Crossroads Conference Lubbock, Texas June 5, 2013

1. Crossroads ConferenceLubbock, TexasJune 5, 2013 Building An Effective Coalition & Basic Requirements of the Federally Qualified Health Centers Program “FQHC 101” West Texas Area Health Education Center – Big Country Region Texas Association of Community Health Centers

2. Specific Problem Addressed Identify if there is a problem regarding access to care in Abilene

3. Steps to Create Our Coalition • AHEC – Responded to community need (neutral) • Recruiting the Right People • Formed the Coalition • Devise a Set of Preliminary Objectives/Activities • Process Begins

4. Who is Our Coalition? • Facilitator – AHEC Office • Representatives from the Hospitals • Mayor/Other City Officials • County Officials • Community Foundations/Leaders • Medical Society

5. Steps Taken with the Coalition • Additional Resources • Nonprofit Luncheon/Workshop • Data Collection • Physician Survey • Dental Survey • What did the data indicate? • Patterns • Strengths of Taylor County • Barriers to Care

6. Community Needs Assessment • Gaps in Health Services • Access to Care and Barriers to Care • Health Disparities of the Community

7. Service Provider Workshop • Primary Health Care • Dental Care • Medical Specialists • Mental Health Treatment

8. Primary Care Provider SurveyResults • 30 Primary Care Providers Responded • 14 Accept Medicare • 16 Accept Medicaid • 14 Accept Uninsured Patients

9. Next Steps of the Coalition • Explore Expansion Opportunities with Existing Clinics • Establish a FQHC • Other

10. Topics of Discussion • FQHC characteristics • BPHC Section 330 program expectations/requirements • Benefits received from FQHC status • How FQHC addresses needs assessment components

11. Characteristics of a FQHC • Community based non-profit or public primary health care clinics • Located in or serving a designated Medically Underserved Area/Population (MUA or MUP) • Consumer Board governance structure • Provide health services to persons in all stages of the life cycle

12. Characteristicsof a FQHC(cont’d) • Provide services to all persons regardless of ability to pay • Charge for services on a sliding-fee scale based on patients’ family income and size • Comply with Section 330 program expectations/requirements and all applicable federal and state regulations

13. Paths to Becoming a FQHC • Collaborate with an existing FQHC to apply for HRSA New Access Point (NAP) grant • Create new not-for-profit that will/does meet all program requirements to apply or HRSA NAP grant • Extremely competitive grant application – less than 10% success rate • Apply to be an FQHC Look-Alike (FQHCLA) • Not-for-profit that meets all program requirements at the time of application • No grant support when designated as a FQHCLA • More competitive when applying for 330 funding

14. Section 330 Program Requirements • Four components: • Governance • Mission and Strategy • Clinical program • Management and finance

15. FQHC Governance • Board composition • Governed by community board • Non-consumer requirements • 9-25 members • By-laws prescribe method for selecting board members • Employees and relatives are ineligible

16. FQHC Governance • Board of Directors responsibilities • Carries legal and fiduciary responsibility for clinic operations and grants • Strategic planning and evaluation of progress toward organizational goals • Approve Annual Budget & Grant Application • Meet At Least Monthly / Keep Minutes • Full authority over all aspects of clinic operations • No other entity/individual can have the ability to override or veto governing board decisions

17. Mission and Strategy • Mission: improve health status of underserved populations • Strategy: • Needs assessment - starting point but can be based on specific parameters in grant application guidance • Design culturally and linguistically appropriate programs • Measure effectiveness through health and financial outcomes • Operate efficiently – maximize revenue and grow net assets • Collaborate with other health care and social service providers

18. Why Demonstrating Need for FQHC is Important • HRSA NAP guidance (HRSA 11-017) • “Information provided on need should serve as the basis for, and align with, the proposed activities and goals described in the clinical and performance measures and throughout the application.” • “Response” section of NAP application should propose activities that address health care and other needs in community

19. Clinical Program • Provides a continuum of care • Primary, secondary and tertiary • Relies on collaboration with system providers to prevent duplication of services • Service Delivery Model • Must have direct control of majority of health care services • Contracting • Only to secure services not provided by center • Written agreements are required • Health Care Planning • Develop goals to impact health care needs and monitor via health outcomes performance • Clinical Staff • Clinical Systems & Procedures • Focus on electronic health and dental records implementation and meaningful use • Others tied to operations and patient satisfaction

20. RequiredServices FQHC must provide directly or through written agreement • Primary care • Dental • Mental health • Substance Abuse • Diagnostic lab and x-ray • Prenatal and perinatal services • Cancer and other disease screening • Blood level screenings • Lead levels • Communicable diseases • Cholesterol • Well child services • Child and adult immunizations • Eye and ear screening for children • Family planning services • Emergency medical • Pharmaceutical • Case management • Outreach and education • Eligibility/Enrollment services • Transportation and interpretation • Referrals

21. Management and Finance Systems • Systems must ensure that CEO and Board of Directors have access to timely information that is critical to sustainability • MIS combines financial and utilization data for informed decision-making • Implementation and meaningful use of electronic health/dental records • Utilization is reported to federal authorities annually in the Uniform Data System report • Financial system must provide for: • Accounting and Internal controls • Budget • Billing and Collections • Independent Financial Audit • Facilities

22. Benefits of FQHC Status CENTER • Federal grants to support costs of uncompensated care* • Prospective Payment System reimbursement for services to Medicaid and Medicare patients • Medical malpractice coverage under Federal Tort Claims Act * • PHS Drug Pricing Discounts • Grant support and loan guarantees for capital improvements • Right to have outstationed eligibility workers on-site COMMUNITY • Community-based organization • Medical home for underserved • Improved access to comprehensive health services • Reduction of use of Emergency Rooms for non-emergent care • Economic impact of federal and state investments • Potential for additional federal investment *FQHC look-alikes do not get federal grant or FTCA coverage

23. Benefits of FQHC Status (cont’d) CENTER • Reimbursement by Medicare for “first dollar” of services (deductible is waived) • Access to Vaccines for Children (VFC) Program • Access to National Health Service Corps (NHSC) Placements • Closely align with definition of Essential Community Providers for participation in Health Insurance Exchanges COMMUNITY • Assistance with streamlined Medicaid and CHIP enrollment • Less financial strain on Medicare patients • Free immunizations for uninsured children • Additional sources of primary care and other health providers • Access to comprehensive primary care and additional services for newly insured

24. How FQHC Addresses Taylor County Needs Assessment Components • Required to serve Medically Underserved Area and target services to persons under 200% of Federal Poverty Level • Mission is to increase access to care for uninsured and underinsured • Required to provide linguistically and culturally appropriate care • History of reducing health disparities • Dental and behavioral health services • Eligibility assistance for public insurance • Need for clinic that will accept uninsured, Medicaid, and Medicare • Sliding fee discount for services

25. Contact Information Kelly Cheek Center Director West Texas Area Health Education Center Big Country Region 325-672-0495 kcheek@bcahec.org Daniel Diaz Director of Community Development Texas Association of Community Health Centers 512-329-5959 ddiaz@tachc.org