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CAH and FQHC: Friend or Foe

CAH and FQHC: Friend or Foe. Elizabeth Morgan Burrows, JD Chief Executive Officer Vermillion Parke Community Health Center June 7, 2011. What are all these “HCs?”. FQHC – Federally Qualified Health Center In hearing about the Affordable Care Act, Community Health Centers are all FQHC

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CAH and FQHC: Friend or Foe

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  1. CAH and FQHC: Friend or Foe Elizabeth Morgan Burrows, JDChief Executive Officer Vermillion Parke Community Health Center June 7, 2011

  2. What are all these “HCs?” • FQHC – Federally Qualified Health Center • In hearing about the Affordable Care Act, Community Health Centers are all FQHC • RHC – Rural Health Clinic • State-funded CHC – Community Health Center • Indiana provides tobacco settlement money to fund state-funded CHCs. • FQHCs and RHCs can also be state-funded CHCs but not all of them are.

  3. Currently in Indiana… • There are 47 state-funded Community Health Centers • 19 of the 47 are Federally Qualified Health Centers • 9 of the 47 are Rural Health Clinics • 62 Rural Health Clinics (9 are state-funded CHCs)

  4. MUA/MUP and HPSA • To start an FQHC, the site must be located in a Medically Underserved Area or Population • To start an RHC, the site must be in a MUA/MUP or Health Professions Shortage Area

  5. FQHCs • Non-profit entity • Governed by a consumer driven governing board (51% of the board members must be patients of the clinic) • Serve ALL patients regardless of their ability to pay through a Sliding Fee Scale • Be located in a Medically Underserved Area/Population • Must provide primary, behavioral, and dental services either on-site or through an arrangement for ALL patients

  6. Benefits of an FQHC • Enhanced Medicaid and Medicare Reimbursement • Medical Malpractice under the Federal Tort Claims Act • Medical Malpractice Insurance is free! • 340B Drug Pricing • National Health Service Corps • Student Loans are Repaid! • Vaccines for Children

  7. State-Funded CHCs • Must meet a set of minimum standards outlined by the state • These standards are less stringent than FQHC standards • Must have a consumer-driven governing board

  8. RHCs • Special Medicaid and Medicare reimbursement • Must be “certified” through CMS • Staffed at least 50% of the time with a midlevel provider • Can be for-profit or non-profit • Can be provider-based • Must be in a rural area and in a HPSA OR MUA/MUP

  9. The Differences FQHCs RHCs Reimbursed at the Medicare All-inclusive rate by Medicaid and Medicare Can be for-profit or non-profit Can be owned by a hospital or other health system • Receive federal operational grant funding • Subject to many more federal regulations • Medicaid PPS Rate • Must be non-profit • Governed and owned by a community governing board; cannot be owned by a hospital or health system (exception for public Entities

  10. Reimbursement FQHC Private Practice Physician Medicaid: $30 Medicare: $50 Commercial: Same (contracted rate) Do not need to accept uninsured. • Medicaid: $148 • Medicare: $119 • Commercial: Same (contracted rate) • Must accept uninsured on a sliding fee scale!

  11. Lessons Learned: Services • You don’t have to do everything on your own from the beginning! • Primary • Dental • Behavioral • Pharmacy • Outreach/Enabling Services

  12. Lessons Learned: Community Support • Without the support of Union Hospital Clinton and the entire Union Hospital Organization, we would not be the success that we are now.

  13. How do we work together? • Labs • Ancillary Services • ER Referrals • In-patient services • After-hours phone service • Strong partnership for community activities

  14. Strong Partnership = Rapid Growth • FQHCs are growing extremely quickly • In 2008, we completed over 3,500 encounters. • In 2009, over 8,000 encounters. • In 2010, over 13,800 encounters. • In 2011, over 25,000 encounters.

  15. Final Thoughts • FQHCs are hard work! • The feds are actually there to help! • There are always more people to serve than the capacity that you have. • Other FQHCs and associations are there to help. • Serving members of my community is the most rewarding experience of my life.

  16. Conclusion • In Vermillion and Parke Counties in Indiana, Union Hospital Clinton and Vermillion Parke Community Health Center are… BEST FRIENDS! • But there are still constant challenges that require a lot of communication and commitment to the partnership!

  17. Resources • www.hrsa.gov • www.isdh.in.gov • www.raconline.org • www.indianapca.org • www.indianaruralhealth.org

  18. Elizabeth Morgan Burrows, JDVermillion-Parke Community Health Centeremorgan@vpchc.org765-828-1003 or 765-492-9042

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