According to Title 42 of the United States Code, the term “health center” refers to an entity that serves a medically underserved population (area with shortages of personal health services and primary care physicians, high percentages of people living in poverty, higher than average infant mortality rates, and high percentages of the elderly), or a special medically underserved population comprised of migratory and seasonal agricultural workers, the homeless, and residents of public housing (Office of the Law Revision Counsel, 2018). It does so by providing, either through the staff and supporting resources of the center or through contracts and cooperative arrangements, required primary health services, which consist of: basic preventive and primary care services, behavioral health services, chronic disease management, enabling services, education, and case management services (Office of the Law Revision Counsel, 2018). Essentially, health centers are community-based and patient-centered organizations that deliver comprehensive, culturally competent, high-quality primary health services to the low-income, uninsured/underinsured, and underserved population (migrant and seasonal farm workers, individuals and families experiencing homelessness, those with limited English proficiency, and those living in public housing), regardless of income or insurance status (HRSA, 2018).
Because health centers operate under the direction of patient-majority governing boards of community-based organizations, the care delivered is guaranteed to be tailored for the needs of the communities they serve (HRSA, 2018). Their goal is to enhance the provision of primary care services in those vulnerable communities by striving to overcome existing barriers to health care access, which include: high costs of care, inadequate or no insurance coverages, and lack of both service availability and culturally competent care (Isham & Kottke, 2010). This emphasized care management of underprivileged patients offered by health centers not only reduces health disparities based on race, ethnicity, socio-economic status and insurance status, but also overcomes geographic, cultural, linguistic, and other aforementioned barriers to health care (Isham & Kottke, 2010). This increased access to health care results in the betterment of those individuals’ physical, social, and mental health status, as well as their overall quality of life.
2. As a designated health center, patients cannot be denied care regardless of their ability to pay. How are fees for services determined at a health center?
In order to be a qualified entity in the Federally Qualified Health Center (FQHC) program and receive entitled benefits, an organization must fall under one of the following categories: a health center grantee that meets the requirements of the Health Center Program under Section 330 of the Public Health Service (PHS) Act; a health center “look-alike,” which meets the specifications of the Health Center Program, but does not receive grant funding under Section 330 of the PHS Act; or an outpatient health program or facility operated by a tribe or tribal organization (HRSA, 2018). Once certified by the Centers for Medicare and Medicaid as an FQHC or FQHC look-alike, such entities are eligible for: Medicare reimbursement under a prospective payment system (PPS), in which Medicare payment is made on a national rate that is adjusted based on service location; Medicaid reimbursement under the PPS or other state-approved alternative payment methodology (APM) for services provided under Medicaid; 340B Drug Pricing Program discounts for pharmaceutical products; free vaccines for uninsured/underinsured children through Vaccines for Children Program; and assistance in the recruitment and retention of primary care providers through the National Health Services Corps (HRSA, 2018). Additional benefits are available for Health Center Program grantees, which include grant funding under Section 330 of the PHS Act and medical malpractice coverage under Federal Tort Claims Act (HRSA, 2018). Health centers must strive to collect appropriate reimbursement for its costs on the basis of the full amount of fees and payments for services provided without any discount application when providing health services to individuals who qualify for those aforementioned benefits.
Health centers must also make every reasonable effort to secure payment for services in accordance with their fee schedules and the corresponding schedule of discounts (sliding fee discount schedule) on the basis of the patient’s ability to pay (HRSA, 2018). They can charge no more than a nominal fee to individuals whose incomes are below the federal poverty level (FPL). Individuals with incomes between 101% and 200% of the FPL must be charged using a sliding fee scale, which entails varying discounts based on patient family size and income (HRSA, 2018). Those with incomes over 200% of the FPL do not receive any discounts. However, no patient is denied health care services due to their inability to pay for such services; therefore, fees or payments for services required by the health center are reduced or waived, if need be (HRSA, 2018).
In short, the majority of health center operating funds come from Medicare, Medicaid, federal grants, private insurances, public assistance programs (e.g. CHIP), and/or patient fees.
3. Provide two recommendations that Neighborhood Care should implement to tighten up the financial management of the practice?
In order to better the financial management of the practice, I consider that it would be beneficial for Neighborhood Care to create a more detailed expenditure log for their records that not only provide specifications on where the money is being spent, but also on how it is being spent. They should also draw down funds strictly based on project needs and do so in a timely manner, assuring that they pay careful attention to the required documents and deadlines for those needed grants. Lastly, Neighborhood Care should formulate a concrete protocol to ensure that it is obtaining supplies in the most efficient and cost effective manner possible.