FQHCs and FQHC Look-alikes: A Sustainable Business Model for RW Part C Programs

FQHCs and FQHC Look-alikes: A Sustainable Business Model for RW Part C Programs

Presenters:

Rebecca M. Johnson, MNPLMark Meye, CPA

Community Link Consulting

Your knowledgeable resource in all things FQHC

www.communitylinkconsulting.org

New Access Point, Service Area CompetitionBudget Period RenewalRyan White Grants & Program SupportFQHC and Look-alike Grantee Support & Services Financial ManagementCost Reporting, UDS, FFRFee Schedule ReviewCorporate Compliance / Compliance ReportingManagement / Staff / Board TrainingStrategic PlanningResidency DevelopmentIT Infrastructure Development and Support

Who’s in the room?

Why now?

Affordable Care ActRW Reauthorization Uncertainty

Changes in HIV Disease

Objectives: By the end of the presentation you will:

•Understand the benefits of becoming an FQHC or FQHC LA •Know how the programs differ•Know which model best supports your program•Have basic information to begin strategic discussions about becoming an FQHC/FQHC-LA •Have a road map for pursuing FQHC/LA status

Federally Qualified Health Center’s Mission

Improve the health of underserved communities and vulnerable

populations by assuring access to comprehensive, culturally

competent, quality primary health care services

Ultimate Goal…

Improving health status (i.e., patient outcomes) of all populations in the target area served by a health center, especially

underserved.

PIN-96-23

Four Core Elements FQHC or FQHC – Look alike

1. Reach Medically Underserved Communities

Impact: CHCs serve populations who otherwise would not get the care they need; CHCs see publicly insured and uninsured patients in areas where there is a lack of providers and/or providers willing to see this population.

2. Governing with Community Involvement

Impact: CHCs reflect the needs of the communities they serve.

3. Treat Patients Regardless of Ability to Pay

Impact: Community Health Centers (CHCs) are the primary care safety net for the uninsured.

4. Provide a Comprehensive Scope of Services

Impact: No other model of primary health care service delivery offers more services in one location or targets more special populations through one model of care.» Reduce/eliminate health disparities. » Help vulnerable patients successfully manage chronic conditions.» Save money in the health care delivery system by keeping patients out of the hospital and ER.

Program Benefits – FQHC Only

•Grant Funding for Operations under Section 330 of the Public Health Services Act -- $650,000 for New Access Point• FTCA – Federal Tort Claims Act Coverage

Additional Program Benefits

National Service Corps Enhanced Medicaid/Medicare Rates340 B Pharmacy Access

Program Requirements:

•Comprehensive primary care (directly or contract)•After hours care•Wrap around “enabling” services•Robust QI Program

System Requirements:

•Ability to bill third party payors•Medicaid and Medicare electronic billing•Financial management policies/procedures

Shared Compliance Requirements:

•Annual Uniform Data Set (UDS) Report (similar to RDR/RSR)•Grant Cycles (similar to Part C)•Cost Reports•Financial Audit (A-133)

Financial Model

Revenue

Expense

Net

Expense

SF424APersonnelFringeTravelSuppliesEquipmentContractualOther

Personnel

Typically 80%

Buckets (i.e., programs)Staffing Ratio Expectations

Revenue

Non-Program RevenueGrantsContractsDonations/FundraisingOther (interest, meaningful use)

Program Income

Program Income

Enhanced Reimbursement Rates

Access to Prospective Payment System - wrap payment for Medicaid

Cost-based reimbursement for Medicaid and Medicare

Medicaid Rate Setting Year

Medicaid – not intuitive

Impact – long term and potentially detrimental

340B Pharmacy

Discount drug pricing program requires drug manufacturers to provide outpatient drugs to covered entities at a reduced price

Benefits of 340B Program

Reported savings that range between 25-50% for covered outpatient drugs as a result of the low 340B prices

Reduces the price of medications for patients

Expands the number of drugs on formularies

Increases the number of indigent patients served

Expands other services offered to patients by the entity – flexible “profit” – unlike RW

Simplified Grant Accounting

Typically tied to payroll

No Double Dipping- Charge only one grant

Applying for FQHC Grants

Needs AssessmentServices – Required and OptionalBusiness PlanGovernance

Rebecca M. Johnson, MNPLHealth Center Solutions, Inc.

360-319-1429Rebecca@healthcentersoluitons.com

Mark Meye, CPA