Services: Federally Qualified Health Center (FQHC)

The authorizing legislation for the Federally Qualified Health Center program uses the term “health center” to refer to four programs that receive federal funding under Section 330 of the Public Health Services Act, as amended by the Health Centers Consolidation Act of 1996 and the Safety Net Amendments of 2002.” The programs included under Section 330 are:

• Community Health Centers (Section 330(e))
• Migrant Health Centers (Section 330(g))
• Healthcare for the Homeless (Section 330(h))
• Public Housing Health Centers (Section 330(i))

In addition, the federal government recognizes an additional class of health centers that meet all of the statutory requirements for receiving a Section 330 grant but do not actually receive grant funding. These health centers are commonly referred to as FQHC “Look-Alikes.” The goal of the FQHC program is to maintain, expand and improve the availability and accessibility of essential primary and preventive health care services (and related enabling services) for low income, medically underserved and vulnerable populations that have traditionally had limited access to affordable services and face the greatest barriers to accessing care. In exchange for meeting rigorous federal requirements, FQHCs are entitled to a range of benefits including cost-based Medicaid and Medicare reimbursement, grants to offset the cost of caring for the uninsured (grantees only), and free federal tort protection (grantees only).

Health Management Associates (HMA) provides a wide array of services for Federally Qualified Health Centers (FQHCs), FQHC “Look-Alikes” and organizations interested in becoming an FQHC, including the following:

• FQHC feasibility studies. HMA frequently conducts analyses of FQHC feasibility and financial impact for organizations interested in becoming an FQHC or Look-Alike. Feasibility studies typically include an operational “gap analysis,” financial impact assessment, community needs assessment and an “environmental scan” for issues that may affect the success of an application.
  
  
• Hospital conversion financial analysis.  For hospitals that are considering converting or spinning off outpatient clinics to FQHCs, HMA can analyze the impact on hospital reimbursement, taking into account supplemental Medicaid payments, Disproportionate Share Hospital (DSH) payments, and payments for Graduate Medical Education (GME/IME). 
  
  
• Services for public entity FQHCs. HMA is uniquely qualified to help public entities, including public hospitals and health departments, evaluate the feasibility and impact of converting outpatient clinics to FQHCs. Federal guidelines are complex but afford substantial flexibility for public entities in the areas of human resources and finance/budget.
  
  
• Development of community-wide strategies for increasing access to primary care services. HMA frequently works with providers, payers, philanthropic organizations and other stake-holders to develop community-wide strategies to increase primary care access through the development of provider partnerships, the establishment of additional FQHC sites, operational changes and other mechanisms.
  
  
• Alternative reimbursement methodologies. HMA has worked with states and providers to design alternative FQHC payment methodologies that meet federal requirements, maximize reimbursement and create incentives for high-quality care. HMA can assist with both the reimbursement design as well as the federal approval process.
  
  
• Negotiating FQHC partnerships. HMA can assist hospitals and other entities in negotiating partnership arrangements with FQHCs that are consistent with the missions of both organizations and mutually beneficial. The knowledge of the financial outcomes of a partnership is necessary to negotiate successfully.
  
  
• Behavioral health integration. HMA can assist providers that are interested in integrating behavioral health services with FQHC primary care services. Services include, but are not limited to, identifying state regulatory and reimbursement barriers to integration and development of alternative reimbursement methodologies that create incentives for integration. HMA can also provide assistance to community mental health centers interested in becoming an FQHC, including analysis of risks and opportunities and development of revenue estimates, staffing and productivity scenarios.
  
  
• Community needs assessments. HMA is adept at completing community needs assessments in the format required by the Need for Assistance (NFA) worksheet on the federal FQHC application. HMA is familiar with the specific data sources and extrapolation methodologies required by the worksheet, as well as techniques for maximizing NFA point values.
  
  
• Designing and implementing quality improvement programs. HMA can assist with the design and implementation of quality improvement programs that are consistent with FQHC requirements and enhance quality of care and outcomes. 
  
  
• Space/architectural analyses. Working in conjunction with an architect subcontractor, HMA can assist FQHCs with space planning to ensure the most optimal and productive use of available space. HMA can also estimate and provide schematic drawings for building modifications, additions and new primary care facilities based on actual and projected patient volumes, service mix and client specifications.
  
  
• Drafting and/or reviewing FQHC, Look-Alike and federal Planning Grant applications. HMA can write and/or review federal applications for FQHC or Look Alike designation as well as planning grant applications. We are very familiar with application requirements as well as the unique features that can make an application “stand out.”