|FQHCs: FREQUENTLY ASKED QUESTIONS|
1. What is the section 330 Community Health Centers Program (federally qualified health center-FQHC)?
The section 330 Consolidated Health Centers Program is a program of grant support authorized under section 330 of the Public Health Service Act (PHSA). The Bureau of Primary Health Care (BPHC) within the Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS), manages the program. The Health Centers Consolidation Act of 1996 combined several health center programs into a single Act and is now authorized under section 330. Other sections of the Act provide support for primary care services to migrant and seasonal farm workers (330g) the homeless (330h) and residents of public housing (330i). But the largest section provides support through section 330(e) to community health centers (CHCs) that provide services to the underserved throughout the community, including the uninsured and low-income populations, regardless of ability to pay. An application can include a combination of any of the types of CHC including school-based health centers (330e).
2. What is a Federally Qualified Health Center Look-Alike?
An FQHC Look-Alike is an organization that meets all of the eligibility requirements of an organization that receives a PHS Section 330 grant, but does not receive grant funding or Federal Torts Claims Act (FTCA) provider liability coverage.
3. Who is eligible to apply for section 330 CHC funding?
Any public or non-profit private entity may apply for section 330 CHC funds.
4. Where must we locate or whom must we serve to qualify for section 330 CHC funds?
By law, section 330 CHCs must serve a federally designated Medically Underserved Area (MUA) or Medically Underserved Population (MUP). The Bureau of Health Professions (BHPr) designates MUAs and MUPs using criteria published in the Federal Register including the medical provider to population ratio and the rate of low infant birth weights. A designation can be granted for an entire geographic area or for a population with specific circumstances within the geographic area, e.g. the homeless, the low income, or migrant/seasonal farm workers. The Primary Care Office (PCO) at the New Jersey Department of Health and Senior Services (DHSS) can help develop a request for MUA or MUP designation if your area or population is not currently designated. A list of currently designated MUAs and MUPs is found at http://www.hrsa.gov/shortage/find.html
5. Is a board of directors required?
Yes, FQHCs must be governed by a board of directors. The board must include a majority (at least 51%) of active, registered clients of the health center who are representative of the populations served by the center. The governing board ensures that the center is community-based and responsive to the community’s health care needs.
6. What services must a section 330 CHC provide?
By law, a section 330 CHC must, at a minimum, provide the following primary care services:
1) Physician and mid-level practitioner services related to family medicine, internal medicine, and pediatrics, obstetrics and gynecology;
2) Diagnostic laboratory and radiology services;
3) Preventive health services including prenatal and perinatal services; screening for cancer, high blood levels, communicable diseases and cholesterol; well-child services and immunizations; pediatric eye, ear, and dental screenings; voluntary family planning services; and preventive dental services;
4) Emergency medical services;
5) Pharmaceutical services as appropriate for particular centers;
6) Referrals to medical, substance abuse, mental health and other health-related providers;
7) Case management (counseling, referral, and follow-up) and services to assist patients establish coverage for Federal, State, and local programs of support for medical, social, housing, educational, or related services;
8) Outreach, transportation, appropriate interpretation/translation and other services that enable patients to use the services of the health center; and patient and community education on availability and proper use of CHC services.
7. Are there special staffing requirements for FQHCs?
No, there are no specific requirements for staffing mix at FQHCs. FQHCs are required to have a core staff of full time providers but there is no specific definition of core staff. It is recommended that they maintain a staffing level that allows for between 4,200-6,000 visits per year for each full-time equivalent health care provider. Another guide to the appropriate number of providers is described in the current Public Information Notice (PIN), such as a physician to patient ratio of 1:1,500 and a midlevel practitioner to patient ratio of 1:750. Additional information about staffing and other requirements is available in the Health Center Program Site Visit Guide, page 6.
8. Is there a minimum community size to qualify for section 330 CHC funds?
Not specifically, however, section 330 health centers are expected to have no, or limited, excess capacity. Experience with over 850 section 330 CHCs shows that communities of less than about 2,000 persons are not able to provide the full range of services and meet the requirements to be a section 330 CHC without extraordinary cost and significant excess capacity. Urban section 330 health centers generally have at least 5 medical providers and rural section 330 CHCs generally have at least 3 medical providers.
Experience also shows that communities of less than about 2,000 persons are best served as part of a larger organization with a central administration. Often this is as a satellite of a larger section 330 CHC with all required services and linkages in place. In a rural area with a small population, this could mean contracting with a larger section 300 CHC to serve the total population of the smaller community. When determining the size of a community, BPHC looks at the total underserved community.
9. Are there minimum hours that an FQHC must be open?
Yes, 32 hours per week is the minimum. FQHCs must also have professional call coverage when the practice is closed, directly or through an after-hours care system. For more information please see the Health Center Program Site Visit Guide, page 9.”
10. Who is eligible for services at a section 330 CHC?
A section 330 CHC must target services to meet the primary care needs of the entire community including all age groups, genders and ethnicities. Although section 330 CHCs should specifically target those with the greatest need, they may not provide services to any group on a preferential basis or define a subset of the community as “their community” even if only a part of the population is designated as an MUP.
A section 330 CHC must have a plan and make arrangements to deliver services, to the extent practicable, in the language and cultural context most appropriate to its patient population groups. This may mean designing multiple service delivery strategies when serving a multi-racial, multi-lingual or multi-cultural community. If your organization is not ready to target the total community population, it is not appropriate for you to consider this joint funding opportunity at this time.
11. How can section 330 CHC funds help provide services to the underserved?
By law, a section 330 CHC must implement a) a cost-based fee schedule and b) a schedule of discounts to be applied to the fee schedule. The discount schedule adjusts the amount for which the patient is actually responsible based on family size and income. The section 330 CHC funds are used to cover the part of the fee for which the patient is not responsible because the discount schedule is applied. The discount schedule must provide for a) full discount to those below 100% of the Federal poverty level, and b) full charges to those at or above 200% of the Federal poverty level. For consistency with reporting requirements, section 330 CHCs most often use divisions at 100%, 125%, 150%, 175%, and 200% of the Federal poverty level. The discount schedule must be applied equally to all patients.
12. What are the benefits of being an FQHC?
There are many benefits of being an FQHC. For FQHCs that are PHS 330 grant recipients, the biggest benefit is the grant funding. For new starts, funding up to $650,000 can be requested. Other benefits include:
13. What are the reporting requirements for the section 330 program?
There are two groups of reporting requirements: program reporting and grants management reporting. The first program report is the annual Uniform Data System (UDS) report. This report includes selected financial, utilization, and clinical information and is used by BPHC to assess the effectiveness of the section 330 program, report to Congress and justify the use of the appropriation of funds. The second program report is the annual application; it includes both a summary of progress to date and a projection of the budget and plan for the use of next year’s funds. The grants management reports are those required by the Payment Management System for disbursement of and accountability for Federal funds. Special, though infrequent, reports may be required if specific issues are raised.
14. How do I apply for section 330 CHC funds?
Applicants for funds to establish a new access point (NAP) can request up to $650,000 per year for operating costs including costs associated with subsidizing low income patients who are expected to pay only part of the cost of service. However, the amount of money that will be awarded is dependent on several factors such as service population, current operating budget and proposed services.
Applying for section 330 CHC funds is a highly competitive process. Applications are accepted throughout the year but there are cut-off dates for applications to be reviewed in given cycles. The applications are reviewed by non-Federal objective reviewers and ranked according to the criteria stated in the program announcement. Following this review, BPHC considers other factors (e.g. urban/rural and geographic distribution), applies the preference factors stated in the program announcement and makes the final funding decisions.
15. How can I get help to develop an application for section 330 CHC support?
Applicants are encouraged to submit a Letter of Interest (LOI) to BPHC as soon as it begins considering an application for Federal support of a new access point. The submission of an LOI is recommended but not required. Past history has shown that applicants benefited from the feedback provided through the LOI process. BPHC uses the LOI process to provide feedback to the organization to improve the quality of the application. Through this process, BPHC will examine whether the proposal is consistent with the objectives of the Consolidated Health Center Program, demonstrates readiness to initiate the project and assures the completeness of the need for assistance data. For more information about what to include in an LOI, please review the application Guidelines. It is also recommended that a copy of the LOI be sent to the New Jersey Primary Care Association (NJPCA) and the Primary Care Office (PCO) of NJDHSS. After an LOI is submitted and feedback is provided, applicants are encouraged to work with their PCA and the Primary Care Office, DHSS to develop the strongest possible application for funding.
If you need further information, please visit the HRSA website to access proposal and guidance materials at www.bphc.hrsa.gov.