Introduction
Federally qualified
health centers (FQHCs) include all organizations receiving grants
under section 330 of the Public Health Service Act, certain tribal organizations, and
FQHC Look-Alikes. FQHCs qualify for enhanced reimbursement from
Medicare and Medicaid, as well as other benefits. FQHCs must serve
an underserved area or population, offer a sliding fee scale, provide
comprehensive services, have an ongoing quality assurance program,
and have a governing board of directors.
Frequently Asked Questions
Tools
BPHC Program Information Notices (PINs)
Web site
Links to Bureau of Primary Health Care Program Information Notices (PINs) from 1994-present.
Bureau of Primary Health Care Health Center Program
Web site
Information and resources for the community health centers program. Includes information about current and past funding, program requirements, and the benefits of health center status.
CMS Federally Qualified Health Centers
Web site
Links to all Medicare Fee-for-Service FQHC specific information from CMS.
CMS Rural Health Open Door Forum
Web site
Provides information on a series of CMS forums addressing rural health issues. Covers Rural Health Clinic (RHC), Community Access Hospital (CAH) and Federally Qualified Health Center (FQHC) issues, as well as some inclusion of other questions and concerns that occur in clinical practice pertaining to other CMS payment systems that also extend into these settings. Includes call-in instructions for the next call and how to register for the mailing list.
Community HealthCorps
Web site
Promotes health care for America's underserved. Works to increase access to health care, provide health education, support use of health care services, and recruit and develop volunteers to support community health centers.
Dental Volunteer
Database
Searchable database of dental health volunteering opportunities in the United States and abroad. Individuals can search for volunteer opportunities and organizations can use the site to seek dental health volunteers.
Developing and Implementing a Discount Fee Schedule
Web site
Basic information for clinics and health centers about developing and implementing
a sliding fee schedule for low-income populations.
Directory of Primary Care Offices (PCO)
Web site
Lists contact information for each state's Primary Care Office (PCO). PCOs represent the needs of the underserved populations and the providers who serve them. These offices can provide information on Conrad 30 J-1 Visa Waiver programs, loan repayment programs, and recruitment and retention.
Directory of State and Regional Primary Care Associations
Web site
Address, phone, email and web addresses for state and regional Primary Care Associations (PCAs). PCAs work to promote, expand, and optimize access to primary care.
EHR Selection Toolkit for Community Health Centers
Web site
Provides a list of criteria to review with vendors of EHR systems to insure the unique needs of community health centers (CHCs) are met.
Find Affordable Health Care
Database
The Bureau of Primary Health Care Service Delivery Sites tool allows users to search for health centers, including Federally Qualified Health Centers and other Bureau of Primary Health Care service delivery sites, by location. These health centers provide free and low-cost health services. Services include primary medical, obstetrical and gynecological, dental, mental health and substance abuse care, other types of medical and support services.
FQHC Look-Alike Program
Web site
Information on the Federally Qualified Health Centers Look-Alike program, including eligibility, program requirements, benefits, and contacts for more information.
Health Centers State-By-State Data
Web site
Provides state-level data on Federally Qualified Health Centers' patients, services provided, staff, patient visits, and costs of care. Includes state maps showing FQHC locations.
HealthCare Volunteer
Database
Searchable database of health care volunteering opportunities in the United States and abroad. Individuals can search for volunteer opportunities and organizations can use the site to seek health care volunteers.
Medically Underserved Area/Medically Underserved Population (MUA/MUP) Database
Database
Allows searching by state, county, or ID number. Includes designation status and date.
Medicare Contracting Reform
Web site
Information and resources concerning the Part A/Part B Medicare Administrative Contractors (MACs), which will replace the current fiscal intermediaries and carriers and handle administration of both the Medicare Part A and Part B programs in specified geographic regions.
Medicare Part D & Safety Net Providers: Contracting with Prescription Drug Plans
Web site
Information for safety net providers about the impact of the Medicare Prescription Drug Program. Addresses contracting with Prescription Drug Plans (PDPs) and includes a sample pharmacy contract addendum.
Medicare Part D Changes in Enrollment & Eligibility for Low Income Subsidy
Web site
Describes common situations facing safety net patients during the Medicare Part D open enrollment period that ends December 31, 2006 and ways that safety net providers can help.
Rural Health Research: Federally Qualified Health Centers (FQHCs)
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of Federally Qualified Health Centers (FQHCs), produced by the Office of Rural Health Policy's funded rural health research centers.
Regulations, Forms & Other Useful Documents
Access Capital: New Opportunities for Meeting America's Primary Care Infrastructure Needs
Sponsoring organization: National Association of Community Health Centers
Examines why significant investments in health center infrastructure are critical to meeting rising numbers of medically underserved and uninsured people.
Date: 03 / 2008
Access Denied: A Look at America's Medically Disenfranchised
Sponsoring organization: National Association of Community Health Centers
Reports results of a study that found inadequate access to a primary care physicians due to shortages of these physicians in certain communities. Includes some rural-specific information on health care access.
Date: 2007
Announcement of Medicare Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Payment Rate Increases
Sponsoring organization: Centers for Medicare & Medicaid Services
Updates the Medicare upper payment limit per visit for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) for 2007.
Date: 01 / 2007
Clinician's Handbook on the Federal Tort Claims Act
Sponsoring organization: Health Resources and Services Administration
Written for Health Center clinicians who are (or will be) receiving Federal Tort Claims Act malpractice protection. Intended to provide a fundamental understanding of the Federal Tort Claims Act.
Date: 2001
Code of Federal Regulations. 42 CFR 405.2400-2472: Federal Health Insurance for the Aged and Disabled
Establishes the requirements for coverage
and reimbursement of Rural Health Clinic and Federally Qualified Health Center services under Medicare.
Date: 2002
Code of Federal Regulations. 42 CFR 410.165: Payment for Rural Health Clinic Services and Ambulatory Surgical Center Services: Conditions
Details the forms and other requirements for payment for Rural Health Clinics and Federally Qualified Health Centers.
Date: 2002
Code of Federal Regulations. 42 CFR 491: Certification of Certain Health Facilities
Covers the conditions Rural Health Clinics and Federally Qualified Health Centers must meet to qualify for reimbursement under Medicare
and that Rural Health Clinics must meet to qualify for reimbursement under Medicaid.
Date: 2002
Comparison of the Rural Health Clinic and Federally Qualified Health Center Programs
Sponsoring organization: Health Resources and Services Administration
Provides a general comparison of the financial
components of the Rural Health Clinic (RHC) and Federally Qualified Health Center
(FQHC) programs under Medicare and Medicaid.
Date: 06 / 2006
Dentist Vacancies in Federally Funded Health Centers
Sponsoring organization: WWAMI Rural Health Research Center
Presents results for dentists from a study of staffing needs at Federally Qualified Health Centers (FQHCs). Provides information on dentist vacancy rates by rural and urban location. Compares dentist vacancies to other health care provider vacancies at FQHCs.
Date: 12 / 2005
Family Physician Vacancies in Federally Funded Health Centers
Sponsoring organization: WWAMI Rural Health Research Center
Presents results for family physicians from a study of staffing needs at Federally Qualified Health Centers (FQHCs). Provides information on family physician vacancy rates by rural and urban location. Compares family physician vacancies to other physician vacancies at FQHCs.
Date: 11 / 2005
Federally Qualified Health Center Fact Sheet
Sponsoring organization: Centers for Medicare & Medicaid Services
A general summary about FQHCs that includes a list of helpful rural health websites.
Date: 03 / 2007
Fundamentals of Community Health Centers
Author(s): Jessamy Taylor
Sponsoring organization: National Health Policy Forum
Describes the history of the community health center (CHC) program. Discusses policy issues influencing health centers, such as Medicaid payment policies and medically underserved area designations. Also discusses recent efforts to expand the CHC program.
Date: 08 / 2004
Health Center Expansion and Recruitment Survey 2004: Results by Health and Human Services Regions and Health Center Geography
Author(s): C. Holly A. Andrilla, L. Gary Hart
Sponsoring organization: WWAMI Rural Health Research Center
Reports findings from the national study of health centers staffing, recruitment and retention. Provides information by HHS region, urban and rural geography, and national overall estimates. Includes 118 graphs of selected survey results.
Date: 03 / 2007
Health Center Program Expectations (PIN 98-23)
Sponsoring organization: Bureau of Primary Health Care
Describes the Bureau of Primary Health Care's expectations for all health center programs covered under Section 330 of the Public Health Service Act as amended by the Health Centers Consolidation Act of 1996.
(P.L. 104-299).
Date: 08 / 1998
Health Centers and Rural Clinics: State and Federal Implementation Issues for Medicaid's New Payment System
Sponsoring organization: Government Accountability Office
Reviews states' implementation of
the prospective payment
system (PPS) for Medicaid
payments to Federally Qualified
Health Centers (FQHCs) and Rural
Health Clinics (RHCs). Includes recommendations for CMS on guidance and oversight for states.
Date: 06 / 2005
Health Centers as Safety Net Providers: An Overview and Assessment of Medicaid's Role
Author(s): Sara Rosenbaum, Peter Shin
Sponsoring organization: Kaiser Family Foundation
Policy brief on health centers and the role they play as providers of care. Also discusses relationship between health centers and Medicaid.
Date: 05 / 2003
Health Centers: Competition for Grants Has Grown and Efforts to Measure Performance Have Increased
Sponsoring organization: Government Accountability Office
Overview of how Federally Qualified Health Center (FQHC) grants are awarded and how FQHCs are monitored under the federal Consolidated Health Centers program.
Date: 08 / 2005
Health Professional Shortage Areas: Problems Remain With Primary Care Shortage Area Designation System
Sponsoring organization: Government Accountability Office
Reviews the number and location of Health Professional Shortage Areas (HPSAs) and federal programs that use HPSA designations to allocate resources or provide benefits. Discusses available research on HPSA designation criteria and methodology. Addresses the impact of a 2002 provision that automatically designates federally qualified health centers (FQHCs) and certain rural health clinics (RHCs) as facility HPSAs.
Date: 10 / 2006
HRSA Grants
Sponsoring organization: Health Resources and Services Administration
HRSA's competitive grant offerings for the current fiscal year. Also known as the HRSA Preview.
Medicare Advantage Organizations Offering PFFS Plans: Payment of Rural Health Clinics and Federally Qualified Health Centers
Sponsoring organization: Centers for Medicare & Medicaid Services
Clarification of CMS payment requirements to Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) under private fee-for-service (PFFS) plans.
Date: 09 / 2007
Medicare Benefit Policy Manual: Chapter 13 - Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services
Sponsoring organization: Centers for Medicare & Medicaid Services
Provides definitions of the Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) programs. Includes definitions of physician services and other services.
Medicare Billing Information for Rural Providers, Suppliers, and Physicians
Sponsoring organization: Centers for Medicare & Medicaid Services
Medicare rural billing charts for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), skilled nursing facilities, home health agencies, and Critical Access Hospitals (CAHs). Provides information on where to submit claims for different services.
Date: 05 / 2007
Medicare Claims Processing Manual: Chapter 9 - Rural Health Clinics / Federally Qualified Health Centers
Sponsoring organization: Centers for Medicare & Medicaid Services
Describes the differences between Rural Health Clinics and Federally Qualified Health Centers. Identifies the rules and regulations for processing Medicare claims.
Public Health Service Act, Section 330
Section 330 of the Public Health Service (PHS) Act defines the requirements for Health Centers. Title 42 of the U.S. Code, Chapter 6A is the Public Health Service Act, and
section 254b is the equivalent of Section 330 of the PHS Act.
Registered Nurse Vacancies in Federally Funded Health Centers: Project Summary
Sponsoring organization: WWAMI Rural Health Research Center
Discusses the registered nurse (RN) vacancy rate in federally funded health centers, which varies by degree of rurality.
Date: 12 / 2006
Results of the 2004 Health Center Expansion and Recruitment Survey for Health Centers: Analyses for Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI States)
Author(s): C. Holly A. Andrilla, L. Gary Hart
Sponsoring organization: WWAMI Rural Health Research Center
Presents a subset of the findings from
the larger national study of Federally Qualified Health Center (FQHC) staffing needs of FQHCs located in Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) overall and by urban and rural geography.
Date: 11 / 2006
Shortages of Medical Personnel at Community Health Centers
Author(s): Roger A. Rosenblatt, C. Holly A. Andrilla, Thomas Curtin, L. Gary Hart
Discusses staffing shortages at Community Health Centers (CHCs) in rural and urban locations and how these workforce shortages may impact efforts to expand the CHC program.
Journal citation: JAMA: The Journal of the American Medical Association Volume 295 Issue 9 Pages: 1042-1049
Date: 03 / 2006
Social Security Act, Section 1832 (a)(2)(D): Scope of Benefits
This section of the Social Security Act lists Rural Health Clinic and Federally Qualified Health Center services as within the scope of benefits.
Social Security Act, Section 1861 (aa): Rural Health Clinic Services and Federally Qualified Health Center Services
Rural Health Clinic Services and Federally Qualified Health Center Services as defined in the Social Security Act. Scroll down to section (aa).
Social Security Act, Section 1902 (bb): State Plans for Medical Assistance
Part (bb) covers state plan requirements for payment for services for Rural Health Clinics and Federally Qualified Health Centers.
Social Security Act, Section 1905 (l): Definitions for RHCs and FQHCs
Definitions of terms used in the Social Security Act related to Rural Health Clinics and Federally Qualified Health Centers.
State Medicaid Manual, Part 4, section 4231: Services, Federally Qualified Health Centers and Other Ambulatory Services
Sponsoring organization: Centers for Medicare & Medicaid Services
Medicaid coverage for federally qualified health center (FQHC) services and qualifications for FQHC status.
Organizations
Bureau of Health Professions
Federal government
Works to assure access to quality health care professionals in all geographic areas and to all segments of society. Part of the Health Resources and Services Administration (HRSA), U.S. Department of Health & Human Services.
Bureau of Primary Health Care (BPHC)
Federal government
Supports access to primary care services. Part of the Health Resources and Services Administration (HRSA), U.S. Department of Health & Human Services.
Centers for Medicare & Medicaid Services (CMS)
Federal government
Runs the Medicare and Medicaid programs - two national health care programs that benefit about 75 million Americans. Part of the U.S. Department of Health and Human Services.
National Association of Community Health Centers (NACHC)
National organization
Provides services and technical assistance to community, migrant, and homeless health centers.
National Health Service Corps (NHSC)
Federal government
Works to improve the health of the underserved by recruiting and retaining the health professionals to deliver health care in underserved communities. Provides technical assistance to federally designated Health Professional Shortage Areas (HPSAs) on projects that enhance the NHSC's site development mission. Part of the Bureau of Health Professionals, Health Resources and Services Administration.
Terms & Acronyms
340B Drug Pricing Program Program that allows qualified entities, such as FQHCs, to purchase prescription and non-prescription medications for their outpatients at reduced cost. Based on Section 340B of Public Law 102-585, the Veterans Health Care Act of 1992.
CMS (Centers for Medicare and Medicaid Services) Federal agency responsible for the Medicare and Medicaid programs. Part of the U.S. Department of Health & Human Services.
Federal Tort Claims Act (FTCA) Provides compensation for people who suffer personal injury due to negligent or wrongful action by federal employees. Replaces need for malpractice coverage for federal health care providers, including federally qualified health centers.
Federally Qualified Health Center (FQHC) FQHCs include all organizations receiving grants under section 330 of the Public Health Service Act, certain tribal organizations, and FQHC Look-Alikes. FQHCs benefit from enhanced reimbursement from Medicare and Medicaid under the prospective payment system.
FQHC Look-Alike Meets all requirements for federal FQHC grant funding but has not received a grant. Look-alikes share many but not all the benefits of FQHC status.
Medically Underserved Area (MUA) Medically Underserved Areas (MUAs) are federal designations derived from the Index of Medical Underservice (IMU). This index ranges from 0 to 100 and is based on four criteria: 1) ratio of primary medical care physicians per 1,000 people, 2) infant mortality rate, 3) percent of the population with incomes below the poverty level and 4) the percent of the population age 65 or older. An IMU of 62.0 or less qualifies an area to be designated a MUA. Geographic areas designated as MUAs can be a whole county or a group of contiguous (adjoining) counties, minor civil divisions (MCD), census county divisions (CCD) or census tracts.
Medically Underserved Population (MUP) A federal designation that is derived by using the Index of Medical Underservice (IMU). This index ranges from 0 to 100 and is based on four criteria: 1) ratio of primary medical care physicians per 1,000 people, 2) infant mortality rate, 3) percent of the population with incomes below the poverty level and 4) the percent of the population age 65 or older.
Medicare Administrative Contractor (MAC) Will replace the current Medicare fiscal intermediaries and carriers and handle administration of both the Medicare Part A and Part B programs in specified geographic regions.
PHS 330 grantees Grant recipients under the Public Health Service Act Section 330, which includes Community Health Centers (CHC), Migrant Health Centers (MHC), Health Care for the Homeless (HCH), Public Housing Primary Care (PHPC), and Healthy Schools, Healthy Communities (HSHC).
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