IV. Definitions
A. “Scope of Project”
A health center’s scope of project includes
the activities that the total approved
section 330 grant-related project budget
supports.6
Specifically, the scope of project defines
the approved service sites, services,
providers, service area(s) and target
populations(s) which are supported (wholly
or in part) under the total section 330
grant-related project budget. A grantee’s
scope of project must be consistent with
applicable statutory and regulatory requirements
and the mission of the health center.
A section 330-funded health center must
include the provision of certain services
within its scope of project, including
primary health care services, referrals
to providers of health-related services,
patient case management services, and
enabling services.7
Section 330-funded health centers may
also provide additional health services
in support of required primary health
services and as appropriate for the health
center population.8
Section 330-funded health centers may
also carry out other activities (other
lines of business) that are not part of
their Federal scope of project and, thus,
are not subject to section 330 requirements.
For example, a grantee corporation may
run a day care center that is not within
the scope of the federally supported project
and does not use section 330 funds, personnel,
or related revenue for support; therefore,
it would not be subject to section 330
requirements or eligible for the benefits
that extend to activities within the grantee’s
scope of project.
Eligibility for Medicaid Prospective
Payment System payment,9Medicare
FQHC reimbursement, and Federal Tort Claims
Act (FTCA) coverage for a health care
service is contingent upon the inclusion
of the service in the health center’s
approved Federal scope of project.10
B. “Provider”
The term “provider” refers to individual
health care professionals (including physicians,
physician assistants, nurse practitioners,
and certified nurse midwives) who deliver
services to health center patients on
behalf of the health center. Providers
assume primary responsibility for assessing
the patient and documenting services in
the patient’s record. Providers include
only those individuals who exercise independent
judgment as to the services rendered to
the patient during an encounter/visit.
Grantees utilize a variety of mechanisms
for provider staffing in order to maximize
access to comprehensive, efficient, cost-effective,
and quality health care. For instance,
grantees may directly employ or contract
with individual providers, may have arrangements
with other organizations, or may utilize
volunteers.11
Grantees must ensure that for all contracted
clinical staff or volunteers, there is
a separate, written agreement.
C. “Service Site”
A service site is any location where
a health center, either directly or through
certain sub-recipients12
or certain established arrangements,13
provides required primary health services
and/or approved additional services to
a defined service area or population.
Service sites are defined as locations
where all of the following conditions
are met:
- health center encounters/visits are
generated by documenting in the patients’
record face-to-face contacts between
patients and providers;
- providers exercise independent judgment
in the provision of services to the
patient;
- services are provided directly by
or on behalf of the grantee, whose governing
board retains control and authority
over the provision of the services at
the location; and
- services are provided on a regularly
scheduled basis (e.g., daily, weekly,
first Thursday of every month).14
However, there is no minimum number
of hours per week that services must
be available at an individual site/location.
Administrative offices or locations that
do not provide direct health care services
are not service sites.
D. Primary Health Care Services
Health services related to family medicine,
internal medicine, pediatrics, obstetrics
and gynecology, preventive dental care,
and mental health/substance abuse treatment
are considered by HRSA to be “primary
health care services” and are included
among the health services that health
centers are required to provide directly
or through contracts or established arrangements
under section 330. Services provided
by primary health care clinicians as part
of their ordinary scope of practice are
not considered “specialty services.”
This PIN addresses change in scope requests
to add services other than services generally
provided under these primary health care
categories.
E. “Specialty Services”
HRSA considers specialty services to
be within the broad category of “additional”
health services, defined in section 330
as services that are not included as required
primary health care services and that
are (1) necessary for the adequate support
of primary health services and (2) appropriate
to meet the health needs of the population
served by the health center.”15
In most cases, HRSA will consider diagnostic/screening
procedures, as well as some treatment
procedures, to be within the scope of
the health center’s section 330 project
as “additional” health services. For
example, where the health center serves
a population with a high prevalence of
diabetes, endocrinology, podiatry, and
optometry/ophthalmology services could
be considered both “supportive” of primary
health services for the diabetic health
center patients as well as appropriate
to meet the health center population’s
needs. (See additional discussion below,
in section VI.A and VI. B. of this PIN.)
F. “Specialists”
For purposes of this PIN, a specialist
is considered to be an appropriately licensed
and credentialed health care provider
(see section VI.E. of this PIN) who has
been granted appropriate specialty-specific
privileges by the health center. The full
range of services within a specialist’s
area of expertise may or may not be within
the Federal scope of project.
issued
December 18, 2008 |