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Introduction To Federally Qualified Health Centers (FQHCs). What is an FQHC?. Federally Qualified Health Center (FQHC) - umbrella term for a number of federally-supported safety-net programs. The term also determines how the programs will be reimbursed by Medicaid. These programs include:

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what is an fqhc
What is an FQHC?
  • Federally Qualified Health Center (FQHC) - umbrella term for a number of federally-supported safety-net programs. The term also determines how the programs will be reimbursed by Medicaid. These programs include:
    • Community/Migrant Health Centers
    • Health Care for the Homeless
    • Public Housing Health Centers
    • School-based, School-linked Health Centers

There are also FQHC ‘Look-Alikes’ (These meet all FQHC requirements but receive no grant)

fqhcs in michigan
FQHCs in Michigan

Thirty one (31) Michigan Community Health Centers provide quality, comprehensive, community-oriented primary health care for nearly 600,000 patients annually at 160 sites across the state.  Of those 31 Community Health Centers, 28 are Federally Qualified Health Centers (FQHCs), 2 are FQHC 'Look-Alikes’, and 1 is both a FQHC and a FQHC ‘Look-Alike’.

where are the fqhc organizations
Where are the FQHC Organizations?
  • Alcona
  • Baldwin
  • Jackson
  • Detroit (3)
  • Grand Rapids
  • Algonac
  • East Jordan
  • Battle Creek (2)
  • Kalamazoo
  • Carleton
  • Muskegon (2)
  • Flint
  • Saginaw
  • Lansing
  • Benton Harbor (2)
  • Houghton Lake
  • Shelby
  • Sault St. Marie
  • Sterling
  • Thunder Bay
  • Marquette
  • This list does not include all access points.
fqhc eligibility requirements
FQHC Eligibility Requirements
  • Must be located in (or serve) a medically underserved area (MUA) or serve a medically underserved population (MUP)
  • Must be a private nonprofit entity or a public entity with a compliant co-applicant board, including tribal, faith-based and community based organizations
fqhc requirements
FQHC Requirements
  • Must have a governing board (board of directors) a majority of which must be consumers of the center’s health services and as a group represent those being served.
  • No more than half of non-consumer members may derive 10% or more of their income from the health care industry.
  • Must have a management team that works with the governing board to achieve the mission of the center.
fqhc requirements1
FQHC Requirements
  • Must be accessible, having extended hours, and having arrangements for off hour coverage (24/7)
  • Must offer a sliding fee scale to adjust fees to a patient’s ability to pay (<200% FPL; nominal for <100% FPL)
  • Must accept Medicare & Medicaid
  • Must provide culturally competent services
fqhc requirements2
FQHC Requirements
  • Must provide comprehensive system of care (either directly or by contract) available & accessible promptly and in a manner that assures continuity of care, including required services:
    • Basic primary and preventive services
    • Referrals to other providers (specialists when medically indicated) and health related services and agencies (substance abuse; mental health)
fqhc requirements3
FQHC Requirements
  • Case management services (counseling; referral & follow-up) and services to assist patients establishing eligibility for financial assistance programs
  • Enabling services: outreach, transportation and translation
  • Health Education: availability & proper use of health services
fqhc requirements4
FQHC Requirements
  • Additional health services as appropriate
    • Behavioral Health
    • Comprehensive oral health
    • Linguistic and cultural competence
    • Special populations services (migrant, homeless, public housing etc.)
fqhc benefits
FQHC Benefits
  • Receive Section 330 funds which significantly support expanded access to health care services to underserved populations (Except Look-Alikes)
  • Receive Medicaid Agency payment rates under the Prospective Payment System (PPS) or other State approved alternative payment methodology (PAL 2001-09; Sec 1902(bb) SSA)
  • Receive an FQHC Medicare All-Inclusive Rate
fqhc benefits1
FQHC Benefits
  • Ability to participate in the Public Health Service Act Sections 340B Drug Pricing Program
  • Automatic HPSA Designation/access to National Health Service Corps
  • Ability to access free medical malpractice insurance under the Federal Tort Claims Act (FTCA) Note: This does not apply to Look-Alikes.
  • Access to the federal Vaccines for Children Program
  • Access to Bureau of Primary Health Care technical assistance
how do fqhcs make a difference
How do FQHCs make a difference?
  • Their mission is to improve access to primary health care for all persons regardless of –
    • Insurance status
    • Location
    • Age
    • Sex
    • Race
    • Disease Status
how do fqhcs make a difference1
How do FQHCs make a difference?
  • They offer a sliding fee scale to the uninsured and underinsured.
  • Local governance – Health centers are governed by a volunteer Board of Directors. The majority of Board Members must be patients of the center. Boards must be able to hire/fire executive director (When owned by public entity, have authority delegated to them to be able to do so.)
  • Responsive to community needs – Health centers tailor their services to fit the special needs and priorities of their communities.
how do fqhcs make a difference2
How do FQHCs make a difference?
  • Create jobs and stimulate economic growth.
  • The Institute of Medicine recognized health centers for reducing and eliminating the health gaps for racial and ethnic minorities.
  • Cost-effective care – A recent study in Michigan demonstrated that health centers provide $44.87 per member per month savings to Michigan Medicaid as compared to other Medicaid providers.
how do fqhcs make a difference cont d
How do FQHCs make a difference? (cont’d)
  • Health centers meet or exceed nationally accepted practice standards for treatment of chronic conditions. All health centers must have a clinical quality program and submit reports on their clinical outcomes (clinical measures).
  • Quality of care provided at health centers is equal to or greater than care provided elsewhere.
web resources
Web Resources
  • Michigan Primary Care Association www.mpca.net
  • National Association of Communty Health Centers www.nachc.com
  • US HHS HRSA Bureau of Primary Health Care http://bphc.hrsa.gov/
    • http://bphc.hrsa.gov/about/
    • http://bphc.hrsa.gov/policy/default.htm
    • http://bhpr.hrsa.gov/shortage/
for more information
For more information
  • Kim Sibilsky, Executive Director
  • Michigan Primary Care Association
  • (517) 381-8000
  • ksibilsky@mpca.net
  • Neal Colburn, Technical Assistance Consultant
  • Michigan Primary Care Association
  • (517) 381-8000 x220
  • ncolburn@mpca.net