COMMUNITY HEALTH CENTER ASSOCIATION OF CONNECTICUT FQHC 101 Connecticut Public Health Association Health Education Committee June 8, 2011 Presented by Jennifer Granger, MPH Chief Operating Officer Community Health Center Association of Connecticut (CHCACT) June 8, 2011

Federally Qualified Health Center 101  Of the Community  By the Community  For the Community

3 Terminology  CHC – Community Health Center  FQHC – Federally Qualified Health Center  FQHC Look-Alike

FQHC Introduction  Located in a high-need area (defined as MUA, MUP, HPSA)  Provide comprehensive primary care, provision or formal linkage to specialty, oral health and mental health services and supportive services (transportation, etc.)  Services available to all with charges based on ability to pay  Governance by community Board whose majority are users of FQHC  Meet all federal requirements regarding how they set up and run their practices

The FQHC Movement  1965:  First neighborhood health centers (NHCs) funded  Medicaid Program enacted (Title XIX)  1970’s:  150 health centers established  1980”s:  Under 1981 Omnibus Budget Reconciliation Act ( OBRA), 186 health centers defunded  Omnibus Budget Reconciliation Act of 1989 Made Federally Qualified Health Center (FQHC) services mandatory under Medicaid and Medicare Programs 5

Small beginnings…  1996: CHC Federal grant program authorized under Section 330 of the Health Centers Consolidation Act of 1996  1998:100% Access/0 Health Disparities  2001: President Bush’s Initiative to Expand Health Centers by providing 1,200 communities with new or expanded health centers by end of FY 2006 to:  Assure access for an additional 6 million people  630 new access points (new and existing grantees)  570 existing sites significantly expanded 6

Grow into great things!  2009 Nationally  ~1200+ grant-funded FQHC entities  ~8000 Delivery sites  >8440 physicians  >5000 nurse practitioners/physician assistants  ~7500 dentists and ~900 dental hygienists  Served 20 million people of whom 38% were uninsured 7

8 The Opportunity  Key “Safety Net” providers  Provide comprehensive primary and preventive care and related services  Serve nation’s most vulnerable, low-income, and uninsured persons living in medically underserved areas

9 FQHC Requirements Mission & Strategy  Public or nonprofit private entity  Organized and operated to provide comprehensive primary care services  Serves a “medically underserved population”  Population of an urban or rural area with a shortage of personal health services (MUA) or  Population group having a shortage of personal health services (MUP)  Serves low income, uninsured, minority and elderly persons  Ongoing quality assurance program 9

Sliding fee does not mean no fee  Services available to individuals regardless of ability to pay  Fee schedule and schedule of discounts  Government Program Provider: Medicaid, Medicare, Charter Oak, State Administered General Assistance (SAGA), Children’s Health Insurance Program (CHIP) 10

11 FQHC Requirements Governance  Governing board  Size = Minimum 9, Maximum 25  51% Majority users  Represents individuals and communities being served by center  No more than ½ of remaining members derive more than 10% of their annual income from health care industry  Remaining members representative of community and expertise in community affairs, local government, finance and banking, legal affairs, trade unions, other commercial and industrial concerns, social service agencies 11

12 FQHC Requirements Governance  Authority and oversight responsibility for health center  Establishes FQHC’s general policies (except public centers)  Selects services provided  Schedules service hours  Approves FQHC’s annual budget  Approves selection of FQHC’s director  Approves 330 grant application  Meets at least once/month 12

13 FQHC Requirements Clinical Program  Required primary health services:  Basic health services  Referrals for medical and other health-related services (including MH/SA and Dental)  Patient case management services and other assistive services  Enabling services  Patient and community education  Diagnostic laboratory and x-ray services, preventive health services  Needed pharmacy services either on-site or through firm arrangement 13

14 FQHC Requirements Clinical Program  Provision of services through:  Staff and supporting resources of center  Contracts or cooperative arrangements  Firm arrangements for after-hours clinical coverage  At least ½ of FTE primary care providers full-time members of staff 14

15 FQHC Benefits  Malpractice insurance through Federal Tort Claims Act  Recruitment and retention assistance  National Health Service Corps Program  Section 340b discount drug pricing program  Enhanced Medicaid and Medicare reimbursement  Joint Commission Accreditation Initiative  Accreditation survey at no direct cost to FQHCHC  NCQA Patient Centered Medical Home Recognition  PCMH Application at no direct cost to FQHC

16 FQHC Evolution in Connecticut  2011: 13 FQHCs and 1 FQHC Look-Alike  Charter Oak Health Center  CIFC Community Health Center of Greater Danbury  Community Health Center  Community Health and Wellness Center of Greater Torrington  Cornell Scott - Hill Health Center  Community Health Services  East Hartford Community HealthCare  Fair Haven Community Health Center  Generations Family Health Center  Norwalk Community Health Center  Optimus Health Care  Southwest Community Health Center  StayWell Health Center  United Community and Family Services [FQHC Look-Alike]

Growth of FQHCs in Connecticut  FY 2010 Federal CHC Program:  13 grant-funded FQHC entities and 1 FQHC Look Alike  >140 Delivery sites  >152 physicians  >145 nurse practitioners/physician assistants/CNMs  ~63 dentists and ~149 dental hygienists/assistants  Served 310,999 people of whom nearly 25% were uninsured and 57% are Medicaid 18

Community Health Center Association of Connecticut  Established in 1989  501(c) 3  Provide training and technical assistance to all FQHCs in CT regardless of member status  13 members  13 staff who oversee a wide variety of grants and programs: Clinical Quality, PCMH, HIT, Workforce Development, Outreach, Finance & Administration 19

Mission Statement CHCACT exists to enable Connecticut’s federally qualified health centers (FQHCs) to provide access to the highest quality health care and social services to Connecticut’s underserved populations. 20

Vision CHCACT will be recognized as the organization most qualified by its leadership, expertise and experience in addressing the issues of significance to all FQHCs and populations needing comprehensive health care. 21

Values  Collaboration: teamwork within the organization; productive partnerships; willingness to participate  Expertise: integration across programs and people; demonstrates breadth of knowledge; willingness to gain new knowledge  Integrity: demonstrates accuracy, consistency, honesty, and accountability  Responsiveness: internal and external communication that is timely and relevant to the need or demand  Social Equality: actions that promote social justice, further the mission of the FQHCs and advance cultural competency 22

Serving Many Masters Federal funders Health Resources and Services Administration (HRSA) Bureau of Primary Health Care (BPHC) HIV/AIDS Bureau (HAB) Bureau of Health Professions/National Health Service Corps Centers for Medicaid and Medicare (CMS) Agency for Healthcare Research and Quality State funders Department of Public Health (DPH) Department of Social Services (DSS) Private foundations Robert Wood Johnson Foundation Connecticut Health Foundation The Donaghue Foundation Universal Health Care Foundation 23

Community Health Care Alliance  The 13 members of CHCACT have joined together to form the Community Health Care Alliance  The Alliance is constitutes the largest provider of health care in Connecticut 24

Social Networking  Find the Community Health Care Alliance on your favorite social network facebook.com/CHCACT twitter.com/CTHealthCenters youtube.com/CHCACT 25

Contact Information Jennifer Granger, MPH, Chief Operating Officer CHCACT 375 Willard Ave. Newington, CT P F