FQHCs and FQHC Look-alikes: A Sustainable Business Model for RW Part C Programs

Rebecca M. Johnson, MNPL Mark Meye, CPA Presenters: Rebecca M. Johnson, MNPL Mark Meye, CPA

Community Link Consulting Your knowledgeable resource in all things FQHC www.communitylinkconsulting.org

New Access Point, Service Area Competition Budget Period Renewal Ryan White Grants & Program Support FQHC and Look-alike Grantee Support & Services  Financial Management Cost Reporting, UDS, FFR Fee Schedule Review Corporate Compliance / Compliance Reporting Management / Staff / Board Training Strategic Planning Residency Development IT Infrastructure Development and Support

Who’s in the room?

RW Reauthorization Uncertainty Why now? Affordable Care Act RW Reauthorization Uncertainty Changes in HIV Disease

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

Ultimate Goal… 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

1. Reach Medically Underserved Communities 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 Impact: CHCs reflect the needs of the communities they serve.

3. Treat Patients Regardless of Ability to Pay Impact: Community Health Centers (CHCs) are the primary care safety net for the uninsured.

4. Provide a Comprehensive Scope of Services 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 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 National Service Corps Enhanced Medicaid/Medicare Rates 340 B Pharmacy Access

Program Requirements: Comprehensive primary care (directly or contract) After hours care Wrap around “enabling” services Robust QI Program

System Requirements: Ability to bill third party payors Medicaid and Medicare electronic billing Financial management policies/procedures

Shared Compliance Requirements: Annual Uniform Data Set (UDS) Report (similar to RDR/RSR) Grant Cycles (similar to Part C) Cost Reports Financial Audit (A-133)

Financial Model Revenue Expense Net

SF424A Personnel Fringe Travel Supplies Equipment Contractual Other Expense SF424A Personnel Fringe Travel Supplies Equipment Contractual Other

Typically 80% Buckets (i.e., programs) Staffing Ratio Expectations Personnel Typically 80% Buckets (i.e., programs) Staffing Ratio Expectations

Revenue Non-Program Revenue Program Income Grants Contracts Donations/Fundraising Other (interest, meaningful use) Program Income

Program Income Enhanced Reimbursement Rates Access to Prospective Payment System - wrap payment for Medicaid Cost-based reimbursement for Medicaid and Medicare

Medicaid Rate Setting Year Medicaid – not intuitive Impact – long term and potentially detrimental

340B Pharmacy Discount drug pricing program requires drug manufacturers to provide outpatient drugs to covered entities at a reduced price

Benefits of 340B Program 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 Typically tied to payroll No Double Dipping - Charge only one grant

Applying for FQHC Grants Needs Assessment Services – Required and Optional Business Plan Governance

Rebecca M. Johnson, MNPL Health Center Solutions, Inc Rebecca M. Johnson, MNPL Health Center Solutions, Inc. 360-319-1429 Rebecca@healthcentersoluitons.com Mark Meye, CPA