About Federally Qualified Health Centers
Programs Authorized under the Health Centers Consolidation Act:
Federally Qualified Health Centers (FQHCs) are reimbursed on a per visit basis for Medicaid services under a Prospective Payment System (PPS). The PPS per visit rate is an all-inclusive, provider specific rate initially established from an average of the 1999 and 2000 finalized Medicaid cost reports. The state average for FQHCs' Medicaid PPS rate in October 2003 was $106.00. Medicaid PPS rates are adjusted annually based on the Medical Economic Index (MEI).
FQHCs are reimbursed on an all-inclusive rate per covered visit basis for Medicare. In Federal Fiscal Year 2004, the per visit limit for rural FQHCs is $89.06 and $103.58 for urban FQHCs. The Medicare all-inclusive rate is adjusted annually based on the MEI.
CHCs are staffed by primary care physicians (family practitioners, general internists, general practitioners, obstetricians/gynecologists, pediatricians), dentists, physician assistants, nurse practitioners, nurse midwives, and support staff.
Basic Eligibility Criteria
1) The required primary health services of the center will be available and accessible in the catchment area of the center promptly, as appropriate, and in a manner which assures continuity;
2) The center has made and will continue to make every reasonable effort to establish and maintain collaborative relationships with other health care providers in the catchment area of the center;
3) The center will have an ongoing quality improvement system that includes clinical services and management, and that maintains the confidentiality of patient records;
4) The center will demonstrate its financial responsibility by the use of such accounting procedures and other requirements as may be prescribed by the Secretary;
5) The center--
a) Has or will have a contractual or other arrangement with the agency of the State, in which it provides services, which administers or supervises the administrations of a State plan approved under title XIX of the Social Security Act for the payment of all or a part of the center's costs in providing health services to persons who are eligible for medical assistance under such a State plan; or
b) Has made or will make every reasonable effort to enter into such an arrangement;
6) The center has made or will make and will continue to make every reasonable effort to collect appropriate reimbursement for its costs in providing health services to persons who are entitled to insurance benefits under title XVIII of the Social Security Act, to medical assistance under a State plan approved under title XIX of such Act, or to assistance for medical expenses under any other public assistance program or private health insurance program;
7) The center--
a) Has prepared a schedule of fees or payments for the provision of its services consistent with locally prevailing rates or charges and designed to cover its reasonable costs of operation and has prepared a corresponding schedule of discounts to be applied to the payment of such fees or payments, which discounts are adjusted on the basis of the patient's ability to pay;
b) Has made and will continue to make every reasonable effort-
8) The center has established a governing board which-
a) Is composed of individuals, a majority of whom are being served by the center and who, as a group, represent the individuals being served by the center;
b) Meets at least once a month, selects the services to be provided by the center, schedules the hours during which such services will be provided, approves the center's annual budget, approves the selection of a director for the center, and establishes general policies for the center;
9) The center has developed an ongoing referral relationship with one or more hospitals
Scope of Services
1) Basic Health Services
a) Health services related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology that are furnished by physicians and where appropriate, physician assistants, nurse practitioners, and nurse midwives;
b) Diagnostic laboratory and radiologic services;
c) Preventive health services, including -
d) Emergency medical services;
e) Pharmaceutical services as may be appropriate for particular centers
2) Referrals to providers of medical services and other health-related services (including substance abuse and mental health services);
3) Patient case management services (including counseling, referral, and follow-up services) and other services designed to assist health center patients in establishing eligibility for and gaining access to Federal, State, and local programs that provide or financially support the provision of medical, social, educational, or other related services;
4) Services that enable individuals to use the services of the health center (including outreach and transportation services and, if a substantial number of the individuals in the population served by a center are of limited English-speaking ability, the services of appropriate personnel fluent in the language spoken by a predominant number of such individuals);
5) Education of patients and the general population served by the health center regarding the availability and proper use of health services
For More Information:For more information, contact Dorie Tschudy at firstname.lastname@example.org or 225.342.1583.