Health Centers

Question 1

Lecture Objectives

Answer 1

1) be familiar with the Public Health Services Act and its relevance to Community Health Centers
2) to understand the function/missions, patient demographics, patient services, and revenue sources of a typical Health Center in addition to the various community benefits provided by Health Centers
3) to know the basic criteria/requirements that a health center must meet to be certified as a Federally Qualified Health Center (FQHC)
4) to understand the advantages of FQHC certification to include look-alike designation
5) to understand optometry’s current role in Community Health Centers to include advocacy efforts (such as National Health Services Corps eligibility) to increase optometry’s participation

Question 2

What is a Health Center?

Answer 2

non-profit public or private entities that serve designated medically underserved populations/areas or special medically underserved population; a primary care clinic that serves as a medical home for particular groups of patients

Question 3

Examples of Health Center?

Answer 3

Church Health (private) Christ Community (public)

Question 4

T/F Health Centers are community based and patient directed organizations

Answer 4

true

Question 5

What is one of the largest safety net systems of primary and preventive care in the country?

Answer 5

a Health Center (50% rural 50% urban)

Question 6

What is the Community Health Center Timeline?

Answer 6

Public Health Service Act 1944, Economic Opportunity Act 1964, and Health Centers Consolidation Act 1996

Question 7

What is the Public Health Service Act?

Answer 7

1944 streamlined the administration of the Public Health Service, provided a framework for federal public health and state public health cooperation, consolidated and revised nearly all legislation relation to public health services, amended multiple times since original passage of law

Question 8

What is the Economic Opportunity Act?

Answer 8

1964, created the first community health centers in the US, 1965 funding was approved for the first two neighborhood health center demonstration projects, later 1975, congress permanently authorized neighborhood health centers as community and migrant health centers

Question 9

What is the Health Centers Consolidation Act?

Answer 9

1996, combined different authorities under Section 330 of PHSA to create a consolidate health center program known as community, migrant, public housing and homeless health centers, program administrated by the Health Resources and Service Administration within the US Department of Health and Human Services

Question 10

Who do Health Centers Serve?

Answer 10

1 in 14 people in the US, 1 in 10 children, 1 in 7 people living in poverty

Question 11

Federal Poverty Level definitions

Answer 11

a measure of income issued every year by the Department of Health and Human Services, Federal poverty levels are used to determine eligibility for certain programs and benefits, including savings on Marketplace health insurance and Medicaid and CHIP coverage

Question 12

What is the current Federal Poverty Level?

Answer 12

for individual $13,590 and family of 4 $27,750

Question 13

70% of health center patients are…

Answer 13

below the poverty level

Question 14

Demographics of health center patients

Answer 14

multiracial, not just minority

Question 15

What age patients utilize health centers?

Answer 15

61% 18-64, 8% 65+, 31% <18

Question 16

What’s the largest part of Health Center reimbursement?

Answer 16

medicaid (increased due to Affordable Care Act)

Question 17

What are Grant supported Federally Qualified Health Centers FQHC?

Answer 17

community health centers, migrant health centers, healthcare for the homeless programs, public housing primary care programs

Question 18

Migrant health center

Answer 18

regional centers for migrant workers

Question 19

What are Health Centers other than FQHC?

Answer 19

non grant-support health centers aka look-a-like (public), outpatient health program/facilities operated by tribal organizations (public), other health centers (private)

Question 20

What is a look-a-like?

Answer 20

a health center that qualifies for a grant but does not receive one, maybe not enough grants

Question 21

What are components of a FQHC to be qualified?

Answer 21

need, services, management and finance, governance

Question 22

What is need?

Answer 22

serve a medically underserved populations

Question 23

What is services?

Answer 23

provide appropriate and necessary services with fees adjusted on patients’ ability to pay; ex: required and additional services + sliding fee discounts

Question 24

What is management and finance?

Answer 24

demonstrate sound clinical and financial management

Question 25

What is governance?

Answer 25

be governed by a board, the majority of which includes health center patients

Question 26

MUA vs MUP

Answer 26

medically underserved area vs medically underserved population

Question 27

HPSA

Answer 27

health professional shortage area

Question 28

What is a medically underserved population?

Answer 28

not enough primary care providers, high infant mortality, high poverty, high older adult population

Question 29

What are required and additional services?

Answer 29

health center provides all required primary, preventive, enabling health services and additional health services as appropriate and necessary, either directly or through established written arrangements and referrals

Question 30

Typical services provided by a FQHC

Answer 30

after hours care, basic lab, behavioral health, case management, dental care, emergency care, hospital/specialty care, pharmacy, primary health care, radiological services, transportation

Question 31

Nationally, what percent of health centers offer vision services?

Answer 31

25%

Question 32

What are sliding fee discounts?

Answer 32

determine eligibility for patient discounts adjusted on the basis of the patient’s ability to pay; full discount to individuals and families with annual incomes at or below 100% of the federal poverty guidelines; no discounts for patients with incomes over 200% of the federal poverty guidelines; no patients will be denied by health care services due to inability to pay

Question 33

Management and Finance

Answer 33

key management staff, contractual/affiliation agreements, collaborative relationships, financial management and control policies, budget, program data reporting systems, scope of project

Question 34

Governance

Answer 34

board authority, board composition, conflict of interest policy; half of the board must use the services

Question 35

What are benefits of FQHC?

Answer 35

Section 330 Grant Funds, and medical malpractice coverage aka federal tort claims act

Question 36

What are benefits for FQHCs and Look-alikes?

Answer 36

prospective payment system reimbursement (medicaid), cost-based reimbursement, eligibility for reduced drug costs/drug discounts, eligibility for vaccines for children program, designation as a HPSA (needed for NHSC eligibility), eligibility for other federal grants/programs

Question 37

Largest revenue sources of Health Centers

Answer 37

1 Medicaid, #2 Section 330 grants

Question 38

What are the community benefits of health centers?

Answer 38

a health home for underserved people, a voice in the operation of the health home, broader health insurance coverage, less costly care, better care, creates jobs and other investment opportunities in economically depressed communities

Question 39

A health home for underserved people

Answer 39

improving public health, reducing the emergency room burden, providing needed services

Question 40

What are the biggest challenges of health centers?

Answer 40

workforce recruitment, lack of adequate referral network, increasing operating costs, inadequate physical space, insufficient insurance reimbursement

Question 41

Community Health Centers and the Affordable Care Act

Answer 41

strengthening community health centers is one of the strategies to increase access to affordable care; established the community health center fund that provides $11 billion over a 5 year period for the operation, expansion, and construction of health centers throughout the nation; projected to allow services to approximately 20 million new patients across the country (medicaid)

Question 42

What percent of Community Health Centers provide in-house optometric service?

Answer 42

18% (National Health Service Corps currently excludes optometry)

Question 43

What is the National Health Service Corps?

Answer 43

builds healthy communities by supporting qualified health care providers dedicated to working in areas of the united states with limited access to care; formed 1972 Department of Health and Human Services, connects 40,000 primary care practitioners to communities with limited access to primary care (currently 10,000 providers)

Question 44

What disciplines is the National Health Service Corp open to?

Answer 44

medicine, dentistry, nurse practitioner, certified nurse-midwife, physician assistant; offers scholarship and loan repayment programs

Question 45

What AOA committee is trying to get included in the National Health Service Corp?

Answer 45

AOA Health Center Committee

Question 46

Rural Health Clinics

Answer 46

4,000 in the US (vs 2000 Health Centers + their clinics); another program also attempts to increase primary care services for patients in underserved communities, must be located in a rural area, required to use a team approach of physicians and non-physician practitioners

Question 47

What is the main advantage of having Rural Health Clinics?

Answer 47

enhanced reimbursement rates for Medicare and Medicaid services