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Look-Alike Overview and Initial Designation Application Process. U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care February 13, 2013. Agenda. Health Center, Look-Alike and FQHC Overview
U.S. Department of Health and Human Services
Health Resources and Services Administration
Bureau of Primary Health Care
February 13, 2013
Health Center Program
Look-alikes are health centers that don’t receive a grant
FQHCs:All health centers in the Health Center Program are eligible to apply to be reimbursed using specific Federally Qualified Health Center (FQHC) payment methodologies.
A Federally Qualified Health Center (FQHC) is an entity defined under Medicare and Medicaid statutes.* The term “FQHC” is used by CMS to indicate eligibility for reimbursement by Medicare, Medicaid, and CHIP using specific payment methodologies.
To be an FQHC, an entity must fall under at least one of the following categories:
* Social Security Act §1861(aa)(4)(B) and §1905(l)(2)(B).
** Under the Indian Self-Determination Act or by an Indian organization receiving funds under Title V of the Indian Health Care Improvement Act.
Applicants must be compliant with all Health Center Program requirements at the time of application.
Applicants must provide the following evidence of operational status:
The operational period may include time during which the organization is coming into compliance with Health Center Program requirements (e.g., part of the 6 months may include finalizing contracts or formal referral arrangements for required services).
Applicant must demonstrate full compliance with Health Center Program requirements, at the time of application.
Applicants must demonstrate there is sufficient need in the proposed service area to support a new health center.
In addition to the conducting a needs assessment and completing the Need for Assistance Worksheet, applicants must:
Services must be available to all residents of the service area without regard for ability to pay.
Attachment 7—Contracts and Affiliation Agreements
Form 8—Health Center Agreements
Develop coordinated plan to establish a new look-alike
Address look-alike eligibility requirements as needed
Assess need for additional primary care services in the community
Collaboratively explore options to address unmet needs
Operate as a primary care provider under governing board’s authority and establish compliance with all Health Center Program Requirements
(6 months prior to application submission)
Establish a compliant governing board
Submit initial designation application
Demonstrate full compliance with all Health Center Program requirements
Request for additional information
Additional information submission
Disapproval and TA
HRSA completeness and eligibility
Initial Designation Application*
HRSA reviews for compliance with all Health Center Program requirements
Newly designated look-alike applies to CMS and State Medicaid agency for FQHC reimbursement and for other benefits (e.g., 340B drug pricing), as appropriate
HRSA issues Notice of Look-Alike Designation (NLD)
*Applications must be responsive to the most current Look-Alike Initial Designation Instructions. HRSA will not review applications that are not responsive to the specific requirements for look-alike designation.
HRSA timeframes are approximate and may vary due to extenuating issues.
MS Word versions of all forms are located at http://bphc.hrsa.gov/about/lookalike.
These forms can be used for planning purposes . However, forms submitted as part of the official application must be completed in the EHB.
Pursue collaboration with all health centers (grantees and look-alikes) and other safety net providers in and adjoining your service area.
HRSA Partner Links (Primary Care Associations, Primary Care Offices, National Cooperative Agreements)
Office of Policy and Program Development
Instructions and TA: http://bphc.hrsa.gov/about/lookalike/
Telephone: (301) 594-4300