Federally Qualified Health Centers

101What is a Community Health

Center?

Key Characteristics of Health CentersCommunity Health Centers (CHCs), aka Federally Qualified Health Centers (FQHCs) and FQHC-Look Alikes

Not-for-profit (Public or private)Provide a Comprehensive Scope of Services Located in or serve a high need community - Medically

Underserved Area (MUA) or a Medically Underserved Population (MUP)

Govern with community involvement (51%-user Board of Directors)

Treat patients regardless of ability to pay

Who are health center patients?Collectively, health centers are the Health Care

Home for 24 Million Americans• 1 of 7 Uninsured Persons, including

– 1 of 5 Low-income Uninsured Persons • 1 of 7 Medicaid Beneficiaries • 1 of 3 Individuals Living in Poverty

– 1 out of 4 Minority Individuals Living in Poverty• 1 of 7 Rural Americans • 923,400 Farmworkers• 1.1 Million Homeless Persons

Source: NACHC, 2012. Includes patients of federally-funded health centers, non-federally funded health centers, and expected patient growth for 2012.

Who are health center patients?Health Center Patients Are Predominately Low Income

Source: Federally-funded health centers only. 2010 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.Note: Federal Poverty Level (FPL) for a family of three in 2010 was $17,600. (See http://aspe.hhs.gov/poverty/08poverty.shtml.) Based on percent known. Percents may not total 100% due to rounding.

100% and be-low72%

101-150%14%

151-200%7%

Over 200%7%

Who are health center patients?Most Health Center Patients

are Uninsured or Publicly Insured

Other public may include non-Medicaid SCHIP and state-funded insurance programs.Source: Federally-funded health centers only. 2010 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.Note: Percents may not total 100% due to rounding.

Medicaid/ SCHIP38%

Medicare7%

Other Public3%

Private14%

Chart Title

Uninsured 38%

Where are health centers located?There are more than 1,200 health center organizations serving more than 24 million patients in over 8,000 rural and urban communities.

>>Locate a Community Health Center<<

Why support health centers?Proud History: 45+ years of bringing high-quality health care to underserved communities, giving people served ownership & control of delivery system

Largest National Primary Care Network: 24+ million people served

Record of Achievement: cited by IOM, OMB, and GAO for excellence in care, disparities reduction, cost-effectiveness, and community benefit

Bipartisan Support: Congressional majority and two Presidents praise work, mission of health centers, call for continuation & growth

Why support health centers?

Health Center Program RequirementsA. Need

B. Services

C. Management and Finance

D. Governance

Health Center Program RequirementsA) Patient Need• Needs Assessment: Health center demonstrates and documents the

needs of its target population, update its service area when appropriate.

• Required and Additional Services: Health center provides all required primary, preventive, enabling health services and additional health services as appropriate and necessary, either directly or through established written arrangements and referrals

Note: CHCs requesting funding to serve homeless individuals and their families must provide substance abuse services among their required services.

Health Center Program RequirementsB) Services

• After Hours Coverage: Health center provides professional coverage during hours when the center is closed.

• Hospital Admitting Privileges & Continuum of Care: Health center physicians have admitting privileges at one or more referral hospitals, or other such arrangements to ensure continuity of care.

In cases where hospital arrangements (including admitting privileges and membership) are not possible, the health center must firmly establish arrangements for hospitalization, discharge planning, and patient tracking.

Health Center Program RequirementsB) Services

• Sliding Fee Discounts: Health center has a system in place to determine eligibility for patient discounts adjusted on the basis of the patient’s ability to pay.

System must provide a full discount to individuals and families with annual incomes at or below 100% of the Federal Poverty guidelines (only nominal fees may be charged) and for those with incomes between 100% and 200% of poverty, fees must be charged in accordance with a sliding discount policy based on family and income.

Health Center Program RequirementsB) Services

• Quality Improvement/Assurance Plan: Health center has an ongoing quality improvement/assurance program that includes clinical services and management, and that maintains the confidentiality of patient records.

Health Center Program RequirementsC) Management and Finance

• Program and Reporting Requirements: Health center has systems that accurately collect and organize data for program reporting.

• Financial Management & Control Policies: Health center maintains accounting and internal controls systems. Health center ensures that an annual independent financial audit is performed in accordance with federal audit requirements.

Source: Private Physician data: 2009 National Ambulatory Medical Care Survey (visits). NACHC, 2012. Based on Bureau of Primary Health Care, HRSA, DHHS, 2010 Uniform Data System. Note: Private Physicians does not equal 100% due to reporting in NAMCS.

Health Centers’ Revenue Sources Do Not Resemble Those of Private Physicians

Health Center Private Physicians

64.0%

15.5%

9.9%

25.3%

4.5%

6.8%

11.6%

64.0%

0.1Self-Pay/Uninsured

Private Insurance

Other Public

Medicare

Medicaid/SCHIP

Income Sources for Health Centers

Health Center Program RequirementsD) Governance

• Board Authority: CHC governing board maintains appropriate authority to oversee the operations of the center.

• Board Composition: CHC has a governing board of between 9 and 25 members. A majority (51%) of the governing board members MUST BE patients of the center and they represent the individuals served by the center in terms of demographic factors such as race, ethnicity, and gender. The non-consumer members of the board must be representative of the community, and no more than half of them may derive more than 10% of their annual income from the health care industry.

Interested in Becoming a Federally Qualified Health Center?

Follow this link to our guide http://tiny.cc/NewStartFQHC

PartnersThere are several state and national partner organizations who support health centers through training and technical assistance:NACHCPCAsPCOsHRSA/BPHC

What is NACHC?• National Association of Community Health Centers is

a membership-supported organization, providing training, technical assistance, group purchasing programs, leadership and professional development, lobbying/advocacy, and group purchasing programs.

• NACHC provides strong advocacy before Congress and with federal administrative and regulatory bodies on all major issues that affect health centers and our mission.

What is HRSA?Health Resources and Services Administration (HRSA)HRSA, an agency of the U.S. Department of Health and Human Services, is the primary Federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable.

Within HRSA, the Health Centers Program is managed and funded through the Bureau of Primary Health Care (BPHC)>>Learn more about HRSA and BPHC<<

What are PCAs?State/Regional Primary Care Associations (PCAs)• PCAs are private, non-profit organizations that provide a wide

spectrum of services individualized to state needs and may include:– Training and technical assistance to health centers– Support for the development of health centers in their state– Operational diagnostics and support– Leadership Development– Group Purchasing Programs– Workforce Retention and Recruitment – Lobbying and Advocacy with state regulatory and legislative entities– And More….! >>Complete listing of the PCA organizations<<

What are PCOs?Primary Care Offices (PCOs)PCOs are state-based offices that provide assistance to communities seeking Health Professional Shortage Area (HPSA) designations and funding for health centers such as Community and Migrant Health Centers and Health Care for the Homeless health centers. PCOs work collaboratively with Primary Care Associations, relevant HRSA programs and offices and other organizations to increase access to primary and preventive health care and improve the status of underserved and vulnerable populations.>>Complete listing of the PCOs<<

America’s Voice for Community Health Care

National Association of Community Health Centers Mission: To promote the provision of high quality, comprehensive and affordable health care that is coordinated, culturally and linguistically competent, and community directed for all medically underserved people.

Learn more about NACHC: www.NACHC.org

CFAHC, a project of NACHCCampaign For America’s Health Centers Mission: To do everything we can to stop threats to health centers and health center patients! We want to provide a way for every health center, every patient and every community that has or needs a health center to act to preserve, strengthen and expand America’s Health Centers.

Join us! http://www.saveourchcs.org/join-the-campaign.cfm