considering the alternative of forming a federally qualified health center
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Congress on the Un and Under Insured/National Congress on Health Reform September 22-24, 2008 Washington, DC. Considering the Alternative of Forming a Federally Qualified Health Center Roger Schwartz, J.D., Associate Vice President of Executive Branch Liaison - PowerPoint PPT PresentationTRANSCRIPT
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Congress on the Un and Under Insured/National Congress on Health Reform
September 22-24, 2008Washington, DC
Considering the Alternative of Forming a Federally Qualified Health CenterRoger Schwartz, J.D., Associate Vice President of
Executive Branch LiaisonNational Association of Community Health Centers
National Association of Community Health Centers
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National Association of Community Health Centers
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• Patients of the Health Center– 1200 health center grantees and 6600 delivery
sites– Medical and health care home for 18 million
people nationwide
National Association of Community Health Centers
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National Association of Community Health Centers
Figure 1Health Center Patients By
Income Level, 2007
Source: Bureau of Primary Health Care, HRSA, DHHS, 2007 Uniform Data System
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National Association of Community Health Centers
Figure 2 Health Center Patients By
Race/Ethnicity, 2007Ethnicity
African American
28%
White62%
More than one Race4%
Race
American Indian/Alaska Native
1%
Asian/Hawaiian/Pacific /HaIslander 4%
Hispanic or Latino34%
All Others66%
Source: Bureau of Primary Health Care, HRSA, DHHS, 2007 Uniform Data System
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National Association of Community Health Centers
Figure 3
Health Center Patients By Insurance Status, 2007
Uninsured39%
Medicaid/SCHIP35%
Medicare8%
Private15%
Other Public3%
Note: “Other Public” may include non-Medicaid SCHIP. Percents may not total 100% due to rounding.Source: Bureau of Primary Health Care, HRSA, DHHS, 2007 Uniform Data System
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• Other Programs and Benefits that Support Health Centers– Medicaid – FQHCs
• Mandatory service: RHC services and any other ambulatory service in state plan
• Prospective payment or alternative payment methodology
• Managed care wrap-around • FQHC Look-alikes• 42 USC 1396d (a)(2)(C),1396a(a)(10)(A), 1396d(1)(2),
1396a(bb)
National Association of Community Health Centers
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• Medicare – FQHCs– Reasonable cost reimbursement but with a “cap”– RHC services plus DSMT, MNT, and preventive
primary care services per Section 330 of PHSA.– Managed care wrap-around under Medicare
Advantage– No deductible – 42 USC 1395x (aa)(3) and (4), 13951(a)(3)
National Association of Community Health Centers
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• Section 340B Drug Rebate Program:– Health centers and FQHCs are “covered entities”– Condition for Medicaid participation by drug
manufacturers– “duplicate discount” issue in Medicaid– 42 USC 256b
National Association of Community Health Centers
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• FTCA Coverage– Deeming process– Covers health centers, their employees and
certain contractors– Issues regarding treatment of non-health center
patients– 42 USC 233 (g)-(n)
National Association of Community Health Centers
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• Federal Anti-kickback Safe Harbors– For waiving cost-sharing for patients with income
below 200% FPL– For certain health centers (not look-alikes)– 42 USC 1320a-7b(b)(3)(D) and (H)– National Health Services Corps (NHSC)
42 USC 254d
National Association of Community Health Centers
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• Where to find out more:– www.nachc.com– “So You Want to Start A Health Center: A Practical
Guide for Starting a Community Health Center(Oct, 2002)
– National Association of Community Health Centers7200 Wisconsin Avenue, NW – Suite 210Bethesda, MD 20814301.347.0400(phone)301.347.0459(fax)
National Association of Community Health Centers