FQHCs and FQHC Look-alikes: A Sustainable Business Model for RW Part C Programs. Presenters:. Rebecca M. Johnson, MNPL Mark Meye, CPA. Community Link Consulting. Your knowledgeable resource in all things FQHC www.communitylinkconsulting.org.
FQHCs and FQHC Look-alikes: A Sustainable Business Model for RW Part C Programs
Rebecca M. Johnson, MNPL
Mark Meye, CPA
Community Link Consulting
Your knowledgeable resource
in all things FQHC
New Access Point, Service Area CompetitionBudget Period RenewalRyan White Grants & Program SupportFQHC and Look-alike Grantee Support & Services Financial ManagementCost Reporting, UDS, FFRFee Schedule ReviewCorporate Compliance / Compliance ReportingManagement / Staff / Board TrainingStrategic PlanningResidency DevelopmentIT Infrastructure Development and Support
Who’s in the room?
Affordable Care Act
RW Reauthorization Uncertainty
Changes in HIV Disease
Objectives: By the end of the presentation you will:
Understand the benefits of becoming an FQHC or FQHC LA
Know how the programs differ
Know which model best supports your program
Have basic information to begin strategic discussions about becoming an FQHC/FQHC-LA
Have a road map for pursuing FQHC/LA status
Federally Qualified Health Center’s Mission
Improve the health of underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary health care services
Improving health status (i.e., patient outcomes) of all populations in the target area served by a health center, especially underserved.
Four Core Elements FQHC or FQHC – Look alike
1. Reach Medically Underserved Communities
Impact: CHCs serve populations who otherwise would not get the care they need; CHCs see publicly insured and uninsured patients in areas where there is a lack of providers and/or providers willing to see this population.
2. Governing with Community Involvement
Impact: CHCs reflect the needs of the communities they serve.
3. Treat Patients Regardless of Ability to Pay
Impact: Community Health Centers (CHCs) are the primary care safety net for the uninsured.
4. Provide a Comprehensive Scope of Services
Impact: No other model of primary health care service delivery offers more services in one location or targets more special populations through one model of care.
» Reduce/eliminate health disparities.
» Help vulnerable patients successfully manage chronic conditions.
» Save money in the health care delivery system by keeping patients out of the hospital and ER.
Program Benefits – FQHC Only
Grant Funding for Operations under Section 330 of the Public Health Services Act -- $650,000 for New Access Point
FTCA – Federal Tort Claims Act Coverage
Additional Program Benefits
National Service Corps
Enhanced Medicaid/Medicare Rates
340 B Pharmacy Access
Comprehensive primary care (directly or contract)
After hours care
Wrap around “enabling” services
Robust QI Program
Ability to bill third party payors
Medicaid and Medicare electronic billing
Financial management policies/procedures
Shared Compliance Requirements:
Annual Uniform Data Set (UDS) Report (similar to RDR/RSR)
Grant Cycles (similar to Part C)
Financial Audit (A-133)
Buckets (i.e., programs)
Staffing Ratio Expectations
Other (interest, meaningful use)
Enhanced Reimbursement Rates
Access to Prospective Payment System - wrap payment for Medicaid
Cost-based reimbursement for Medicaid and Medicare
Medicaid Rate Setting Year
Medicaid – not intuitive
Impact – long term and potentially detrimental
Discount drug pricing program requires drug manufacturers to provide outpatient drugs to covered entities at a reduced price
Benefits of 340B Program
Reported savings that range between 25-50% for covered outpatient drugs as a result of the low 340B prices
Reduces the price of medications for patients
Expands the number of drugs on formularies
Increases the number of indigent patients served
Expands other services offered to patients by the entity – flexible “profit” – unlike RW
Simplified Grant Accounting
Typically tied to payroll
No Double Dipping
- Charge only one grant
Applying for FQHC Grants
Services – Required and Optional
Rebecca M. Johnson, MNPLHealth Center Solutions, [email protected] Meye, CPA