Clinics in Rural California

1. Clinics in Rural California HIT informational Hearing June 9, 2010 Andie Martinez, Mpp Associate director of policy California primary care association

2. Types of Clinics State Federal • Hospital based outpatient clinics (section 1250) • 1204(a) licensed clinics • Community Clinics • Free Clinics • Planned Parenthood • FQHCs • Federally Qualified Health Centers (FQHC) • Migrant • Homeless • Public Housing • FQHC Look-Alikes • Rural Health Clinics • Indian Health Service Clinics 1204(a): an organized outpatient health facility which provides direct medical, surgical, dental, optometric, or podiatric advice, services, or treatment to patients who remain less than 24 hours

3. Located in or serve a high need community (designated Medically Underserved Area or Population). • Governed by a community board composed of a majority (51% or more) of health center patients who represent the population served. • Providecomprehensive primary health care services as well as supportive services (education, translation and transportation, etc.) that promote access to health care. • Provide services available to all with fees adjusted based on ability to pay. • Meet otherperformance and accountability requirements regarding administrative, clinical, and financial operations. What is a Federally Qualified Health Center?

4. A clinic certified to receive special Medicare and Medicaid reimbursement. • The purpose of the RHC program is improving access to primary care in underserved rural areas. • RHCs are required to use a team approach of physicians and midlevel practitioners such as nurse practitioners, physician assistants, and certified nurse midwives to provide services. • The clinic must be staffed at least 50% of the time with a midlevel practitioner. • RHCs are required to provide out-patient primary care services and basic laboratory services. What is a Rural Health Clinic?

6. Must be a licensed 1204(a) clinic, or exempt from licensure under section 1206 • Has a written policy of non-discrimination based on ability to pay and has either a sliding scale fee based on income and family size or a no-fee policy; • Has a community board California Primary Care Association members

7. FQHCs 159 • FQHC Look Alikes 6 • Community and Free Clinics 47 • 1204(a) licensed RHCs 23 • RHCs 265 TOTAL 454 How many clinics are there in rural California? By comparison, there are an additional 590 FQHCs/Free & Community Clinics/FQHC Look Alikes in urban California

8. What are the major HIT barriers facing clinics in rural California? Barriers Opportunities • Connectivity • Cost of equipment • Staffing • Reimbursement rates • California Telehealth Network • Medicare/Medicaid EHR incentives • 30% needy only applies to FQHC/RHC • Incentives directed at provider, not clinic/health center • CalHIPSO (regional extension center)

9. Advocate to the federal Centers for Medicare & Medicaid Services (CMS): • EHR incentives directly to the entity • FQHC • RHC • Community and Free Clinics • Advocate to U.S. Dept of Health & Human Services, Office of the National Coordinator for Health Information Technology (ONC): • Remove the provider cap placed upon regional extension centers • No cap • OR, if necessary, 30 by site What can the State do to address barriers?

10. CONTACT INFORMATION California Primary Care Association Andie Martinez, Associate Director of Policy amartinez@cpca.org / (916) 440-5170 www.cpca.org California Association of Rural Health Clinics Gail Nickerson, President nickergw@ah.org / (916) 774-7308 www.carhc.org California Rural Indian Health Board Arreola Pro Rosario, Health Systems Development Director rosario.arreola@crihb.net / (916) 929-9761 www.crihb.org