How To Run A Cmmunity Health Center
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1 Cmmunity Health Centers Thursday, Octber 16, 2014 Pineer Rm State Capital Linda Rss, CEO Cmmunity HealthCare Assciatin f the Daktas
2 2 Abut CHAD The Cmmunity HealthCare Assciatin f the Daktas (CHAD) is a 501(c)3 membership rganizatin serving as the Primary Care Assciatin (PCA) fr Nrth and Suth Dakta. The rle f a PCA is t prvide supprt t ur Cmmunity Health Center (CHC) members in the areas f training, technical assistance and advcacy, as well as assist the CHCs in maintaining cmpliance with their prgram requirements, perating grants, and grwth planning.
3 3 Our Missin It is ur missin t enhance access t quality primary care thrugh services t ur members. We strive t serve the needs f ur members and t supprt their missin t prvide quality health care t the peple f Nrth and Suth Dakta.
4 4 What is a Federally Qualified Health Center (FQHC)? Accrding t the Centers fr Medicare and Medicaid Services (CMS), FQHCs are safety net prviders such as cmmunity health centers, public husing centers, utpatient health prgrams funded by the Indian Health Service, and prgrams serving migrants and the hmeless. The main purpse f the FQHC Prgram is t enhance the prvisin f primary care services in underserved urban and rural cmmunities. Cmmunity health centers (CHCs) are nn-prfit cmmunitydriven clinics prviding high quality primary and preventive care t all individuals, with r withut insurance and regardless f their ability t pay.
5 5 What is an FQHC? (cnt d) FQHCs must fall under ne f the fllwing categries t qualify fr enhanced reimbursement frm Medicare and Medicaid, as well as ther benefits. Meets requirements f the Health Center Prgram and receives a grant under sectin 330 f the Public Health Service Act. Meets requirements f the Health Center Prgram but des nt receive a grant under sectin 330 f the Public Health Service Act. Qualifies as an utpatient health prgram r facility perated by a tribe r tribal rganizatin.
6 6 FQHC vs. CHC FQHC designatin cmes frm CMS and is a payment mechanism CHC designatin cmes frm Health Resurces and Services Administratin (HRSA) Fr the purpse f this cnversatin, we will use them interchangeably
7 7 Types f Health Centers Grant-Supprted Federally Qualified Health Centers are public and private nn-prfit health care rganizatins that meet certain criteria under the Medicare and Medicaid Prgrams (respectively, Sectins 1861(aa)(4) and 1905(l)(2)(B) f the Scial Security Act and receive funds under the Health Center Prgram (Sectin 330 f the Public Health Service Act). Cmmunity Health Centers serve a variety f underserved ppulatins and areas (Sectin 330) Migrant Health Centers serve migrant and seasnal agricultural wrkers (Sectin 330g) Healthcare fr the Hmeless Prgrams reach ut t hmeless individuals and families and prvide primary care and substance abuse services (Sectin 330h) Public Husing Primary Care Prgrams serve residents f public husing and are lcated in r adjacent t the cmmunities they serve (Sectin 330i)
8 8 Types f Health Centers (cnt d) Nn-grant-supprted Health Centers are health centers that have been identified by HRSA and certified by the Centers fr Medicare and Medicaid Services as meeting the definitin f health center under Sectin 330 f the PHS Act, althugh they d nt receive grant funding under Sectin 330. They are referred t as Lk-Alikes. Outpatient health prgrams/facilities perated by tribal rganizatins (under the Indian Self-Determinatin Act, P.L ) r urban Indian rganizatins (under the Indian Health Care Imprvement Act, P.L ).
9 9 Health Center Prgram Fundamentals Private nt-fr-prfit r public entities that serve a high-need cmmunity r ppulatin Medically Underserved Area (MUA) r a Medically Underserved Ppulatin (MUP) Prvide cmprehensive primary health care services as well as supprtive services (educatin, translatin and transprtatin, etc.) that prmte access t health care Gverned by a cmmunity bard cmpsed f a majrity (51% r mre) f health center patients wh represent the ppulatin served Prvide services available t all with fees adjusted based n ability t pay (Sliding Fee Discunt Prgram) Cllabrate with safety net prviders and thers (e.g., State and lcal health departments) in the area Held t strict accuntability and perfrmance measures fr clinical, financial and administrative peratins by HRSA (19 Key Prgram Requirements)
10 10 Sliding Fee Discunt Prgram Applicability t all individuals and families with annual incmes at r belw 200 percent f the Federal Pverty Guidelines (FPG). Full discunt fr individuals and families with annual incmes at r belw 100 percent f the FPG, r allwance fr a nminal charge nly, cnsistent with health center plicy. Adjustment f fees (partial discunt) based n family size and incme fr individuals and families with incmes abve 100 and at r belw 200 percent f the FPG. N discunts fr individuals and families with annual incmes abve 200 percent f the FPG.
11 11 19 Key Health Center Prgram Requirements Need Needs Assessment Gvernance Bard Authrity Bard Cmpsitin Cnflict f Interest Plicy Services Required and Additinal Services Staffing Requirements Accessible Hurs f Operatin/Lcatin After Hurs Cverage
12 12 19 Key Health Center Prgram Requirements Services (cnt d) Hspital Admitting Privileges and Cntinuum f Care Sliding Fee Discunt Quality Imprvement/Assurance Plan Management and Finance Key Management Staff Cntractual/Affiliatin Agreements Cllabrative Relatinships Financial Management and Cntrl Plicies Billing and Cllectins Budget Prgram Data Reprting Systems Scpe f Prject
13 13 UDS Reprting Every year, CHCs are required t cmplete a cre set f infrmatin called the Unifrm Data System (UDS). This data includes patient demgraphics, services prvided, staffing, clinical indicatrs, utilizatin rates, csts, and revenues. The data is used t ensure cmpliance with regulatry requirements, reprt achievements f the cmmunity health center prgram, mnitr perfrmance f the prgram, and t identify areas f technical assistance needs.
14 14 Benefits t the Health Center Sectin 330 grant funds t ffset the csts f uncmpensated care and ther key enabling services (Health Center Prgram grantees receive these grant funds. Lk-alikes are eligible t cmpete fr them.) Medical malpractice cverage under Federal Trt Claims Act (FTCA) (Lk-alikes are nt eligible fr this benefit.) Prspective Payment System (PPS) reimbursement fr services t Medicaid patients Cst-based reimbursement fr services t Medicare patients Drug Pricing Discunts fr pharmaceutical prducts under the 340B Prgram Access t Vaccines fr Children Prgram fr uninsured children
15 15 Benefits t the Health Center (cnt d) Federal lan guarantees fr capital imprvements (Lk-alikes are nt eligible fr this benefit.) Autmatic Health Prfessinal Shrtage Area (HPSA) Designatin The Natinal Health Service Crps (NHSC) can help health centers, lk-alikes, and free clinics recruit and retain qualified prviders Natinal netwrk f similar rganizatins cmmitted t imprving the health f the Natin s underserved cmmunities and vulnerable ppulatins Eligibility fr varius ther federal grants and prgrams
16 16 Sectin 330 Public Health Service Act Health Center Prgram Defines the Federal Health Center Prgram as the funding pprtunity fr rganizatins t prvide care t underserved ppulatins New Access Pints Grants prvide funding t supprt new service delivery sites that will prvide cmprehensive primary health care and access t ral and mental health services. Applicants can be existing grantees r new rganizatins that d nt currently receive sectin 330 grant funds. Expanded Medical Capacity Grants prvide funding t expand access t primary health services in the health center's current service area (e.g. by adding new medical prviders r medical services r expanding hurs f peratin). Only existing grantees are eligible t apply.
17 17 Sectin 330 Public Health Service Act Health Center Prgram (cnt d) Service Expansin Grants prvide funding t add new r expand existing mental health/substance abuse, ral health, pharmacy, and enabling services fr special ppulatins at existing health centers. Only existing grantees are eligible t apply. Service Area Cmpetitin Grants prvide nging cmpeting cntinuatin funding fr service areas currently served by health center grantees. Bth currently funded sectin 330 grantees whse prject perids have expired and new rganizatins prpsing t serve the same areas r ppulatins being served by existing sectin 330 grantees may apply.
18 18 Benefits t the Cmmunity A health hme fr underserved peple, imprving public health, reducing the burden n hspital emergency rms, and prviding needed services such as free immunizatins fr uninsured children A vice (thrugh the cnsumer majrity Bard f Directrs) in the peratin f that health hme Brader health insurance cverage as the health center assists uninsured patients enrll in Medicaid, CHIP, and ther assistance prgrams Less cstly care fr Medicare patients, whse Medicare deductible csts are waived fr FQHC-prvided services
19 19 Services Prvided by CHCs All Services Prvided t All Ages Primary Health Care Dental Care Behaviral Health Pharmacy Basic Lab Emergency Care Radilgical Services Transprtatin Case Management After Hurs Care Hspital/Specialty Care Nte: This is nt a cmplete list f services. All services required n site r thrugh established written arrangements/referrals
20 20 Nrth Dakta FQHCs Cmmunity Health Service Inc.
21 21 Nrth Dakta Cmmunity Health Center Snapsht
22 22 FQHC / Lk-Alike Rural Health Clinic Benefits Benefits Cmparisn Must be either a nt-fr-prfit r public facility. May be either a fr-prfit r nt-fr-prfit. Can be public r private. Health Center Prgram grant funding Lk-Alike Eligible t cmpete RHC N Gverned by a Bard f Directrs f which at least 51% must be patients f the cmmunity health center. Nt required t have a Bard f Directrs. Medical Malpractice Cverage - FTCA Lk-Alike N RHC N Must prvide care fr all ages. May be limited t a specific type f primary care practice. (Pediatrics, OB/Gyn) Prspective Payment System (PPS) -Medicaid patients Lk-Alike Yes RHC -Yes Must prvide primary health care; maternity and prenatal care; preventive care fr infants, children, and adults; sme emergency care; and pharmaceutical services. Required t prvide emergency care n a 24-hur basis. Required t serve all residents f their service area with charges n a sliding fee scale based upn ability t pay. N minimum service requirements. Must prvide utpatient primary care services and basic lab service. RHCs have n requirement fr after-hur emergency care. Nt required t prvide services t lw-incme patients r t prvide sliding fee reductins. If emplying a NHSC prvider, thse services need t be prvided n a sliding fee scale. Cst-based reimbursement - Medicare Drug Pricing Discunts - 340B Prgram Vaccines fr Children Prgram Lk-Alike Yes RHC Yes Lk-Alike Eligible t participate RHC N - Hwever a cvered CAH can register their utpatient clinic in the prgram. Lk-Alike Yes RHC Yes Cmparisn f FQHC LAL RHC Required t have an nging quality assurance prgram that identifies and takes actins necessary t crrect prblems. Must be lcated in a rural r urban area which is underserved r lacking health prfessinals. (MUAs and HPSAs). N specific requirements fr quality assurance plans. It is a requirement fr RHCs t cnduct an annual prgram evaluatin t include vlume and type and review bth current and clsed charts. May retain status regardless f the designatin f their service area. RHCS must be lcated in a nn-urban rural area with current health care shrtage designatins. Federal lan guarantees HPSA Designatin Lk-Alike N RHC N Lk-Alike Yes RHC Yes See handut fr greater detail Required t be pen at least 32 hurs per week and prvide emergency cverage after nrmal business hurs. N minimum hurs r emergency cverage requirements. NHSC Lk-Alike Yes RHC Yes as lng as the requirements are met Required t submit an annual independent audit as well as regular financial reprts. Must submit an annual audit but have n specific financial reprting requirements. Grants / Other Prgrams New Access Pint Lk-Alike Eligible t apply RHC Eligible t apply Expanded Medical Capacity Lk-Alike N RHC N Service Expansin Lk-Alike N RHC N Service Area Cmpetitin Lk-Alike Eligible t apply RHC Eligible t apply
23 23 Questins? Thank yu! Linda Rss, MBA CEO Cmmunity HealthCare Assciatin f the Daktas
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