Occupancy Capabilities and Limitations of Federally Qualified Health Centers in Emergency Situations Jessica Yanow, MPH Director of Women’s Health Programs and Grant Administration

AACHC Mission: To promote and facilitate the development and delivery of affordable and accessible community-oriented, high quality, culturally effective primary healthcare for everyone in the state of Arizona. This will be accomplished through advocacy, education, and technical assistance.

AACHC Membership  35 Members  Members include: –16 Federally Qualified Health Centers (FQHCs) –1 FQHC Look-Alikes –2 Rural Health Centers –16 other community-based, primary care organizations 180+ clinical locations statewide

What is an FQHC? Entity that receives a grant under Section 330 of the Public Health Service Act – Health Center Program: -Community Health Center Program – Section 330(e) -Migrant Health Center Program – Section 330(g) -Health Care for the Homeless Program – Section 330(h) -Public Housing Primary Care Program – Section 330(i)

FQHC Requirements  Demonstrate Need in their Service Area  Medically Underserved Area (MUA) / Medically Underserved Population (MUP)  Provide Primary, Preventive, Enabling and Additional Health Services as Appropriate and Necessary  Accessible Hours of Operation  Sliding Fee Discounts  Collaborative Relationships with Other Health Care Providers  Collect and Report Data via Uniform Data System  Board / Governance Requirements

FQHC Services  Family Medicine  OB/GYN and Pediatrics  Dental  Family Planning  Behavioral Health  Immunizations  Pharmacy  Outreach  Health Education Programs  Eligibility Assistance  Prenatal Care  Transportation  Radiology  Translation  Disease Management  Referrals for Specialty Services  Physical Therapy

FQHCs in Arizona 384,287 Patients Served in Main FQHCs : 135 Clinical Sites

FQHCs and Emergency Preparedness: Things to know  Each is an independently operating business  Size of FQHCs vary widely  Staffing varies  EP activities required by HRSA and ADHS  Transportation resources vary (including mobile units)  Encouraged to develop mutual aid agreements –Personnel, equipment, supplies  Work in Progress –Hurricane Katrina

FQHCs and Emergency Preparedness: Scope of work  Primary care services  Special/Hard to Reach Populations  HRSA involvement  Services consistent with their approved scope of project

Federal Tort Claims Act (FTCA) The Federal Tort Claims Act is the statute by which the United States authorizes tort suits to be brought against itself. With exceptions, it makes the United States liable for injuries caused by the negligent or wrongful act or omission of any federal employee acting within the scope of his employment, in accordance with the law of the state where the act or omission occurred.

FTCA coverage and Emergencies within Service Area  Temporary locations are within the covered entity’s service area or neighboring counties, parishes, or other political subdivisions adjacent to the covered entity’s service area  Services provided by covered individuals are within the covered entity’s approved scope of project; and  All activities of covered individuals are conducted on behalf of the covered entity.

FTCA coverage outside service area  Prior approval from HRSA.  Demonstrate that the purpose of the temporary site is to provide services primarily to its original health center target population and that the population has been displaced by the emergency and that other displaced medically underserved populations may need their services as well;  Services provided are on a temporary basis;  Services are provided by covered individuals and are within the covered entity’s approved scope of project; and  All activities of covered individuals are conducted on behalf of the covered entity.

FTCA does not cover  Health center employees volunteering at other sites  Volunteers at FQHC  Health center employees conducting work outside their approved project scope either at their site or at an alternate site

Thoughts on working with FQHCs  Collaboration and clear identification of resources and capacities of the specific health center sites in your community  Understanding current scope of work and intent of FQHCs  Accepting that Emergency Prep is still a work in progress  Knowing patient population  FQHCs as a resource for worried well or primary care services

Questions? Jessica Yanow, MPH Director of Women’s Health Programs and Grant Administration