include non-Medicaid SCHIP and state-funded insurance programs. Source: Federally-funded health centers only. 2010 Uniform Data Medicaid/ System, Bureau of Primary Health Care, HRSA, DHHS. SCHIP Note: Percents may not total 100% due to rounding. 38%
  • 6. Where are health centers located? There are more than 1,200 health center organizations serving more than 24 million patients in over 8,000 rural and urban communities. >>Locate a Community Health Center<<
  • 7. Why support health centers? Proud History: 45+ years of bringing high-quality health care to underserved communities, giving people served ownership & control of delivery system Largest National Primary Care Network: 24+ million people served Record of Achievement: cited by IOM, OMB, and GAO for excellence in care, disparities reduction, cost-effectiveness, and community benefit Bipartisan Support: Congressional majority and two Presidents praise work, mission of health centers, call for continuation & growth
  • 9. Health Center Program Requirements A. Need B. Services C. Management and Finance D. Governance
  • 10. Health Center Program Requirements A) Patient Need • Needs Assessment: Health center demonstrates and documents the needs of its target population, update its service area when appropriate. • Required and Additional Services: 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: CHCs requesting funding to serve homeless individuals and their families must provide substance abuse services among their required services.
  • 11. Health Center Program Requirements B) Services • After Hours Coverage: Health center provides professional coverage during hours when the center is closed. • Hospital Admitting Privileges & Continuum of Care: Health center physicians have admitting privileges at one or more referral hospitals, or other such arrangements to ensure continuity of care. In cases where hospital arrangements (including admitting privileges and membership) are not possible, the health center must firmly establish arrangements for hospitalization, discharge planning, and patient tracking.
  • 12. Health Center Program Requirements B) Services • Sliding Fee Discounts: Health center has a system in place to determine eligibility for patient discounts adjusted on the basis of the patient’s ability to pay. System must provide a full discount to individuals and families with annual incomes at or below 100% of the Federal Poverty guidelines (only nominal fees may be charged) and for those with incomes between 100% and 200% of poverty, fees must be charged in accordance with a sliding discount policy based on family and income.
  • 13. Health Center Program Requirements B) Services • Quality Improvement/ Assurance Plan: Health center has an ongoing quality improvement/assurance program that includes clinical services and management, and that maintains the confidentiality of patient records.
  • 14. Health Center Program Requirements C) Management and Finance • Program and Reporting Requirements: Health center has systems that accurately collect and organize data for program reporting. • Financial Management & Control Policies: Health center maintains accounting and internal controls systems. Health center ensures that an annual independent financial audit is performed in accordance with federal audit requirements.
  • 15. Health Centers’ Revenue Sources Do Not Resemble Those of Private Physicians 10.0% Self-Pay/Uninsured 11.6% Private Insurance 4.5% 9.9% 64.0% Other Public Medicare 6.8% 64.0% Medicaid/SCHIP 25.3% Source: Private Physician data: 2009 National Ambulatory Medical Care Survey (visits). NACHC, 2012. Based on Bureau of Primary Health Care, HRSA, DHHS, 2010 Uniform Data System. Note: Private 15.5% Physicians does not equal 100% due to reporting in NAMCS. Health Center Private Physicians
  • 16. Income Sources for Health Centers
  • 17. Health Center Program Requirements D) Governance • Board Authority: CHC governing board maintains appropriate authority to oversee the operations of the center. • Board Composition: CHC has a governing board of between 9 and 25 members. A majority (51%) of the governing board members MUST BE patients of the center and they represent the individuals served by the center in terms of demographic factors such as race, ethnicity, and gender. The non-consumer members of the board must be representative of the community, and no more than half of them may derive more than 10% of their annual income from the health care industry.
  • 18. Interested in Becoming a Federally Qualified Health Center? Follow this link to our guide http://tiny.cc/NewStartFQHC
  • 19. Partners There are several state and national partner organizations who support health centers through training and technical assistance: NACHC PCAs PCOs HRSA/BPHC
  • 20. What is NACHC? • National Association of Community Health Centers is a membership-supported organization, providing training, technical assistance, group purchasing programs, leadership and professional development, lobbying/advocacy, and group purchasing programs. • NACHC provides strong advocacy before Congress and with federal administrative and regulatory bodies on all major issues that affect health centers and our mission.
  • 21. What is HRSA? Health Resources and Services Administration (HRSA) HRSA, an agency of the U.S. Department of Health and Human Services, is the primary Federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable. Within HRSA, the Health Centers Program is managed and funded through the Bureau of Primary Health Care (BPHC) >>Learn more about HRSA and BPHC<<
  • 22. What are PCAs? State/Regional Primary Care Associations (PCAs) • PCAs are private, non-profit organizations that provide a wide spectrum of services individualized to state needs and may include: – Training and technical assistance to health centers – Support for the development of health centers in their state – Operational diagnostics and support – Leadership Development – Group Purchasing Programs – Workforce Retention and Recruitment – Lobbying and Advocacy with state regulatory and legislative entities – And More….! >>Complete listing of the PCA organizations<<
  • 23. What are PCOs? Primary Care Offices (PCOs) PCOs are state-based offices that provide assistance to communities seeking Health Professional Shortage Area (HPSA) designations and funding for health centers such as Community and Migrant Health Centers and Health Care for the Homeless health centers. PCOs work collaboratively with Primary Care Associations, relevant HRSA programs and offices and other organizations to increase access to primary and preventive health care and improve the status of underserved and vulnerable populations. >>Complete listing of the PCOs<<
  • 24. America’s Voice for Community Health Care National Association of Community Health Centers Mission: To promote the provision of high quality, comprehensive and affordable health care that is coordinated, culturally and linguistically competent, and community directed for all medically underserved people. Learn more about NACHC: www.NACHC.org
  • 25. CFAHC, a project of NACHC Campaign For America’s Health Centers Mission: To do everything we can to stop threats to health centers and health center patients! We want to provide a way for every health center, every patient and every community that has or needs a health center to act to preserve, strengthen and expand America’s Health Centers. Join us! http://www.saveourchcs.org/join-the-campaign.cfm