Introduction To Federally Qualified Health Centers (FQHCs)

1. Introduction ToFederally Qualified HealthCenters (FQHCs)

2. 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)

3. 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’.

4. 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 • Thunder Bay • Marquette • This list does not include all access points.

5. 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

6. FQHC Requirements • Must have a governing board (board of directors) a majority of which must be consumers of the center’s 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.

7. 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 patient’s ability to pay (<200% FPL; nominal for <100% FPL) • Must accept Medicare & Medicaid • Must provide culturally competent services

8. 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)

9. 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

10. FQHC Requirements • Additional health services as appropriate • Behavioral Health • Comprehensive oral health • Linguistic and cultural competence • Special populations services (migrant, homeless, public housing etc.)

11. 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

12. 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

13. 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

14. 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.

15. 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.

16. How do FQHCs make a difference? (cont’d) • 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.

17. 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/

18. For more information • Kim Sibilsky, Executive Director • Michigan Primary Care Association • (517) 381-8000 • ksibilsky@mpca.net • Neal Colburn, Technical Assistance Consultant • Michigan Primary Care Association • (517) 381-8000 x220 • ncolburn@mpca.net