fqhcs and fqhc look-alikes: a sustainable business model for rw part c programs
TRANSCRIPT
FQHCs and FQHC Look-alikes: A Sustainable Business Model for RW Part C Programs
Presenters:
Rebecca M. Johnson, MNPLMark Meye, CPA
Community Link Consulting
Your knowledgeable resource in all things FQHC
www.communitylinkconsulting.org
New Access Point, Service Area CompetitionBudget Period RenewalRyan White Grants & Program SupportFQHC and Look-alike Grantee Support & Services Financial ManagementCost Reporting, UDS, FFRFee Schedule ReviewCorporate Compliance / Compliance ReportingManagement / Staff / Board TrainingStrategic PlanningResidency DevelopmentIT Infrastructure Development and Support
Who’s in the room?
Why now?
Affordable Care ActRW 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 Rates340 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
Expense
SF424APersonnelFringeTravelSuppliesEquipmentContractualOther
Personnel
Typically 80%
Buckets (i.e., programs)Staffing Ratio Expectations
Revenue
Non-Program RevenueGrantsContractsDonations/FundraisingOther (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 AssessmentServices – Required and OptionalBusiness PlanGovernance
Rebecca M. Johnson, MNPLHealth Center Solutions, Inc.
Mark Meye, CPA