A Federally Qualified Health Center (FQHC) is a reimbursement designation from the
Bureau of Primary Health Care
The Bureau of Primary Health Care (BPHC) is a part of the Health Resources and Services Administration (HRSA), of the United States Department of Health and Human Services. HRSA helps fund, staff and support a national network of health clinics fo ...
and the
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer M ...
of the
United States Department of Health and Human Services
The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is ...
. This designation is significant for several health programs funded under the
Health Center Consolidation Act
The Health Center Consolidation Act of 1996 in the United States is commonly also called Section 330. The Act brings together various funding mechanisms for the country's community health facilities, such as migrant/seasonal farmworker health ...
(Section 330 of the
Public Health Service Act
The Public Health Service Act is a United States federal law enacted in 1944. The full act is codified in Title 42 of the United States Code (The Public Health and Welfare), Chapter 6A (Public Health Service).
Contents
The act clearly establis ...
).
An FQHC is a community-based organization that provides comprehensive
primary care
Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care t ...
and
preventive care
Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing disease, prolonging life, and promoting physical and mental hea ...
, including
health
Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...
,
oral
The word oral may refer to:
Relating to the mouth
* Relating to the mouth, the first portion of the alimentary canal that primarily receives food and liquid
**Oral administration of medicines
** Oral examination (also known as an oral exam or oral ...
, and
mental health
Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health ...
/
substance abuse
Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods which are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, ...
services to persons of all ages, regardless of their ability to pay or
health insurance status. Thus, they are a critical component of the health care safety net.
FQHCs are called Community/Migrant Health Centers (C/MHC), Community Health Centers (CHC), and 330 Funded Clinics. FQHCs are automatically designated as
health professional shortage facilities.
Funded programs
Health programs funded include:
*
Community Health Centers which serve a variety of federally designated
Medically Underserved Areas/Populations (MUA or MUP).
*Migrant Health Centers which provide culturally competent and primary preventive medical care to migrant and seasonal agricultural workers.
[
*Health Care for the Homeless Programs which reach out to homeless individuals and families and provide primary and preventive care and substance abuse services][ and
*Public Housing Primary Care Programs that serve residents of public housing and are located in or adjacent to the communities they serve.][
]
Leadership
FQHCs operate under a consumer Board of Directors governance structure and function under the supervision of the Health Resources and Services Administration
The Health Resources and Services Administration (HRSA) is an agency of the U.S. Department of Health and Human Services located in North Bethesda, Maryland. It is the primary federal agency for improving access to health care services for peop ...
(HRSA), which is part of the United States Department of Health and Human Services
The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is ...
(HHS). FQHCs were originally meant to provide comprehensive health services to the medically underserved to reduce the patient load on hospital emergency room
An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of pati ...
s.
Their mission has changed since their founding. Their mission now is to enhance primary care services in underserved urban and rural communities.migrant worker
A migrant worker is a person who Human migration, migrates within a home country or outside it to pursue work. Migrant workers usually do not have the intention to stay permanently in the country or region in which they work.
Migrant worker ...
s and non-U.S. citizens
Citizenship of the United States is a legal status that entails Americans with specific rights, duties, protections, and benefits in the United States. It serves as a foundation of fundamental rights derived from and protected by the Constitut ...
.Federal Tort Claims Act
The Federal Tort Claims Act (August 2, 1946, ch.646, Title IV, 28 U.S.C. Part VI, Chapter 171and ) ("FTCA") is a 1946 federal statute that permits private parties to sue the United States in a federal court for most torts committed by person ...
(FTCA).
Look-Alikes
The government also designates a category of health centers as "FQHC Look-Alikes." These health centers do not receive grants under Section 330 but are determined by the Secretary of the Department of Health and Human Services (HHS) to meet the requirements for receiving a grant based on the Health Resources and Services Administration recommendations.[ Also, FQHC Look-Alikes receive cost-based reimbursement for their Medicaid services, but do not receive malpractice coverage under FTCA or a cash grant. Look-Alikes also qualify as health professional shortage areas (HPSA) automatically.
]
Services under Medicare
FQHC benefit under Medicare became effective October 1, 1991, when Section 1861(aa) of the Social Security Act
The Social Security Act of 1935 is a law enacted by the 74th United States Congress and signed into law by US President Franklin D. Roosevelt. The law created the Social Security program as well as insurance against unemployment. The law was pa ...
was amended by Section 4161 of the Omnibus Budget Reconciliation Act of 1990
The Omnibus Budget Reconciliation Act of 1990 (OBRA-90; ) is a United States statute enacted pursuant to the budget reconciliation process to reduce the United States federal budget deficit. The Act included the Budget Enforcement Act of 1990 whic ...
.[ FQHCs provide Medicare beneficiaries with preventive primary health services such as immunizations, visual acuity and hearing screenings, and prenatal and post-partum care.][ However, eyeglasses, hearing aids, and preventive dental services are not covered under the FQHC preventive primary services. A FQHC ]Prospective Payment System A prospective payment system (PPS) is a term used to refer to several payment methodologies for which means of determining insurance reimbursement is based on a predetermined payment regardless of the intensity of the actual service provided.
It in ...
(PPS) was scheduled to be implemented in 2014.[ The Patient Protection and Affordable Care Act (ACA) mandates that the Centers for Medicare and Medicaid Services (CMS) collect and analyze health services data prior to developing and implementing the new payment system. This requires that the appropriate revenue code and ]Healthcare Common Procedure Coding System The Healthcare Common Procedure Coding System (HCPCS, often pronounced by its acronym as "hick picks") is a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT).
History
The acronym '' ...
(HCPCS) code be listed with each service provided.[ Currently, Medicare pays FQHC directly based on an all-inclusive per visit payment.][
]
Advanced Primary Care Practice demonstration project
In June 2011, the Department of Health and Human Services announced the Federally Qualified Health Center Advanced Primary Care Practice (FQHC APCP) demonstration project.[
] This demonstration project is conducted under the authority of Section 1115A of the Social Security Act, which was added by section 3021 of the ACA and establishes the Center for Medicare and Medicaid Innovation (Innovation Center).[ This initiative was designed to evaluate the impact of the advanced primary care practice (APCP) model, also referred to as the patient-centered medical home (PCMH) on improving health, quality of care and lowering the cost of care provided to Medicare beneficiaries.][ The ACA will pay an estimated $42 million over three years (November 1, 2011 to October 31, 2014) to 500 FQHCs to coordinate care for 195,000 Medicare patients.][ Participating FQHCs agree to adopt care coordination practices set by the ]National Committee for Quality Assurance
The National Committee for Quality Assurance (NCQA) is an independent 501(c)(3) nonprofit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and ...
(NCQA) and are expected to achieve Level 3 patient-centered medical home recognition.[
President Bush launched the ]Health Centers Initiative
Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...
to significantly increase access to primary health care services in 1,200 communities through new or expanded health center sites. Between 2001 and 2006, the number of patients treated at health centers increased by over 4.7 million, representing a nearly 50 percent increase in just five years. In 2006 the number of patients served topped the 15 million mark for the first time.
Throughout the United States there are over 1,000 health centers that operate approximately 6,000 sites.[ In 2010, the health centers served an estimated 20 million patients.][
] The data collected via the Uniform Data System (UDS) reports that of those patients served, 62 percent were members of a racial or ethnic minority (predominantly Hispanic), 93 percent lived at or below 200 percent of the federal poverty level, 72 percent lived at or below 100 percent of the federal poverty level, and 38 percent were uninsured. In particular, during 2010 health centers served 862,775 migrant and seasonal farm workers and their families; more than 1 million individuals experiencing homelessness; and 172,731 residents of public housing.[
]
Impact of the Patient Protection and Affordable Care Act
The health center program's annual federal funding has grown from $1.16 billion in fiscal year 2001 to $1.99 billion in fiscal year 2007. The passage of the Patient Protection and Affordable Care Act
The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act and colloquially known as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by Presi ...
(ACA) in March 2010 resulted in provisions that increased federal funding to FQHCs to help them meet the anticipated health care demand of millions of Americans who will gain health care coverage as result of the health reform law.[
]
Total centers by location
{, class="wikitable sortable" style="text-align:right"
, + FQHCs in 2016
References
External links
Bureau of Primary Health CareCenter for Medicare and Medicaid AdvocacyNational Association of Community Health CentersGeneral information Texas Association of Community Health CentersCommunity Health Center Association of ConnecticutCommunity Health Center of Central Florida
Healthcare in the United States