Increase awareness of HRSA s programs and intersections with state and territorial health agencies

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2 Increase awareness of HRSA s programs and intersections with state and territorial health agencies Increase awareness of the health care safety net and the role of public health agencies Increase understanding of designating public entities Facilitate dialogue, through a Question and Answer period, on safety net issues

3 Association of State and Territorial Health Officials Marcia K. Brand, Ph.D. Deputy Administrator Department of Health and Human Services Health Resources and Services Administration

4 Purpose of this Presentation Overview of the Health Resources and Services Administration (HRSA) Agency s programs and priorities Investments in your State and Territory Resources Data Future Opportunities

5 Healthy Communities, Healthy People

6 HRSA Overview Vision statement: Healthy Communities, Healthy People. Mission statement: Improve health and achieve health equity through access to quality services, a skilled health workforce and innovative programs. Strategic plan: 1. Improve access to quality health care and services 2. Strengthen the health workforce 3. Build healthy communities 4. Improve health equity

7 Key Programs and Priorities: Workforce and Shortage Areas Identify workforce shortages in states and territories Strengthen primary care workforce Programs support nurses, physicians, oral health providers, physicians assistants, geriatricians

8 Key Programs and Priorities: Workforce and Shortage Areas Health Professional Shortage Areas (HPSAs) Just over 6,000 primary care HPSAs Just over 4,000 dental HPSAs Just over 3,000 mental health HPSAs Medically Underserved Areas (MUAs) Just over 3,000 nation wide Medically Underserved Populations (MUPs) Just over 400 nation wide Primary Care Offices (PCOs)

9 Key Programs and Priorities: Clinician Recruitment and Service National Health Service Corps (NHSC) Seeks to ensure a diverse, well-trained and distributed workforce through scholarships and loan repayment programs Places providers in medically underserved areas in exchange for student loan repayment and scholarships Supports 8,800 NHSC clinicians at more than 10,000 sites HRSA State Loan Repayment Program

10 Key Programs and Priorities: Health Care Systems Transplantation Pharmacy Services 340 B program Poison Control toll free hotline Vaccine Injury Compensation

11 Key Programs and Priorities: Health Information Technology Health Center Controlled Networks Visit Examples of Grants Health IT Electronic Health Records Telehealth Network Grants Rural Hospital Flexibility Grant Program (FLEX)

12 Key Programs and Priorities: Primary Care Oral Health Initiative Oral health promotion/disease prevention Increase access to oral health care Enhance oral health workforce Eliminate oral health disparities

13 Key Programs and Priorities: Primary Care Behavioral Health Community Health Centers Workforce development RYAN White HIV/AIDS programs Maternal and Child Health Returning Veterans

14 Key Programs and Priorities: Access to Health Care Maternal and Child Health One of the oldest and best known federal public health programs Provides services to 60% of women who give birth in the US each year The largest effort is the Maternal and Child Health Services Block Grant to States Home Visiting new program ($1.5 billion) with Administration for Children and Families

15 HRSA s Key Programs: Access to Health Care Ryan White HIV/AIDS program Part A provides emergency assistance to eligible areas most severely affected by HIV/AIDS Part B provides grants to all States and Territories Part C provides comprehensive primary health care in out patient setting Part D provides family-centered care involving outpatient or ambulatory care for women, infants, children and youth Part F provides funds for a variety of programs: Special projects of national significance AIDS Education and Training Centers Dental Programs Minority AIDS Initiative Call or go to hhtp:// for technical assistance

16 Key Programs and Priorities: Access to Health Care Office of Rural Health Policy (ORHP) Coordinates activities related to rural health care for 62 million residents of rural America through grants to all States Programs integrate and streamline rural health care institutions Aids in the recruitment and retention of providers in rural hospitals and clinics Seeks to build capacity at local and State levels Supports expanded use of telehealth to connect underserved people to distant providers through remote monitoring devices and teleconferencing

17 Key Programs and Priorities: Access to Health Care Office of Rural Health Policy (ORHP) Border Health Division U.S. / Mexico Border Community Based Division Hospital State Division Policy-Research Team Office for the Advancement of Telehealth (OAT)

18 Key Programs and Priorities: Access to Health Care Community Health Centers More than 1100 grantees provided primary and preventive services at over 7,900 sites Served nearly 19 million patients in 2009 Over the next 5 years, HRSA will invest $11 billion made possible by the Affordable Care Act for the operation, expansion and construction of health centers

19 HRSA in Your State Visit and click on the icon you see here to find real-time information and data on HRSA investments in your state

20 HRSA Resources: State and County Data Sources Rural Assistance Center (RAC) Economic Impact Analysis Tool Impact of spending on job growth and economic activity Available on RAC website summer of 2011 Area Resource File (ARF) HRSA Data Warehouse http.//datawarehouse.hrsa.gov County Health Rankings

21 HRSA Resources: Regional and State Based Partners Office of Regional Operations (ORO) Primary Care Offices (PCOs) Primary Care Associations (PCAs) State Offices of Rural Health

22 Additional Resources Center for Integrated Health Solutions Jointly funded by Substance Abuse and Mental Health Services Administration (SAMHSA) and HRSA http// integrated_health_solutions HealthCare.gov

23 Future Funding Opportunities Funding Opportunity Announcements (FOA) Register Get a DUNS number Register with Central Contractor Registry (CCR) Register with Grants.gov Become a Grant Reviewer

24 Contact Information Marcia K. Brand, PhD Deputy Administrator Health Resources and Services Administration

25 ASTHO-HRSA Webinar The Role of HRSA in Supporting the State Public Health Safety Net May 19, 2011 Jim Macrae Associate Administrator U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care Tonya Bowers Director, Office of Policy and Program Development U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care

26 Health Center Program: Background HRSA provides federal grant funding under the Health Center Program to more than 1,100 health center grantees, which operate over 7,900 service delivery sites that provide care to nearly 19 million people annually in every U.S. State, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin Health centers that receive a federal grant under the Health Center Program are often referred to as PHS section 330 Federally Qualified Health Centers (FQHCs) May

27 Other Types of Federally Qualified Health Centers (FQHCs) Federally Qualified Health Center Look-Alikes are health centers that have been identified by HRSA and certified by the Centers for Medicare and Medicaid Services as meeting the definition of health center under Section 330 of the PHS Act, although they do not receive grant funding under Section 330 Outpatient health programs/facilities operated by tribal organizations (under the Indian Self-Determination Act, P.L ) or urban Indian organizations (under the Indian Health Care Improvement Act, P.L ) May

28 Health Center Program: Fundamentals Private non-profit or public entities that must be located in or serve a high need community, i.e. medically underserved areas (MUA) or medically underserved populations (MUP) Governed by a community board composed of a majority (51%) of health center patients who represent the population served May

29 Health Center Program: Fundamentals Provide comprehensive primary care services as well as supportive services such as education, translation and transportation that promote access to health care Services available to all with fees adjusted upon ability to pay Meet other performance and accountability requirements regarding administrative, clinical, and financial operations May

30 Health Center Program: Benefits Access to Federal grant funds to support the costs of uncompensated care. Enhanced Medicaid and Medicare Reimbursement Prospective Payment System (PPS) or other Stateapproved alternative payment methodology Federally Qualified Health Center (FQHC) Medicare allinclusive rate May

31 Health Center Program: Benefits Participation in the 340B (discounted) Drug Pricing Program Automatic Health Professional Shortage Area Designation and participation in National Health Service Corps Federal Tort Claims Act (FTCA) malpractice coverage May

32 Health Center Program: Who is Served Health centers served 18.8 million patients and provided 73.8 million patient visits in % at or Below 200% Poverty 38% Uninsured 63% Racial/Ethnic Minorities May 2011 Source: Uniform Data System, 2009, Service Sites: HRSA Electronic Handbooks Scope Repository 32

33 Health Center Program: Revenue Sources May 2011 Source: Uniform Data System,

34 Overview of Public Center Requirements May

35 Public Center Requirements Private, charitable, tax-exempt nonprofit organization must meet all program requirements (except where waivers permitted). Public center may be structured in two different ways to meet the program requirements (direct or coapplicant arrangement). Section 330(r)(2)(A) limits the total grant funding to public centers to no more than 5 percent of the appropriated funds for public health centers receiving funding under section 330(e) and 330(g). May

36 What Is a Public Health Center? As detailed in HRSA PIN , to be considered a public center the organization must be either: a State or a political subdivision of a State with one or more sovereign powers, and thus is a government entity that is not taxed by the Internal Revenue Service (IRS); OR a subdivision, municipality, or instrumentality of a United States (U.S.) affiliated sovereign State that is formally associated with the U.S.; OR an instrumentality of government, such as those exempt under Internal Revenue Code section 115, and the entity has obtained a letter ruling (i.e., a positive written determination by the IRS of this status) by following the procedures specified in Revenue Procedure or its successor, as applicable. May

37 What is a Public Health Center? DIRECT: Public entity meets all of the requirements of the section 330 program directly No special considerations are needed CO-APPLICANT ARRANGEMENT: Public entity with co-applicant governing Board of Directors collectively the two meet all section 330 requirements and are considered the health center Must meet all Board composition and selection requirements Some special considerations for exercising certain Board authorities; however, there may be some sharing of other responsibilities, provided that the co-applicant Board retains final and ultimate decision-making Must be documented in a fully executed co-applicant agreement which describes the delegation of authority and defines each party s role, responsibilities, and authorities. May

38 Public Center Co-Applicant Arrangement Health Center = Both Public Agency and Co-Applicant Governing Board Co-Applicant Governing Board (Separate 501(c)(3) entity preferred) 1. Complies with all Section 330 composition & selection req. 2. Maintains key authorities and approvals regarding the 330 project 3. May employ management team/staff Co-Applicant Agreement Section 330 grant funds HRSA/BPHC FQHC Look-Alike Designation Public Entity 1. Licensed provider (typically) 2. May establish general financial management and control systems 3. May establish personnel policies 4. May employ management team/staff, including CEO May

39 Jim Macrae, Associate Administrator Bureau of Primary Health Care Health Resources and Services Administration Tonya Bowers, Director Office of Policy and Program Development Bureau of Primary Health Care Health Resources and Services Administration May

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41 Collaborating with Community Health Centers Mary C. Selecky Washington State Secretary of Health May 19, 2011

42 Working Toward Common Goals Our Mission: To protect and improve the health of people in Washington State

43 Working Toward Common Goals Health Center Association Mission: Working toward healthy communities where every Washingtonian has access to health care

44 WA Community Health Centers Serve 1 in 10 Washington residents 1 in 4 Medicaid beneficiaries 1 in 4 uninsured persons 1 in 2 uninsured children 1 in 5 people of color 1 in 3 people in poverty

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46 Collaborating for Healthier Families Oral Health Women, Infants, and Children Immunizations Community Health Planning Tobacco Prevention Emergency Preparedness

47 Opportunities Ahead Public health + clinical access = better health Addressing health disparities Improving health status Workforce development

48 Affordable Care Act Health Centers will be needed to provide care to the additional Medicaid clients in Health Centers need a quality workforce. Department of Health helps recruit health care providers for Community Health Centers. The state loan repayment and National Health Service Corps provides incentives for providers to work in Community Health Centers.

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