1. Federally Qualified Health Center Look-Alike Application Instructions for Calendar Year 2011/2012 Renewal of Designation and Annual Certification Applications

2. Call Overview FQHC Definition, Benefits, and Eligibility Application Types, Components, and Content Overview Application Submission Information Review Timelines Tips for Preparing a Successful Application Technical Assistance Resources 2

3. What is an FQHC? Medicare and Medicaid statutes define a provider type: “Federally Qualified Health Center” (FQHC) –Respectively, Social Security Act §1861(aa)(4) and §1905(l)(2)(B) Entity that receives a grant under section 330 of the Public Health Service Act – Health Center Program. Entity that is determined by DHHS to meet requirements to receive funding without actually receiving a grant (i.e., FQHC Look-Alike). Entities that are outpatient health programs or facilities operated by a tribe or tribal organization under the Indian Self-Determination Act or by an Indian organization receiving funds under Title V of the Indian Health Care Improvement Act. 3

4. Fundamental Principles Private non-profit or public entities that serve a high- need community or population Governed by a community board of which at least a majority are health center patients who represent the patient population served Provide comprehensive primary care and enabling and supporting services Services are available to all, with fees adjusted based upon ability to pay Meet all performance and accountability requirements for administrative, clinical, and financial operations 4

5. Benefits BenefitHealth Center Grantees FQHC Look- Alikes Grant fundingYESNO Eligible for Medicaid Prospective Payment System (PPS) YES Eligible for Medicare cost-based reimbursement YES Access to 340B drug pricingYES Eligible for Federal Tort Claims Act medical malpractice insurance YESNO Automatic Health Professional Shortage Area (HPSA) Designation YES Vaccines for ChildrenYES Eligible for supplemental HRSA funding (PCMH, capital investments, HIT incentive payments) YESNO 5

6. Eligibility Must be a private, charitable, tax-exempt nonprofit organization, OR public entity Must serve a medically underserved area (MUA) or medically underserved population (MUP) designated by DHHS Must NOT be owned, controlled, or operated by another entity Must be operational and providing primary care services at the time of application submission 6

7. FQHC Look-Alike Application Types Application TypeDescription Initial DesignationComprehensive application required for organizations seeking initial FQHC Look-Alike designation Renewal of DesignationComprehensive application required for existing Look-Alike organizations to renew their FQHC Look-Alike designation after an initial two-year designation period, and thereafter, typically every five-years Annual CertificationAn annual program update submitted by existing FQHC Look-Alikes 7

8. Application Components Program Narrative Forms Attachments 8

9. Program Narrative Need Response Collaboration (New!) Evaluative Measures Impact (Annual Certification application only) Resources/Capabilities Governance 9

10. Forms Renewal of Designation Application ContentType Cover PageForm Form 1A: General Information WorksheetForm Table of ContentsDocument Project AbstractDocument Project NarrativeDocument Clinical Performance MeasuresForm Financial Performance MeasuresForm Form 2: Staffing ProfileForm Form 3: Income Analysis FormDocument Form 3A: FQHC Look-Alike Budget (New!)Form Form 4: Community CharacteristicsForm Form 5A: Services ProvidedForm Form 5B: Service SitesForm Form 5C: Other Activities/Locations (As Applicable)Form Form 6A: Current Board Member CharacteristicsForm Form 6B: Request for Waiver of Governance RequirementsForm Form 8: Health Center AgreementsForm Form 9: Need for Assistance (New!)Form Form 10: Annual Emergency Preparedness and Management ReportForm Form 12: Contacts InformationForm 10

11. Forms Annual Certification Application ContentType Cover Page (Required)Form Project Abstract (Required)Document Project Narrative (Required)Document Clinical Performance Measures (Required)Form Financial Performance Measures (Required)Form Form 1A: General Information Worksheet (Required)Form Form 2: Staffing Profile (Required)Form Form 3: Income Analysis Form (RequiredDocument Form 3A: FQHC Look-Alike Budget (New!)Form Form 5A: Services Provided (Read Only)Form Form 5B: Service Sites (Read Only)Form Form 5C: Other Activities/Locations (Read Only)Form Form 6A: Current Board Member Characteristics (Required)Form Form 8: Health Center Agreements (As Applicable)Form Form 10: Annual Emergency Preparedness and Management Report (Required)Form Form 12: Contacts Information (Required)Form 11

12. Attachments Renewal of Designation Application ContentType Attachment 1: Service Area MapDocument Attachment 2: Current or Requested MUA/MUP DesignationDocument Attachment 3: Governing Board BylawsDocument Attachment 4: Co-Applicant Agreement for Public Centers (As Applicable)Document Attachment 5: Affiliation, Contract, and/or Referral Agreements (As Applicable)Document Attachment 6: Articles of IncorporationDocument Attachment 7: Evidence of Non-Profit or Public Agency StatusDocument Attachment 8: Medicare and Medicaid Provider DocumentationDocument Attachment 9: Organizational ChartDocument Attachment 10: Position Descriptions for Key PersonnelDocument Attachment 11: Resumes for Key PersonnelDocument Attachment 12: Schedule of Discounts/Sliding Fee ScaleDocument Attachment 13: Most Recent Independent Financial AuditDocument Attachment 14: Letters of SupportDocument Attachment 15: Floor PlansDocument Attachment 16: Other InformationDocument 12

13. Attachments Annual Certification Application ContentType Attachment 1: Service Area MapDocument Attachment 2: Governing Board Bylaws (As Applicable)Document Attachment 3: Affiliation, Contract, and/or Referral Agreements (As Applicable) Document Attachment 4: Organizational Chart (As Applicable)Document Attachment 5: Position Descriptions for Key Personnel (As Applicable) Document Attachment 6: Resumes for Key Personnel (As Applicable)Document Attachment 7: Other Information (As Applicable)Document 13

14. Key Differences Between PIN 2009-06 & the New Instructions All applications must be submitted through HRSA Electronic Handbooks (EHB). Renewal of Designation and Annual Certification applications will be submitted according to existing designation periods. Data will now be reported separately from the Annual Certification application through the Uniform Data System (UDS) in the EHB. This data will be reported on a calendar year (CY) basis. Data reported in the EHB will no longer be included in the Annual Certification application. 14

15. Key Differences Between PIN 2009-06 & the New Instructions Contracts for required services will be summarized in an attachment rather than attached in full, except for contracts that constitute a substantial scope of the project. A budget form (Form 3A) has been added to the application requirements. The Change in Scope process is unchanged from and can still be found in PIN 2009-06. 15

16. Application Submission RENEWAL OF DESIGNATION Applications must be submitted through the HRSA EHB –Refer to HRSA’s Electronic Submission User Guide, available online at http://bphc.hrsa.gov/about/lookalike/index.html for detailed application and submission instructions.http://bphc.hrsa.gov/about/lookalike/index.html Once the Renewal of Designation application process is started in the EHB system, it must be completed and submitted in a maximum of 90 calendar days. Applications that are ineligible or not completed within 90 days will not be considered for designation. Failure to submit the Renewal of Designation application could result in termination of the FQHC Look-Alike designation and all corresponding benefits. 16

17. Application Submission ANNUAL CERTIFICATION Applications must be submitted through the HRSA EHB –Refer to HRSA’s Electronic Submission User Guide, available online at http://bphc.hrsa.gov/about/lookalike/index.html for detailed application and submission instructions.http://bphc.hrsa.gov/about/lookalike/index.html Once the Annual Certification application process is started in the EHB system, it must be completed and submitted in a maximum of 60 calendar days. Applications that are ineligible or not completed within 60 days will not be considered for designation. Failure to submit the application could result in termination of the FQHC Look-Alike designation and all corresponding benefits. 17

18. Estimated Timelines Responsible Entity Step in Process Number of Days Applicant Development and submission of application once the application process has been initiated in the EHB. 90 HRSA Initial review of the application once received in EHB. 75 Applicant Response to any follow-up information requested by HRSA. 30 (unless otherwise specified by PO) HRSA HRSA review of applicant response to requested follow-up information. 30 CMSCMS review and approval process30 RENEWAL OF DESIGNATION APPLICATION 18

19. Estimated Timelines ANNUAL CERTIFICATION APPLICATION Responsible Entity Step in Process Number of Days Applicant Development and submission of application once the application process has been initiated in the EHB. 90 HRSA Initial review of the application once received in EHB. 75 Applicant Response to any follow-up information requested by HRSA. 30 (unless otherwise specified by PO) HRSA HRSA review of applicant response to requested follow-up information. 30 CMSCMS review and approval process30 19

20. Preparing for a Successful Application Perform a thorough needs assessment early Request technical assistance from your PCA/PCO or other experienced health centers Ensure that the organization is operating in full compliance with each program requirement, including active involvement and oversight of a governing board Ensure that all application forms, attachments, and program narrative provide consistent information 20

21. Key Resources for Application Development FQHC Look-Alike Application Instructions 2011-2012 and EHB System User Guides: http://bphc.hrsa.gov/about/lookalike/index.html http://bphc.hrsa.gov/about/lookalike/index.html Service Area Overlap: Policy and Process (PIN 2007- 09) for guidance on preparing a service area overlap analysis Health Center Program Requirements: http://bphc.hrsa.gov/about/requirements/index.html http://bphc.hrsa.gov/about/requirements/index.html FQHC Look-Alike Application Resources document under “Application Help” on the TA page 21

22. Technical Assistance Program Contacts: –Jennifer Joseph; Chief, Strategic Operations Branch –Nicole Amado; Public Health Analyst –Telephone: 301-594-4300 –Email: FQHCLAL@hrsa.govFQHCLAL@hrsa.gov Look-Alike Program TA Webpage: –http://bphc.hrsa.gov/about/lookalike/index.htmlhttp://bphc.hrsa.gov/about/lookalike/index.html 22

23. Question & Answer Session 23