Health Center
Operations

PACHC is here to assist our organizational members with support for operational, financial, and administrative tasks to ensure the delivery of quality, affordable primary health care for all.

PACHC provides support, resources, and technical assistance (TA) to Pennsylvania’s Community Health Centers and other partner organizations. The range of TA encompasses the full spectrum of health center operations. Here are some of the areas where PACHC can provide TA:

Financial: billing, sliding fee, payment policy related to Medicaid, Medicare, Children’s Health Insurance Program, and audits
Health Center Operations: Operational Site Visits, HRSA program requirements, governance/board, compliance, 340B discount drug program, and emergency preparedness
Workforce/Human Resources: recruitment, retention, credentialing, and loan repayment
Clinical: Patient-Centered Medical Home/accreditation, primary physical health, oral health, behavioral health, substance use disorders, quality improvement/risk management, and FTCA
Outreach & Enrollment: Health Insurance Marketplace, eligibility/enrollment for Medicaid, CHIP, or Medicare
Community Development: how to start a health center and letters of support
Marketing and Communications: community health center branding, external and internal communications, media relations, and public relations

If your technical assistance need is not listed here, please contact PACHC.

Providing Care to Underserved Communities5

Billing and Finance5

Governance5

Emergency Preparedness5

Enrollment Assisters Information5

FQHCs, FQHC Look-Alikes and RHCs provide quality, affordable care to medically underserved communities in Pennsylvania.

What is a health center?

Most health centers are grantees of the Health Resources and Services Administration (HRSA), under Section 330 of the US Public Health Service Act, and include community health centers (FQHCs), migrant health centers, health care for the homeless health centers, and public housing primary care centers. Others are known as FQHC Look-Alikes. They meet all the requirements of health centers and reap most of the benefits of health center status, but do not receive a federal grant.

Federally Qualified Health Centers (FQHCs)

Federally Qualified Health Centers (FQHCs) or Community Health Centers are community-based, non-profit organizations that provide affordable, quality, and comprehensive primary health care to patients in their community. FQHCs are created by individuals in a community coming together with a mission to improve access to primary medical care in an underserved area. Every Community Health Center is different, but they all care for patients in a community-oriented, culturally competent setting, and they contribute to the local economy by employing area residents and purchasing products and services. They are not operated by the government.

FQHCs:

Receive funding under Section 330 of the Public Health Service Act through HRSA.
Must meet 19 specific program requirements set by HRSA that help promote optimal patient care
Must have a patient-majority (at least 51%) governing board of directors
Must serve at least one Medically Underserved Area (MUA) or Medically Underserved Population (MUP)
Provide a range of core health and ancillary services
Treat anyone who seeks care regardless of insurance or ability to pay.
Each FQHC must develop a sliding fee discount program for those below 200% of poverty
Learn more about Pennsylvania’s FQHCs.

FQHC Look-Alikes

FQHC Look-Alikes provide comprehensive primary health care services to all persons regardless of ability to pay and must meet all program requirements consistent with FQHC program requirements. Look-Alikes, however, do not receive section 330 grant funding. Look-Alikes are:

Eligible to apply to the Centers for Medicare and Medicaid Services (CMS) for reimbursement under FQHC Medicare and Medicaid payment methodologies
Eligible to purchase discounted drugs through the 340B Drug Discount Program
Receive automatic Health Professional Shortage Area designation
Eligible to access National Health Service Corps providers

Rural Health Clinics (RHCs)

The following is excerpted from the Rural Health Information Hub: The Rural Health Clinic (RHC) program is intended to increase access to primary care services for Medicaid and Medicare patients in rural communities. RHCs can be public, nonprofit, or for-profit healthcare facilities, however, they must be in rural, underserved areas. They are required to use a team approach of physicians working with non-physician practitioners such as nurse practitioners (NP), physician assistants (PA), and certified nurse midwives (CNM) to provide services. The clinic must be staffed at least 50 percent of the time with a NP, PA, or CNM. RHCs are required to provide outpatient primary care services and basic laboratory services.

Your Toolkit to Navigating the Complexities of Health Center Billing and Finance

Health center billing and finance is unique in that payment streams are different than traditional primary care. In addition, health centers are required to meet specific Health Resources and Services Administration (HRSA) regulations and follow federal cost principles as a recipient of federal grant funds. The challenge is meeting both federal and state regulations as well as maintaining a fiscally stable environment to meet the health center’s mission of providing quality care to the communities served.

One of PACHC’s core functions is related to payment policy, especially Medicaid policy. PACHC meets monthly with the PA Medicaid staff directly responsible for FQHC/RHC payment policy; every other month the meetings are expanded to include Department of Human Services staff responsible for Medicaid policy, CHIP and Medicaid behavioral health services. PACHC’s strong relationship with the PA Medicaid program provides an avenue for vital communication about challenges, questions and two-way feedback with the goal being fiscally sound health centers that can provided needed health services to their communities.

PACHC’s trainings, technical assistance, resources, peer networking groups and regular group communication on critical finance and billing issues offer timely, relevant support for health centers across the state in navigating the complex environment facing organizations today.

Billing and Finance Resources for Finance Staff

Pennsylvania State Resources

Federal Grant Regulations/Requirements

Federal Medicare Information

Other Resources

Revenue Cycle Flow Chart

Governing from the Community Perspective

One of the unique features of an FQHC or FQHC Look-Alike is its governance. Board of directors at Community Health Centers reflects the personality, culture and needs of the community served.

The Health Resources and Services Administration (HRSA) has outlined several governance requirements related to board authority, function, composition and responsibilities.

The health center governing board maintains appropriate authority to oversee the operations of the organization.
The health center governing board is composed of individuals, a majority (51 percent) of whom are patients receiving health care at the health center.
The board must be representative of the community being served in terms of demographic factors such as race, ethnicity, and sex and include representation from any special populations served.
Health center bylaws must be established and approved by the health center’s governing board through a board resolution.

HRSA’s Compliance Manual is a valuable tool concerning governance.

The health center governing board maintains appropriate authority to oversee the operations of the organization.
The health center governing board is composed of individuals, a majority (51 percent) of whom are patients receiving health care at the health center.
The board must be representative of the community being served in terms of demographic factors such as race, ethnicity, and sex and include representation from any special populations served.

Other available resources related to health center governance:

HRSA Governance Resources

NACHC Health Center Program Governing Board Workbook (MyNACHC)

MyNACHC has several other publications and webinars dedicated to health center governance and board training. Creating a MyNACHC account is free.

Information for Health Center Program Participants

HRSA publishes PINs and PALs that cover important information for those participating in the Health Center Program.

Policy Information Notices (PINs) are documents published by the Health Resources and Services Administration (HRSA) that define and clarify “must follow” health center program policies and procedures.

Program Assistance Letters (PALs) summarize and explain items of significance for health centers, including, for example, implementation of HRSA program activities, Uniform Data System (UDS) changes, recently enacted laws, final regulations, and new initiatives.

You may view a chronological listing of all PINs and PALs.

Emergency Preparedness

Review the latest federal policies and rules from the Centers for Medicare and Medicaid Services.

Federally Qualified Health Centers (FQHCs) and other Medicare/Medicaid certified providers should be aware of new regulations that went into effect November 15, 2017.

After review of provider emergency plans and policies across the nation, the Centers for Medicare and Medicaid Services (CMS) concluded that, in large part, emergency preparations were inadequate. CMS found this to be particularly true considering the frequency of storm-related disasters and public health concerns in the last several years.

To improve performance of providers and have higher standards of care for individuals in the event of an emergency, CMS published a Final Rule in September 2016 establishing new requirements. These conditions of participation (CoP) and conditions for coverage (CfC) regarding emergency preparedness apply to all Medicare/Medicaid certified providers, including FQHCs and rural health clinics (RHCs).

Many of these requirements reiterate recommendations from the Bureau of Primary Health Care found in Program Information Notice 2007-15, Health Center Emergency Management Program Expectations.

The requirements within the final rule fall into four basic categories:

Risk assessment and planning
Policies and procedures
Communication plan
Training and testing

The deadline for compliance with these new CMS requirements is November 15, 2017.

PA HAN

The PA Health Alert Network (PA HAN) is part of the Pennsylvania Department of Health’s Public Health Emergency Preparedness and Response Program. PA HAN serves as a secure communication network among state and local public health agencies, health care providers, hospitals, and emergency management officials. Sign up for PA HAN to receive timely health alerts and advisories.

TRACIE

The Technical Resources Assistance Center and Information Exchange (TRACIE) strives to meet the information and technical assistance needs of organizations involved in healthcare emergency preparedness and disaster medicine. Check out the resources and guidance specific to FQHCs.

Healthcare Coalition Preparedness Project

The Pennsylvania Department of Health (PADOH) partners with Public Health Management Corporation (PHMC) to support several healthcare coalitions across Pennsylvania. PADOH initiated the partnership to provide healthcare facilities with a resource to refine, enhance, and test individual health care facility preparedness activities and response plans via their Healthcare Coalitions. Public Health Management Corporation’s (PHMC) Healthcare Emergency Management network supports regional collaboration and health care preparedness and response by encouraging the development and sustainment of health care coalitions (HCCs). HCCs include a wide variety of organizations including, but not limited to, acute care facilities, long-term care facilities, and health centers and clinics. HCCs also include partner organizations such as local and county Emergency Management Agencies.

PHMC’s Emergency Management staff support Pennsylvania’s health centers to prepare for and respond to emergencies. Disasters may include, but are not limited to:

Natural disasters such as floods, blizzards, tornadoes, hurricanes
Mass casualty incidents include multiple vehicle accidents, train accidents, active shooter incidents
Environmental accidents such as chemical fires and spills
Acts of domestic and foreign terrorism
Public health threats such as the COVID-19 pandemics

If you would like help with your disaster planning and coordination efforts by getting involved in your Healthcare Coalition, please contact the emergency preparedness regional manager for your region.