Frequently Asked Questions About Community Health Centers
Community health centers (CHC) are the family doctor’s office and medical home to one in eight Americans. They provide primary and preventive medical care, as well as oral health and behavioral health care that is tailored to the needs of the communities they serve. They are open to everyone in the community regardless of a person’s ability to pay. They offer a sliding fee discount to people who qualify based on income. CHCs are non-profit or public consumer-governed organizations that receive part of their support from federal grants.
Idaho has 12 CHCs and one Federally Qualified Health Center “Look-Alike” that provide high quality health care to about 130,000 people each year. They are located in 37 communities throughout the state. The difference between these two types of health centers is not obvious because they both operate under similar federal program requirements. The main difference is that FQHC Look-Alikes do not receive the federal grant funds.
For a fact sheet on community health centers click here.
What’s Different about Community Health Centers?
Community health centers are local, non-profit, community-owned health care providers serving all members of a community without regard to insurance status or ability to pay. They are located in medically-underserved areas or populations.
They offer services that make accessing health care easier, such as transportation, translation, case management, health education and culturally-sensitive health care.
They also go above and beyond the traditional role of preventive medicine, providing dental, behavioral health, pharmacy, and community outreach services.
Their costs of care rank among the lowest, and they can reduce the need for more expensive hospital in-patient and specialty care, producing significant savings for taxpayers.
Benefits for Which Health Centers Are Eligible
The following list summarizes various benefits that accrue (or may accrue) to health centers that receive grants under Section 330 of the Public Health Service ("PHS") Act (42 U.S.C. 254b). Benefits designated by an asterisk are also available to Federally Qualified Health Center (“FQHC”) “look-alikes” (i.e., health centers that meet all Section 330 requirements but do not receive Section 330 grants) as well as Section 330 grant recipients.
1. Access to Federal grants, i.e., expansion grants, to support the costs of otherwise uncompensated comprehensive primary and preventive health care and "enabling services" delivered to uninsured and underinsured populations at sites within the Section 330 approved scope of project. FQHC “look-alikes” are eligible to apply for “new start” Section 330 grants when funding is available for such purposes.
2. Access to Federal grants to support the costs of planning and developing a network or plan for the provision of health services which may include the provision of services on a prepaid basis or through another managed care arrangement, to some or all of the individuals served by the Section 330 grantee.
3. Access to Federal loan guarantees of the principal and interest on loans made by non-Federal lenders for the costs of developing and operating managed care networks or plans which are majority owned and/or controlled by Section 330-supported health centers.
4. Access to grant support and loan guarantees for capital improvements.
5. Access to Federal Tort Claims Act ("FTCA") coverage (in lieu of purchasing malpractice insurance) for the Section 330-supported health center and its health care professionals, including certain contracted professionals, providing services to health center patients within the approved scope of project and the professionals’ employment/contractor agreements.
*6. Access to favorable drug pricing under Section 340B of the PHS Act, which allows FQHCs (including "look-alikes") to purchase covered outpatient prescription pharmaceuticals for health center patients at substantially discounted prices for distribution either directly by a health center pharmacy or through contract with a retail pharmacy.
*7. Access to reimbursement under the Prospective Payment System (“PPS”) or other state-approved alternative payment methodology (which is predicated on a cost-based reimbursement methodology) for Medicaid services and cost-based reimbursement for services provided under Medicare. Available under the Medicaid program even if FQHC is a subcontractor to a managed care plan.
*8. Absent an alternative approved by the Centers for Medicare and Medicaid Services (“CMS”), right to have State Medicaid agencies outstation Medicaid eligibility workers on FQHC site. FQHCs can also contract with State Medicaid agencies for FQHC staff to carry out (and be reimbursed for) outstationing activities at FQHC sites.
*9. Reimbursement by Medicare for "first dollar" of services rendered to Medicare beneficiaries, i.e., deductible is waived.
*10. Safe harbor under the Federal anti-kickback statute for waiver of co-payments to the extent a patient is below 200% of Federal income poverty guidelines and therefore entitled to a discount based on the health center's application of its schedule of discounts.
*11. Access to providers through the National Health Service Corps if the health center's service area is designated a Health Professional Shortage Area (“HPSA”).
*12. Access to the Federal Vaccine For Children program, which distributes to FQHCs (and other eligible providers) vaccinations at no charge for either the vaccine or its delivery to FQHCs to be provided by the FQHC to uninsured children. FQHCs are also eligible to participate in the Pfizer Sharing the Care Program.
--Prepared by Feldesman, Tucker, Leifer, Fidell & Bank LLP
Links to information resources
Health Center Program Expectations - Department of Health & Human Services, Bureau of Primary Health Care
A Practical Guide for Starting a Federally Qualified Health Center - National Association of Community Health Centers