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Clinics in Rural California

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					Clinics in Rural California

    HIT INFORMATIONAL HEARING
            JUNE 9, 2010



        ANDIE MARTINEZ, MPP
    ASSOCIATE DIRECTOR OF POLICY
CALIFORNIA PRIMARY CARE ASSOCIATION
                                Types of Clinics

State                                        Federal

• Hospital based outpatient                  • Federally Qualified
  clinics (section 1250)                        Health Centers (FQHC)
                                               • Migrant
• 1204(a) licensed clinics
    •   Community Clinics                      • Homeless
    •   Free Clinics                           • Public Housing
    •   Planned Parenthood                   • FQHC Look-Alikes
    •   FQHCs                                • Rural Health Clinics
1204(a): an organized outpatient health
facility which provides direct medical,      • Indian Health Service
surgical, dental, optometric, or podiatric      Clinics
advice, services, or treatment to patients
who remain less than 24 hours
                  Located in or serve a high need
What is a            community (designated Medically
Federally            Underserved Area or Population).
Qualified           Governed by a community board
Health Center?       composed of a majority (51% or more) of
                     health center patients who represent the
                     population served.
                    Provide comprehensive primary health
                     care services as well as supportive services
                     (education, translation and transportation,
                     etc.) that promote access to health care.
                    Provide services available to all with fees
                     adjusted based on ability to pay.
                    Meet other performance and
                     accountability requirements regarding
                     administrative, clinical, and financial
                     operations.
                A clinic certified to receive special
                   Medicare and Medicaid
What is a          reimbursement.
Rural Health      The purpose of the RHC program is
Clinic?            improving access to primary care in
                   underserved rural areas.
                  RHCs are required to use a team
                   approach of physicians and midlevel
                   practitioners such as nurse practitioners,
                   physician assistants, and certified nurse
                   midwives to provide services.
                  The clinic must be staffed at least 50% of
                   the time with a midlevel practitioner.
                  RHCs are required to provide out-patient
                   primary care services and basic
                   laboratory services.
California      Must be a licensed 1204(a) clinic,
Primary Care     or exempt from licensure under
Association      section 1206
members
                Has a written policy of non-
                 discrimination based on ability to
                 pay and has either a sliding scale
                 fee based on income and family
                 size or a no-fee policy;
                Has a community board
                  FQHCs                                159
How many
                  FQHC Look Alikes                     6
clinics are
                  Community and Free Clinics           47
there in rural
California?       1204(a) licensed RHCs                23
                  RHCs                                 265

                 TOTAL                                  454




                 By comparison, there are an additional 590
                 FQHCs/Free & Community Clinics/FQHC Look
                 Alikes in urban California
  What are the major HIT barriers facing clinics in
                 rural California?

Barriers                    Opportunities


 Connectivity               California Telehealth
                              Network
 Cost of equipment
                             Medicare/Medicaid EHR
 Staffing                    incentives
 Reimbursement rates            30% needy only applies to
                                  FQHC/RHC
                                 Incentives directed at
                                  provider, not clinic/health
                                  center
                             CalHIPSO (regional
                              extension center)
                Advocate to the federal Centers for
What can the
State do to      Medicare & Medicaid Services (CMS):
address             EHR incentives directly to the entity
barriers?               FQHC
                        RHC
                        Community and Free Clinics
                Advocate to U.S. Dept of Health &
                 Human Services, Office of the
                 National Coordinator for Health
                 Information Technology (ONC):
                    Remove the provider cap placed upon
                     regional extension centers
                        No cap
                        OR, if necessary, 30 by site
                         CONTACT INFORMATION

California Primary Care Association
Andie Martinez, Associate Director of Policy
amartinez@cpca.org / (916) 440-5170
www.cpca.org

California Association of Rural Health Clinics
Gail Nickerson, President
nickergw@ah.org / (916) 774-7308
www.carhc.org

California Rural Indian Health Board
Arreola Pro Rosario, Health Systems Development Director
rosario.arreola@crihb.net / (916) 929-9761
www.crihb.org

				
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