Transcript Community Health Center Benefits

Community Health Center
Benefits
Grant Funded Health
Centers & Look-Alikes
Prospective Payment System
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Provides special Medicaid payments
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Based on cost of care
Includes all allowable costs
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Core services: medical, dental, behavioral health
Administration
Enabling services
Negotiated with State Medicaid programs
Provides payment/encounter w/settlement
Enhanced Medicare Payments
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Special payment rates
First dollar coverage (deductibles waived)
Cost-based payment formula
Subject to national cap
Special payment intermediary
Requires “Deeming”
Limited scope; facility based
Pharmacy Benefit
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340B drug pricing program
Special program providing lowest drug price
available
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FQHC price may be adjusted for administrative
cost
FQHC price may include margin to increase
services to underserved
All patients of funded CHC eligible
Recruitment
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Automatic Health Provider Shortage Area (HPSA)
designation, eligible for National Health Service
Corps clinical providers
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Physicians, physician assistants
Nurse Practitioners, midwives etc
Psychiatrics, LMSWs, psychologists, therapists etc.
Dentists, hygienists
NHSC Scholar & Loan Repayment Programs
Also state programs, when available
Other Benefits
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Vaccines for Children program
Participation in federal QI programs
Access to on-site eligibility workers
Part of a national and state community of
providers sharing mission & information
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HHS HRSA/BPHC; NACHC; MPCA; AHCAHP
etc.
Grant Funded Health Centers
Additional Benefits
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Section 330 Grant Funding
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Offsets costs of uncompensated care
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Sliding fee scale, based on ability to pay (<200% FPL)
Offsets costs of enabling services
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Translation
Benefits assistance
Transportation
Case management
Chronic disease management, etc.
Malpractice Coverage
(Funded grantees only)
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Federal Tort Claims Act
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Similar to coverage of US military
Covers all in-scope services
Covers the health center corporation
CHC grantee must be “deemed”
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Eligibility and scope determined
Risk management program required
Other Benefits
(Funded grantees only)
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Federal loan guarantee program (Not Look-Alikes)
Eligible to apply for: (Look-Alikes not eligible)
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Expanded medical capacity funds
Services expansion funds, etc., etc.
Special benefits (i.e. stimulus awards)
Benefits to Community
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Providing a health home for all community,
particularly the underserved
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Alternative to emergency department
Alternative to uncoordinated urgent care
Provide needed quality, comprehensive primary care
(Providing continuity of care)
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Acute primary
Preventive (i.e. immunizations, exams, etc.)
Chronic disease management etc.
Supplemental (health education) and enabling services
(translation, cultural competence etc.)
Benefits to Community (Continued)
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Enhanced insurance and benefit coverage
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Medicaid (FQHC bundle of services)
Medicare (First dollar coverage)
Access to benefit eligibility enrollment
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Discounted fees to underserved
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Medicare
Medicaid
SCHIP
Sliding fee scale adjusting fees to ability to pay
Special consideration for inclusion in many special
federal and state health care programs
Michigan Primary Care Association
Neal Colburn
Technical Assistance Consultant
Michigan Primary Care Association
7215 Westshire Drive
Lansing, MI 48917
(517) 381-8000 x220
[email protected]