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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.

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Presenters

Presenters: RW Part C Programs

Rebecca M. Johnson, MNPL

Mark Meye, CPA


Community link consulting

Community Link Consulting RW Part C Programs

Your knowledgeable resource

in all things FQHC

www.communitylinkconsulting.org


Fqhcs and fqhc look alikes a sustainable business model for rw part c programs

New Access Point, Service Area Competition RW Part C ProgramsBudget 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

Who’s in the room? RW Part C Programs


Why now

Why now? RW Part C Programs

Affordable Care Act

RW Reauthorization Uncertainty

Changes in HIV Disease


Objectives by the end of the presentation you will

Objectives RW Part C Programs: 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

Federally Qualified Health Center’s Mission RW Part C Programs

Improve the health of underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary health care services


Ultimate goal

Ultimate Goal… RW Part C Programs

Improving health status (i.e., patient outcomes) of all populations in the target area served by a health center, especially underserved.

PIN-96-23


Four core elements fqhc or fqhc look alike

Four Core Elements RW Part C Programs FQHC or FQHC – Look alike


1 reach medically underserved communities

1. Reach Medically Underserved Communities RW Part C Programs

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

2. Governing with Community Involvement RW Part C Programs

Impact: CHCs reflect the needs of the communities they serve.


3 treat patients regardless of ability to pay

3. Treat Patients Regardless of Ability to Pay RW Part C Programs

Impact: Community Health Centers (CHCs) are the primary care safety net for the uninsured.


4 provide a comprehensive scope of services

4. Provide a Comprehensive Scope of Services RW Part C Programs

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

Program Benefits – FQHC Only RW Part C Programs

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

Additional Program Benefits RW Part C Programs

National Service Corps

Enhanced Medicaid/Medicare Rates

340 B Pharmacy Access


Program requirements

Program Requirements: RW Part C Programs

Comprehensive primary care (directly or contract)

After hours care

Wrap around “enabling” services

Robust QI Program


System requirements

System Requirements: RW Part C Programs

Ability to bill third party payors

Medicaid and Medicare electronic billing

Financial management policies/procedures


Shared compliance requirements

Shared Compliance Requirements: RW Part C Programs

Annual Uniform Data Set (UDS) Report (similar to RDR/RSR)

Grant Cycles (similar to Part C)

Cost Reports

Financial Audit (A-133)


Financial model

Financial Model RW Part C Programs

Revenue

Expense

Net


Expense

Expense RW Part C Programs

SF424A

Personnel

Fringe

Travel

Supplies

Equipment

Contractual

Other


Personnel

Personnel RW Part C Programs

Typically 80%

Buckets (i.e., programs)

Staffing Ratio Expectations


Revenue

Revenue RW Part C Programs

Non-Program Revenue

Grants

Contracts

Donations/Fundraising

Other (interest, meaningful use)

Program Income


Program income

Program Income RW Part C Programs

Enhanced Reimbursement Rates

Access to Prospective Payment System - wrap payment for Medicaid

Cost-based reimbursement for Medicaid and Medicare


Medicaid rate setting year

Medicaid Rate Setting Year RW Part C Programs

Medicaid – not intuitive

Impact – long term and potentially detrimental


340b pharmacy

340B Pharmacy RW Part C Programs

Discount drug pricing program requires drug manufacturers to provide outpatient drugs to covered entities at a reduced price


Benefits of 340b program

Benefits of 340B Program RW Part C Programs

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

Simplified Grant Accounting RW Part C Programs

Typically tied to payroll

No Double Dipping

- Charge only one grant


Applying for fqhc grants

Applying for FQHC Grants RW Part C Programs

Needs Assessment

Services – Required and Optional

Business Plan

Governance


Fqhcs and fqhc look alikes a sustainable business model for rw part c programs

Rebecca M. Johnson, MNPL RW Part C ProgramsHealth Center Solutions, Inc.360-319-1429Rebecca@healthcentersoluitons.comMark Meye, CPA