Federally Qualified Health Centers
According to the Centers for Medicare and Medicaid Services FQHCs are “safety net” providers such as community health centers, public housing centers, outpatient health programs funded by the Indian Health Service, and programs serving migrants and the homeless. The main purpose of the FQHC Program is to enhance the provision of primary care services in underserved urban and rural communities. FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. FQHCs must fall under one of the following categories:
There are many benefits of being an FQHC. For FQHCs that are PHS 330 grant recipients, the biggest benefit is the grant funding. For newly funded grantees, funding up to $650,000 can be requested. Other benefits include:
A 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. Look-alikes receive many of the same benefits as FQHCs, including:
Section 330 of the Public Health Service (PHS) Act defines the Federal Health Center Program as the funding opportunity for organizations to provide care to underserved populations. These include the following grant programs:
Full text of this document, Title 42 of the U.S. Code, Chapter 6A, Public Health Service Act, and section 254b, (the equivalent of Section 330) is available at the Legal Information Institute website.
No. A health center must be a public entity or a private non-profit.
Yes, health centers receiving Section 330 grants and look-alikes must be governed by a board of directors. The board must include a majority (at least 51%) of active, registered users 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.
Are there location requirements for FQHCs? It depends. Each FQHC that receives PHS 330 grant funding must meet the requirements of that grant. However, community health centers must serve a Medically Underserved Area (MUA) or Medically Underserved Population (MUP). To determine if your area qualifies, 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: email@example.com 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.
No, there are no specific requirements for staffing mix at health centers. Health Centers are required to have a core staff that is able to carry out the necessary functions of the health center. This will vary from health center to health center based on the needs of the community. 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. Additional information about staffing and other requirements is available in HRSA's Health Center Program Requirements.
Health Centers must provide primary care services for all age groups. Health Centers must provide preventive health services on site or by arrangement with another provider. Other requirements that must be provided directly by a health center or by arrangement with another provider include:
HRSA Health Center Programs (section 330 grantees or look-alikes) have no site-specific requirements on the number of hours that a particular site must be open. These health centers are required on an organizational level to provide services at times and locations that assure accessibility and meet the needs of the population to be served and to record their hours of operation in the current scope of project (as described on Form 5B). However, health centers may be subject to minimum hour requirements to receive certain FQHC and other benefits. For example, there are minimum hour requirements for providers to receive FTCA coverage, which is discussed in the FTCA Manual. As another example, there are minimum patient-care hour requirements for NHSC providers. Additionally, individual state Medicaid agencies, CMS, and private third party insurers may have their own policies regarding operational hours and schedules. Each health center is responsible for ensuring that they comply with the requirements of the benefit/third party payor programs they participate in.
Yes, health centers must use a sliding fee scale with discounts based on patient family size and income in accordance with federal poverty guidelines. Health centers must be open to all, regardless of their ability to pay. For more information, see HRSA's Health Center Program Requirements.
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 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 Administrative Contractors.
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. For information on the program requirements and application procedures please see: PIN 09-06, Federally Qualified Health Center Look-Alike Guidelines and Application.
The first step is to make sure your location or population served is eligible and that you have community support. Health centers 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.
Last Reviewed: 9/17/2013