HRSA defines non-grant-supported Federally Qualified Health Center as “…health centers that have been identified by HRSA and certified by the Centers for Medicare and Medicaid Services as meeting the definition of ‘health center’ under Section 330 of the PHS Act, although they do not receive grant funding under Section 330. They are referred to as ‘look-alikes.’”
FQHCs provide, either directly or through an established arrangement, a broad range of primary, preventive and enabling services such as family medicine, internal medicine, pediatrics, obstetrics and gynecology, diagnostic laboratory and radiological services, pharmaceutical services as appropriate, preventive health services, and enabling services. In the current health service environment, FQHCs face the challenges of limited resources and increased compliance scrutiny and the expansion of new payment structures. Our Health Law attorneys work closely with FQHCs to identity strategies to coordinate care with other providers.
The Community Health Centers program consists of over two thousand centers, totaling approximately 9,000 sites, which serve over 22 million patients nationwide. This health safety net program grew out of the 1960s War on Poverty. The common characteristics of all health centers are that they serve a designated medically-underserved population, are governed by a board of directors with a majority of patient-directors, they offer the full range of primary and preventive care, and they serve all residents regardless of ability to pay. In exchange for complying with the requirements established in Section 330 of the Public Health Services Act and implementing regulations, health centers may receive cost-based reimbursement under Medicaid, as well as access to other federal programs, such as discounted prescription drugs under the Section 340B Program and medical malpractice coverage under the Federal Tort Claims Act.
Under health care reform, health centers are presented with many opportunities and challenges. Similar to other health care providers, health centers must adapt to new reimbursement models and market pressures. Many health center patients are newly insured under the Exchanges, and health centers must navigate how to contract with the Qualified Health Plans or otherwise serve this population. Additionally, health centers must decide whether to enter in to new affiliations with other providers, such as joining an Accountable Care Organizations or collaborating with a hospital emergency department, to improve integrated care coordination.
Our Health Law practice group assists health centers in assessing potential affiliations, drafting and negotiating agreements, preparing for and responding to government audits, and challenging disputed government findings/actions. We also provide trainings to health centers on a wide variety of topics, from board governance to Managed Care contracting to the Federal Tort Claims Act. We also advocate for the interests of health centers, both individually through negotiating fair contracts and assisting compliance efforts, and collectively through our policy work as general counsel to the National Association of Community Health Centers.
We routinely help health centers prepare for government audits through on-site assessments, whereby we work with key management and conduct a compliance assessment of the center. Such assessments can help a health center avoid potential grant conditions and funding restrictions. We assist centers in coming in to compliance with Section 330 requirements through appropriate contracting, improved policies and procedures, and trainings. Additionally, health centers have engaged us in the midst of a government investigation or following negative government findings to guide them in properly responding to stated government concerns, all with the goal of elevating patient services to underserved communities.