FQHC Frequently Asked Questions
Question: What is a Federally Qualified Health Center (FQHC)and what are the benefits?
Answer:A federally qualified health center (FQHC) is a type of provider defined by the Medicare and Medicaid statutes. FQHCs include all organizations receiving grants under Section 330 of the Public Health Service Act, certain tribal organizations, and FQHC Look-Alikes. Requirements for Indian Health Service funded FQHCs may differ from the requirements for FQHCs receiving Section 330 grants and for FQHC Look-Alikes.
There are many benefits of being an FQHC. For FQHCs that are PHS 330 grant recipients, the biggest benefit is the grant funding. For new starts, funding up to $650,000 can be requested. Other benefits include:
Question: What is a Federally Qualified Health Center Look-Alike and what are the benefits?
Answer:An FQHC Look-Alike is an organization that meets all of the eligibility requirements of an organization that receives a PHS Section 330 grant, but does not receive grant funding. FQHC Look-Alikes receive many of the same benefits as FQHCs, including:
Question: What is a PHS Section 330 grant?
Answer:Section 330 of the Public Health Service Act defines federal grant funding opportunities for organizations to provide care to underserved populations. Types of organizations that may receive 330 grants include: Community Health Centers, Migrant Health Centers (see Migrant Health for more information), Health Care for the Homeless Programs, and Public Housing Primary Care Programs.
Question: Can a for-profit clinic be an FQHC?
Answer:No. An FQHC must be a public entity or a private non-profit.
Question: Is a board of directors required?
Answer:Yes, FQHCs receiving Section 330 grants and FQHC Look-Alikes must be governed by a board of directors. The board must include a majority (at least 51%) of active, registered clients of the health center who are representative of the populations served by the center. The governing board ensures that the center is community based and responsive to the community’s health care needs. Under certain conditions the board composition requirements can be waived for migrant, homeless, public housing only health centers.
Question: Are there location requirements for FQHCs?
Answer:It depends. Each FQHC that receives PHS 330 grant funding must meet the requirements of that grant. Community Health Centers must serve a Medically Underserved Area (MUA) or Medically Underserved Population (MUP). To determine if your area qualifies, search the MUA/MUP database. If an area does not have the MUA/MUP designation they can apply for it and can put in an application for a PHS Section 330 grant while the designation is being processed.
Migrant Health Centers, Health Care for the Homeless and Public Housing Primary Care Programs do not need to meet the MUA/MUP restriction. FQHCs may be located in rural and urban areas.
Question: Are there special staffing requirements for FQHCs?
Answer:No, there are no specific requirements for staffing mix at FQHCs. FQHCs are required to have a core staff of full time providers but there is no specific definition of core staff. It is recommended that they maintain a staffing level that allows for between 4,200-6,000 visits per year for each full-time equivalent health care provider.
Another guide to the appropriate number of providers is described in the Requirements of Fiscal Year 2005 Funding Opportunity for Health Center New Access Point Grant Applications (PIN 2005-01) as a physician to patient ratio of 1:1,500 and a mid-level practitioner to patient ratio of 1:750.
Question: What types of services do FQHCs provide?
Answer:FQHCs must provide primary care services for all age groups. FQHCs must provide preventive health services on site or by arrangement with another provider. Other requirements that must be provided directly by an FQHC or by arrangement with another provider include:
Question: Are there minimum hours that an FQHC must be open?
Answer:Yes, 32 hours per week is the minimum. FQHCs must also have professional call coverage when the practice is closed, directly or through an after-hours care system.
Question: Is a sliding fee scale required?
Answer:Yes, FQHCs must use a sliding fee scale with discounts based on patient family size and income in accordance with federal poverty guidelines. FQHCs must be open to all, regardless of their ability to pay.
Question: What are the Medicare Administrative Contractors (MACs) and what is their role in administering Medicare Part A and Part B?
Answer:Section 911 of the Medicare Modernization Act of 2003 mandates that the Secretary for Health & Human Services replace the current contractors administering the Medicare Part A or Part B fee-for-service programs with new Medicare Administrative Contractors (MACs). Part A/Part B Medicare Administrative Contractors (MACs) will replace the current fiscal intermediaries and carriers and handle administration of both the Medicare Part A and Part B programs in specified geographic regions.
Question: How do I get certified as an FQHC or FQHC Look-Alike?
Answer:Community Health Centers, Migrant Health Centers, Health Care for the Homeless Programs, and Public Housing Primary Care Programs that receive grant funding under section 330 of the PHS Act are automatically certified as FQHCs.
Existing clinics that meet FQHC requirements can request certification as FQHC Look-Alikes.
Question: How do I apply for a Community Health Center PHS 330 grant?
Answer:The first step is to make sure your location or population served is eligible and that you have community support. Community Health Centers (CHCs) must serve a Medically Underserved Area or Population. To determine community support, you may want to hold a meeting. This will help you identify the people and groups who will be willing to work with you on this project.
Answer:A federally qualified health center (FQHC) is a type of provider defined by the Medicare and Medicaid statutes. FQHCs include all organizations receiving grants under Section 330 of the Public Health Service Act, certain tribal organizations, and FQHC Look-Alikes. Requirements for Indian Health Service funded FQHCs may differ from the requirements for FQHCs receiving Section 330 grants and for FQHC Look-Alikes.
There are many benefits of being an FQHC. For FQHCs that are PHS 330 grant recipients, the biggest benefit is the grant funding. For new starts, funding up to $650,000 can be requested. Other benefits include:
- Enhanced Medicare and Medicaid reimbursement
- Medical malpractice coverage through the Federal Tort Claims Act
- Eligibility to purchase prescription and non-prescription medications for outpatients at reduced cost through the 340B Drug Pricing Program
- Access to National Health Service Corps
- Access to the Vaccine for Children Program
- Eligibility for various other federal grants and programs
Question: What is a Federally Qualified Health Center Look-Alike and what are the benefits?
Answer:An FQHC Look-Alike is an organization that meets all of the eligibility requirements of an organization that receives a PHS Section 330 grant, but does not receive grant funding. FQHC Look-Alikes receive many of the same benefits as FQHCs, including:
- Enhanced Medicare and Medicaid reimbursement
- Eligibility to purchase prescription and non-prescription medications for outpatients at reduced cost through the 340B Drug Pricing Program
- Automatic designation as a Health Professional Shortage Area (HPSA). The HPSA designation provides eligibility to apply to receive National Health Service Corps (NHSC) personnel and eligibility to be a site where a J-1 Visa physician can serve.
Question: What is a PHS Section 330 grant?
Answer:Section 330 of the Public Health Service Act defines federal grant funding opportunities for organizations to provide care to underserved populations. Types of organizations that may receive 330 grants include: Community Health Centers, Migrant Health Centers (see Migrant Health for more information), Health Care for the Homeless Programs, and Public Housing Primary Care Programs.
Question: Can a for-profit clinic be an FQHC?
Answer:No. An FQHC must be a public entity or a private non-profit.
Question: Is a board of directors required?
Answer:Yes, FQHCs receiving Section 330 grants and FQHC Look-Alikes must be governed by a board of directors. The board must include a majority (at least 51%) of active, registered clients of the health center who are representative of the populations served by the center. The governing board ensures that the center is community based and responsive to the community’s health care needs. Under certain conditions the board composition requirements can be waived for migrant, homeless, public housing only health centers.
Question: Are there location requirements for FQHCs?
Answer:It depends. Each FQHC that receives PHS 330 grant funding must meet the requirements of that grant. Community Health Centers must serve a Medically Underserved Area (MUA) or Medically Underserved Population (MUP). To determine if your area qualifies, search the MUA/MUP database. If an area does not have the MUA/MUP designation they can apply for it and can put in an application for a PHS Section 330 grant while the designation is being processed.
Migrant Health Centers, Health Care for the Homeless and Public Housing Primary Care Programs do not need to meet the MUA/MUP restriction. FQHCs may be located in rural and urban areas.
Question: Are there special staffing requirements for FQHCs?
Answer:No, there are no specific requirements for staffing mix at FQHCs. FQHCs are required to have a core staff of full time providers but there is no specific definition of core staff. It is recommended that they maintain a staffing level that allows for between 4,200-6,000 visits per year for each full-time equivalent health care provider.
Another guide to the appropriate number of providers is described in the Requirements of Fiscal Year 2005 Funding Opportunity for Health Center New Access Point Grant Applications (PIN 2005-01) as a physician to patient ratio of 1:1,500 and a mid-level practitioner to patient ratio of 1:750.
Question: What types of services do FQHCs provide?
Answer:FQHCs must provide primary care services for all age groups. FQHCs must provide preventive health services on site or by arrangement with another provider. Other requirements that must be provided directly by an FQHC or by arrangement with another provider include:
- Dental services
- Mental health and substance abuse services
- Transportation services necessary for adequate patient care
- Hospital and specialty care
Question: Are there minimum hours that an FQHC must be open?
Answer:Yes, 32 hours per week is the minimum. FQHCs must also have professional call coverage when the practice is closed, directly or through an after-hours care system.
Question: Is a sliding fee scale required?
Answer:Yes, FQHCs must use a sliding fee scale with discounts based on patient family size and income in accordance with federal poverty guidelines. FQHCs must be open to all, regardless of their ability to pay.
Question: What are the Medicare Administrative Contractors (MACs) and what is their role in administering Medicare Part A and Part B?
Answer:Section 911 of the Medicare Modernization Act of 2003 mandates that the Secretary for Health & Human Services replace the current contractors administering the Medicare Part A or Part B fee-for-service programs with new Medicare Administrative Contractors (MACs). Part A/Part B Medicare Administrative Contractors (MACs) will replace the current fiscal intermediaries and carriers and handle administration of both the Medicare Part A and Part B programs in specified geographic regions.
Question: How do I get certified as an FQHC or FQHC Look-Alike?
Answer:Community Health Centers, Migrant Health Centers, Health Care for the Homeless Programs, and Public Housing Primary Care Programs that receive grant funding under section 330 of the PHS Act are automatically certified as FQHCs.
Existing clinics that meet FQHC requirements can request certification as FQHC Look-Alikes.
Question: How do I apply for a Community Health Center PHS 330 grant?
Answer:The first step is to make sure your location or population served is eligible and that you have community support. Community Health Centers (CHCs) must serve a Medically Underserved Area or Population. To determine community support, you may want to hold a meeting. This will help you identify the people and groups who will be willing to work with you on this project.
Are you interested in becoming an FQHC or FQHC Look Alike?
FQHCmd Consulting has experience working with many types of organizations, including Primary Care Associations, Hospital Systems, Behavioral Health Centers, Medical Practices, and Community Organizations that are interested in obtaining either FQHC or FQHC Look Alike status.
We will work with you to determine the best strategy to move forward and obtaining your goals.
We will work with you to determine the best strategy to move forward and obtaining your goals.