FQHC
Frequently Asked Questions
Question: What is a Federally Qualified Health
Center (FQHC)?
Answer:
A federally qualified health center (FQHC) is a type of provider
defined by the Medicare and Medicaid statutes. FQHCs include
all organizations receiving grants under Section 330 of the
Public Health Service Act, certain tribal organizations, and
FQHC Look-Alikes. In the questions and answers that follow, we
will focus on the program requirements and benefits for FQHCs
receiving Section 330 grants and for FQHC Look-Alikes. Requirements
for Indian Health Service funded FQHCs may differ from the requirements
for FQHCs receiving Section 330 grants and for FQHC Look-Alikes.
Question: What is a Federally Qualified Health
Center Look-Alike?
Answer:
An FQHC Look-Alike is an organization that meets all of the eligibility
requirements of an organization that receives a PHS Section 330
grant, but does not receive grant funding.
Question: What is a PHS Section 330 grant?
Answer:
Section 330 of the Public Health Service Act defines federal grant
funding
opportunities for organizations to provide care to underserved populations.
Types of organizations that may receive 330 grants include: Community
Health Centers, Migrant Health Centers (see Migrant Health for more information), Health Care for the Homeless
Programs, and Public Housing Primary Care Programs.
Question: Where
can I find the text of PHS Section 330?
Answer:
The Public Health Service Act is part of the U.S. Code. Section 330
was the numbering for the health centers section when the Public Health
Services Act was a stand-alone document. The term "Section 330" is
still
used today. However, as part of the U.S. Code, it has been renumbered.
Title 42 of the U.S. Code, Chapter 6A is the Public Health Service Act, and
section 254b is the equivalent of Section 330. It is available online at
http://www4.law.cornell.edu/uscode/42/254b.html.
Question: Can a for-profit clinic be an FQHC?
Answer:
No. An FQHC must be a public entity or a private non-profit.
Question: Is a board of directors required?
Answer:
Yes, FQHCs receiving Section 330 grants and FQHC Look-Alikes must
be governed by a board of directors. The board must include a
majority (at least 51%) of active, registered clients of the
health center who are representative of the populations served
by the center. The governing board ensures that the center is
community based and responsive to the community’s health
care needs. Under certain conditions the board composition requirements can be waived for migrant, homeless, public housing only health centers.
Question: Are there location requirements for
FQHCs?
Answer:
It depends. Each FQHC that receives PHS 330 grant funding must meet
the requirements of that grant. Community Health Centers must serve
a Medically Underserved Area (MUA) or Medically Underserved Population
(MUP). To determine if your area qualifies, you can search the MUA/MUP
database. If an area does not have the MUA/MUP designation they can apply for it and can put in an application for a PHS Section 330 grant while the designation is being processed. For additional information regarding the MUA/MUP designation contact the Shortage Designation Branch: sdb@hrsa.gov or 1-888-275-4772. Press option 1, then option 2. Migrant Health Centers, Health Care for the Homeless
and Public Housing Primary Care Programs do not need to meet the
MUA/MUP restriction. FQHCs may be located in rural and urban areas.
Question: Are there special staffing requirements
for FQHCs?
Answer:
No, there are no specific requirements for staffing mix at FQHCs.
FQHCs are required to have a core staff of full time providers
but
there is no specific definition of core staff. It is recommended
that they maintain a staffing level that allows for between
4,200-6,000
visits per year for each full-time equivalent health care provider.
Another guide to the appropriate number of providers is described
in the
Requirements of Fiscal Year 2005 Funding Opportunity for Health Center New Access Point Grant Applications (PIN 2005-01) as a physician to patient
ratio of 1:1,500 and a midlevel practitioner to patient ratio
of
1:750. Additional information about staffing and other requirements is available in
Health Center Program Expectations (PIN 98-23).
Question: What types of services do FQHCs provide?
Answer:
FQHCs must provide primary care services for all age groups. FQHCs
must provide preventive health services on site or by arrangement
with another provider. Other requirements that must be provided
directly by an FQHC or by arrangement with another provider include:
dental services, mental health and substance abuse services, transportation
services necessary for adequate patient care, hospital and specialty
care. For more information, please see Health Center Program Expectations (PIN 98-23).
Question: Are there minimum hours that an FQHC
must be open?
Answer:
Yes, 32 hours per week is the minimum. FQHCs must also have professional
call coverage when the practice is closed, directly or through an
after hours care system. For more information, please see Health Center Program Expectations (PIN 98-23).
Question: Is a sliding fee scale required?
Answer:
Yes, FQHCs must use a sliding fee scale with discounts based on
patient family size and income in accordance with federal poverty
guidelines. FQHCs must be open to all, regardless of their ability
to pay. For more information, please see Health Center Program Expectations (PIN 98-23).
Question: What are the benefits of being an
FQHC?
Answer:
There are many benefits of being an FQHC. For FQHCs that are PHS
330 grant recipients, the biggest benefit is the grant funding.
For new starts, funding up to $650,000 can be requested. Other benefits
include:
- Enhanced Medicare and Medicaid reimbursement
- Medical malpractice coverage through the Federal Tort Claims
Act
- Eligibility to purchase prescription and non-prescription medications
for outpatients at reduced cost through the 340B
Drug Pricing Program
- Access to National Health
Service Corps
- Access to the Vaccine
for Children program
- Eligibility for various other federal grants and programs
Not all of these benefits are extended to FQHC
Look-Alikes. The funding for new starts - up to $650,000
- is not available to FQHC Look-Alikes.
Question: What
are the Medicare Administrative Contractors (MACs) and what is
their role in administering Medicare Part A and Part B?
Answer:
Section 911 of the Medicare Modernization Act of 2003 mandates
that the Secretary for Health & Human Services replace the
current contractors administering the Medicare Part A or Part
B fee-for-service programs with new Medicare Administrative Contractors
(MACs). Part A/Part B Medicare Administrative Contractors
(MACs) 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. For more information,
please see the CMS overview of Medicare
Contracting Reform.
Question: What are the benefits of being an
FQHC Look-Alike?
Answer:
FQHC Look-Alikes receive many of the same benefits as FQHCs, including:
- Enhanced Medicare and Medicaid reimbursement
- Eligibility to purchase prescription and non-prescription medications
for outpatients at reduced cost through the 340B
Drug Pricing Program
- Automatic designation as a Health Professional Shortage Area
(HPSA). The HPSA designation provides eligibility to
apply to receive National Health Service Corps (NHSC) personnel
and eligibility
to be a site where a J-1 visa physician can serve.
Look-Alikes, by definition, are not recipients of
PHS 330 grant funding. However, because they already meet the program
requirements for this grant funding, FQHC Look-Alikes are mature
applicants for PHS 330 funding.
Question: How do I get certified as an FQHC
or FQHC Look-Alike?
Answer:
Community Health Centers, Migrant Health Centers, Health Care for
the Homeless Programs, and Public Housing Primary Care Programs
that receive grant funding under section 330 of the PHS Act are
automatically certified as FQHCs.
Existing clinics that meet FQHC requirements can
request certification as FQHC Look-Alikes. Information on the program
requirements and application procedures are available: FQHC
Look-Alike Program. It is recommended
that an applicant submit a Letter of Interest (LOI)
to the Bureau of Primary Health Care as soon as it begins considering
applying for FQHC Look-Alike designation. For a description of
how to submit an LOI, please see section V of PIN
2003-21, Federally Qualified Health
Center Look-Alike Guidelines and Application.
Question: How do I apply for a Community Health
Center PHS 330 grant?
Answer:
The first step is to make sure your location or population served
is eligible and that you have community support. Community Health
Centers (CHCs) must serve a Medically Underserved Area or Population:
MUA/MUP database.
To determine community support, you may want to hold a meeting.
This will help you identify the people and groups who will be willing
to work with you on this project.
New Access Point funding opportunities for Section 330 grants
are posted on Grants.gov, when
available. The application guidance will include a description
of how applicants can submit a Letter of Interest (LOI)
to the Bureau of Primary Health Care.
Question: What other options are there for
providing primary care in rural areas?
Answer:
Some other options include the Rural Health Clinics
program and the Critical Access Hospitals program. See Options
for Supporting Primary Care for comparisons of these options.
Credits
