Federal Grant Fiduciary Responsibility

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					Federally Qualified Health
Centers: Qualifications and

             Connie Berry
       Texas Primary Care Office
Texas Department of State Health Services
           October 13, 2008
             What is an FQHC?
A Federally Qualified Health Center (FQHC) is a
  comprehensive primary care clinic that:
 Has competed successfully for federal funds

   Receives these federal grant funds to serve the

   Receives grant funding directly from the Federal
       I. Mission and Strategy:
The key element of the health center’s mission must be to
  improve the health status of underserved populations.

Health centers must assess the needs of underserved
  populations and design programs and services for the

They must measure the effectiveness and quality of their

They must operate as efficiently as possible. Health
  centers must collaborate with other organizations.
             II. Clinical Program:
Health centers must have a system of care that ensures access to
  primary and preventive services, and facilitates access to
  comprehensive health and social services. Access for the
  underserved is assured through a sliding fee schedule and
  acceptance of Medicare and Medicaid. They are not “free clinics.”

Services must be responsive to the needs and culture of the target
   community and/or populations.

Quality of health center services is paramount. Services include
  primary medical, dental, mental health and substance abuse.
     Required Services for FQHCs
   Primary care                  Well child services
   Dental                        Child and adult immunizations
   Mental health                 Eye and ear screening for
   Substance Abuse                children
   Diagnostic lab and x-ray      Family planning services
   Prenatal and perinatal        Emergency medical
   Cancer and other disease      Pharmaceutical
    screening                     Case management
   Blood level screenings        Outreach and education
      Lead levels                Eligibility/Enrollment services
      Communicable diseases      Transportation and
      Cholesterol                 interpretation
   Prenatal and perinatal        Referrals
                  III. Governance:
FQHCs must be a non-profit (501c3) or public entity

The board must be at least 51% consumers of the services provided by
  the clinic (for both non-profits and public entities.)

The board must assume full authority and oversight responsibility for
  the health center.

The board carries out its legal and fiduciary responsibility by providing
  policy level leadership and by monitoring and evaluating the health
  centers performance.
  IV. Management and Finance:
A strong management team is essential to health center
   success, ensuring that the health center is financially
   viable and cost-competitive.

Health center management must be supported by strong
  personnel, financial, information, and clinical systems.

Management Team consists of: Chief Executive Officer,
  Chief Medical Officer, and Chief Financial Officer of the
  non-profit or public entity organization.
       Benefits of FQHC status
   Grant up to $650,000 for first three years, then
    competitive and can increase
   Federal Tort Claims Act malpractice coverage
   Prospective Payment System reimbursement for
    services to Medicaid and Medicare patients
   Reimbursement by Medicare for “first dollar” of
    services (deductible is waived)
   340B Drug Pricing Discounts
   Access to Vaccines for Children (VFC) Program
   Right to have out-stationed eligibility workers on-site
   Access to National Health Service Corps (NHSC)
    So what is an FQHC Look Alike?

    A clinic that meets all the requirements of an FQHC, but
    has not been awarded federal grant funding.

   FQHC Look Alikes “look like” an FQHC– open at least 32
    hours per week, same services, governance, etc., as an

   Look Alikes are well-positioned to become grant funded
     FQHC Incubator Grant Program

   The Texas Primary Care Office or TPCO,
    manages state grant funds to expand and
    develop FQHCs in Texas

   The Incubator grant program assists in Planning,
    Development, Transitional Operating Support
    and Capital Improvements

   Up for reauthorization this year, the program
    has funded 25 new FQHCs or Look Alikes and 25
    expanded FQHCs
             FQHCs in Texas

   There are currently 58 FQHCs, operating
    over 300 health care sites

   26 of the FQHCs have received federal
    grant funding within the past 8 years

   There are 6 FQHC Look Alikes
      Obstacles and Challenges to
        Developing New FQHCs
   The 51%+ consumer board can be
    challenging for some organizations
   Viability or community size can be a
    challenge– capacity for 3 Full Time
    Equivalencies (FTEs) or an expansion of
    3000 new patients
   Business model needed to demonstrate
    diversity in payer mix and funding streams
      Obstacles and Challenges to
        Developing New FQHCs
   Initial federal grant is up to $650,000–
    one size does not fit all!
   Recruiting providers and key management
    staff into a system that is not typical
   Outlook for future funding: Development
    can be intensive and costly, with no
    assurance federal grant dollars will be
       Obstacles and Challenges to
         Developing New FQHCs
   Many federal requirements and processes
    must be in place or developed quickly

   Federal funding doesn’t transfer the cost
    of care for the uninsured– it is intended to
    expand what is already in place (non-
      Obstacles and Challenges to
        Developing New FQHCs
   FQHCs grow/develop from the community
    up, in other words, DSHS doesn’t put
    FQHCs in place
   Incubator funds must be leveraged with
    other local support (resources/funding)
   Technical assistance also must be
    leveraged with other expertise (not just
 For Additional Information
       Texas Primary Care Office
Texas Department of State Health Services

              (512) 458-7518

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