Mr. Joe Liszak, partner with FQHCmd Consulting is a featured speaker today at the Mississippi Primary Care Associations Clinical Conference.  
Joe's presentation is on the HRSA PROGRAM REQUIREMENTS  – GOVERNANCE AND ADMINISTRATION
His session will cover Governance and Administration Performance. Topics such as governing board authority, board composition and conflicts of interest, budgets and clinical aspects that board members should know and understand, staffing requirements and collaborative relationships will be addressed.


We were happy to be asked to present at the conference and you there are any other questions about the 3 day event please visit http://www.mphca.com/

Recently, the Health Resources and Services Administration (HRSA issued a “System Announcement” through the Electronic Handbook (EHB), notifying grantees of a legislative provision limiting the amount of an employee’s salary that can be paid using federal grant funds.  This provision is part of the Consolidated Appropriations Act of 2012 (P.L. 112-74, or “the Act”), signed into law on December 23, 2011.  The Act is the law that appropriates funds to support activities (including grant-making) conducted by the federal government’s agencies (such as HRSA and other agencies of the Department of Health and Human Services or HHS).  

The provision states that the funds appropriated to HHS cannot be used by grantees receiving such funds to pay an employee’s salary “at a rate in excess of Executive Level II.”  The Executive Level II amount for FY 2012 is $179,700.  

According to the HRSA announcement, the limitation applies to organizations that have “received HRSA funds” on or after December 23, 2011.  HRSA has not yet clarified its interpretation of “received”; however, until further clarification, NACHC interprets this to mean that the $179,700 cap applies only to Notice of Grant Awards (NGAs) with award dates on or after December 23, 2011 – not to NGAs with prior award dates from which funds were (or are) drawn down after December 23, 2011.  

Based on discussions with HRSA officials, the provision is not intended to limit the amount a health center is allowed to pay its employees.  Rather, it establishes a ceiling (or a “cap”) on the portion of an individual employee’s salary that can be charged to the federal grant.  Health centers can charge to the grant an amount no more than the ceiling of $179,700 per employee, with the remaining costs (if any) charged to non-grant funds, such as program income.[1]

If an employee is not full-time (less than 1.0 FTE), or if a full-time employee splits his or her time between the HRSA-funded project and a separate non-HRSA-project, the salary cap amount that can be charged to the HRSA project should be proportionate to the amount of time expended by the employee on activities supported by the HRSA grant.  For example, if an individual is a .5 FTE or is full-time but works only 50% of his or her time on the health center project, the amount of his or her salary that can be charged to the project would be capped at $89,850 (50% of $179,700). 

Additionally, if an employee’s time is charged to more than one HHS grant, the amount of his or her salary that can be charged to all HHS grants in the aggregate cannot exceed the $179,700 cap, with each grant charged an amount proportionate to the employee’s time expended on activities supported by such grant (if appropriate under the terms of the specific grant). 

There are several outstanding questions yet to be addressed, including how grantees should: (1) develop their budgets going forward given that many do not currently itemize their expenses by funding source; and (2) address administrative salaries that are charged in part to an indirect cost rate.  Further, while HRSA has confirmed that the application of the cap discussed above is their current interpretation, they have left open the possibility of a future modification.  Thus, health centers affected by this cap should continue to check with the EHB and their project officers to confirm that there have not been any changes in interpretation.   NACHC will continue to monitor these and other related issues and will post any updates and clarifications.

[1] Both our interpretation of non-retroactivity addressed in the previous paragraph and HRSA’s (apparent) view of the salary limitation applying solely to federal funds are supported by statute and case law dealing with federal budgeting and accounting. 

WASHINGTON, D.C. — The President’s FY2013 Budget released this week funds the Health Centers Program at a total programmatic level of $3.1 billion, or a $300 million increase. This level of funding would allow health centers to continue to meet the needs of the more than 20 million patients who rely on them for primary care today.  In addition, if the $300 million increase were fully utilized, it would provide enough funding for an additional 2.5 million Americans to receive access to high quality care at a health center next year.  This is a vitally important step, especially during this time when an estimated 60 million Americans, many of whom have health insurance, do not have access to primary medical care in their communities. The budget also addresses the need for steady and sustainable growth for the Health Centers Program, including in FY2015 and beyond. Unfortunately, the policy reflected in the budget also calls for limited utilization of the proposed increase, supporting the creation of just 25 new health centers that would expand care to only about 60,000 additional patients, while allocating the bulk of next year’s increase to prevent future year shortfalls in funding.  As a result, there will be less health center expansion in the years leading up to 2014, and insufficient primary care capacity to meet the needs of the projected 32 million newly insured, particularly those on Medicaid.  Importantly, the President’s budget also speaks to the continued importance of health centers in the future, highlighting that health centers “provide an accessible and dependable source of primary care services in underserved communities” that will be critically important as millions of uninsured Americans receive coverage in the coming years. "In light of the economic conditions that forced the Administration to make many difficult choices, we are grateful that the President’s Budget reflects the important role that health centers play in the health care system and the value that they offer and we appreciate its recognition of the need to sustain the efforts of existing health centers," said Tom Van Coverden, President and CEO of the National Association of Community Health Centers. "However, in a time where most health centers are seeing unrelenting demand for their services and thousands of communities are still waiting for accessible primary care through a health center, and with only two years left to gear up for the coverage expansions, we are disappointed at the slowed expansion of the Health Centers Program that is also reflected in this proposal."

We have updated our brochure as well as revamped both of our websites:  FQHCmd.com and FQHCConsulting.com.
Please visit us and check out our new look.

We have updated the look of FQHCmd.com.  Please feel free to browse through the pages and though we wanted it to be complete and be able to give our visitors a lot of information, we have tried to make it as user friendly as possible.  Any comments are welcomed.

A study published in the January-March Issue of The Journal of Ambulatory Care Management finds that patients who receive a majority of their ambulatory care at Community Health Centers have significantly lower health care costs than other patients.  The study by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative assessed the potential cost savings associated with health centers based on econometric analyses of the 2006 Medical Expenditure Panel Survey.

Highlights of the study’s findings include:

• Patients who used health centers for the majority of their care incurred $3500 in total annual medical expenditures compared with $4594 for non health center users, for an annual estimated savings in 2006 of $1093.  
• Health centers were associated with annual savings of $402 in ambulatory costs (25% less), and $29 in emergency costs (18% less), and $218 for (or 18 percent less) for hospital in patient expenditures. 

These results are consistent with other independent studies indicating that by providing good quality primary care, Community Health Centers can reduce the utilization of other medical services.  The report goes on to say: 

“CHCs can provide good-quality primary care that low-income patients in medically underserved areas might not otherwise obtain, helping to reduce the demand for subsequent specialty and emergency and inpatient medical care. Not only does this demonstrate the utility of CHCs, but it also provides further support of the utility of improved primary care as a cost-saving approach to health care delivery.”

An abstract of the report can be found by visiting this link  (the full text must be purchased).  You can also read more studies about the cost-effectiveness of health centers by visiting this link on the NACHC research page.

This was released on 12/16........

WASHINGTON, D.C. -- The FY2012 Omnibus Appropriations Act released last night funds the Health Centers program at a total programmatic level of $2.78 billion. This legislation, were it to become law, provides funding to maintain current levels of federal grant support and all existing operations at Health Centers, and will also extend access to care to nearly 1.5 million additional people in need of care. An estimated 60 million Americans -- many of whom have health insurance -- do not have access to primary medical care because of a shortage of providers in their communities.

Importantly, this legislation allows the full Community Health Center Fund increase to be used to support expansion of the Health Centers program, consistent with the original intent of the Fund. This legislation would allow HHS to fund applications from among the more than 1,800 pending at the Department of Health and Human Services (HHS) for new and expanded health centers.

"At a time when health centers are seeing ever increasing demand for their services in rural and urban communities across the country, we are grateful that Congress has responded with this bipartisan bill which begins to address that need," said Tom Van Coverden, President and CEO of the National Association of Community Health Centers. “Health centers stand ready to serve even more patients who need access to their care and appreciate the bipartisan efforts of the House and Senate Appropriations Committees and in particular the Labor-HHS Subcommittee leaders for their efforts to support health centers in this legislation.” 

This year, bipartisan Health Centers program funding letters were led by Senators Debbie Stabenow (MI) and John Boozman (AR) and by Representatives Gus Bilirakis (FL) and Frank Pallone (NJ). 

Health care law will help rebuild aging clinics

Thanks to the Affordable Care Act, more than $14 million was awarded today to 45 school-based health centers across the country allowing the number of children served to increase by nearly 50 percent, HHS Secretary Kathleen Sebelius has announced.

Clinics receiving the awards, made possible by the health reform law, are already providing much-needed health care services to 112,000 children.  Today’s infusion of new money will enable them to expand their capacity and modernize their facilities, which will allow them to treat an estimated additional 53,000 children in 29 States.

“Children are the foundation upon which this country will grow,” said Secretary Sebelius.  “The Affordable Care Act will help ensure our children get the high-quality health care they need and deserve.”

Funds awarded today will help create jobs for Americans across the country. Funds will support job opportunities as more Americans will be needed to meet the clinics’ pressing capital needs - including construction, renovation and new equipment. 

School-based health centers enable children with acute or chronic illnesses to attend school, and improve the overall health and wellness of all children through health screenings, health promotion and disease prevention activities.

Typically, a school-based clinic provides a combination of primary care, mental health care, substance abuse counseling, case management, dental health, nutrition education, health education and health promotion activities.

“These grants will enable school-based health centers to establish new sites or upgrade their current facilities, which will increase their ability to provide preventive and primary health care services, and help children improve their health and remain healthy,” said HRSA Administrator Mary K. Wakefield, Ph.D., R.N. 

The Affordable Care Act provides $200 million in funding from 2010 – 2013 for the School-Based Health Center Capital Program to address significant and pressing capital needs and to improve delivery and support expansion of services at school-based health centers.

Today’s grants are the second in the series of awards that will be made available to school-based health centers under the Affordable Care Act.  The Health Resources and Services Administration (HRSA) oversees the School-Based Health Center Capital Program.

A full list of today’s grantees is available at http://www.hhs.gov/news/press/2011pres/12/20111208a_grantees.html

To learn more about School-Based Health Centers, visit http://www.healthcare.gov/news/factsheets/2011/12/health-centers12082011a.html

To learn more about the Affordable Care Act, visit www.healthcare.gov. 

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The Health Resources and Services Administration is part of the U.S. Department of Health and Human Services.  HRSA is the primary Federal agency responsible for improving access to health care services for people who are uninsured, isolated, or medically vulnerable.  For more information about HRSA and its programs, visit www.hrsa.gov.


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Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.

Last revised: December 8, 2011

The following article was originally published by Crain Chicago Business on November 22, 2011.  The link to the full article is given below:
UIC pushes ahead with $26-million clinic plan
By: Micah Maidenberg November 22, 2011  
(Crain’s) ― The University of Illinois Medical Center is cobbling together plans for a $26-million clinic nearly two years after scuttling a proposal for a $650-million overhaul of its Near West Side campus due to a lack of financing.

The new Mile Square Health Center, proposed for a site two blocks from the medical center, would be the headquarters for UIC’s network of nine community clinics, replacing an outdated building nearly 1.5 miles away.

To read the entire story please go to http://www.chicagobusiness.com/article/20111122/NEWS03/111129957/uic-pushes-ahead-with-26-million-clinic-plan

Bethesda, MD -America’s Health Centers are vital tools in the war against diabetes, a disease that impacts 25.8 million children and adults in the United States.  November is American Diabetes Month, a time to raise awareness about the disease and urge people at risk to get screened and treated to avoid serious and costly diabetes-related complications.  The World Health Organization and American Diabetes Association projects that deaths from diabetes are projected to rise by more than 50% in the next 10 years.

Yet, America’s Health Centers are quietly fighting the disease through the Health Centers Diabetes Collaboratives, an innovative health program designed to generate improved health outcomes for chronic diseases nationwide.  By providing affordable and comprehensive primary care services, health centers are able to reduce both the complications associated with diabetes and the health care costs that go along with treating people who suffer from diabetes-related illnesses, such as kidney damage, blindness, and poor circulation that can lead to limb amputation.

“As a medical home easily accessible to our community members, our health center sees a lot of patients who have been living with diabetes, but have never been tested for it,” said Gary Wiltz, MD, President and CEO of Teche Action Center in Franklin, LA, and the Board Chair elect of the National Association of Community Health Centers (NACHC).  “We not only provide the screening, but also teach patients how to manage the disease with proper nutrition, exercise and regular testing.  The health center model is focused on quality, patient-centered, preventive care so that chronic diseases never reach the acute stage where the treatment is costlier and less effective.”

Some 57 million Americans have prediabetes and are at risk for developing type 2 diabetes.  The death rate due to diabetes has also risen by 45 percent since 1987. One out of every three children (and one in two minority children) born in the United States today will face a future with diabetes.  The good news is that screenings and treatment are available at Community Health Centers and tools are available for patients to help manage their diabetes on their own.  Health center patients are two times more likely than the national norm to have glycohemoglobin (blood sugar) tests performed at regular intervals, and are thus better able to avoid the complications associated with the disease. 

According to the Health Resources and Services Administration (HRSA), which administers the Federal Health Centers program, diabetes is one of the most prevalent chronic diseases among health center patients, generating more than 3.5 million patient visits in 2009 (the most recent data available).  There are also clear signs those numbers will only increase.  A report by Direct Relief International showed that number of uninsured patients with diabetes at health centers increased by almost 7% last year

The Institute of Medicine and the General Accounting Office have recognized health centers as models for screening, diagnosing and managing chronic conditions such as diabetes, cardiovascular disease, asthma, depression, cancer and HIV.  Health centers’ efforts have led to improved health outcomes for their patients, which in turn generates cost-savings for the entire U.S. health care system.