Overview

This document describes expectations of entities funded by the Bureau of Primary Health Care (BPHC) under section 330 of the Public Health Service Act as amended by the Health Centers Consolidation Act of 1996.

All health centers authorized to receive grants under section 330 are covered by these expectations including community health centers providing care to diverse underserved populations - section 330 (e); those serving migratory and seasonal farm workers and their families - section 330 (g); those serving homeless people including homeless children - section 330 (h); and those serving residents of public housing - section 330 (i).

The expectations also apply to school-based health centers funded through the Healthy Schools, Healthy Communities program. Federally Qualified Health Center (FQHC) look-alikes, by definition, must meet the requirements for health centers under section 330. Thus, they are governed by these expectations to the same extent as health centers, subject to any waivers.

Migrant Voucher Programs are not covered by the expectations.

The term "health center" is used throughout the Program Expectations to refer to all the diverse types of organizations and programs covered by the various subsections of section 330, including organizations funded to serve migrant and seasonal agricultural workers, the homeless, and residents of public housing. The expectations emphasize the similarities but recognize the differences among health centers.

There is no "model" health center, yet all health centers share many attributes including:

• their mission to provide primary and preventive health services to underserved populations, while working with constrained resources;
• the imperative to maintain strong leadership, finances and infrastructure in order to adapt and survive the challenges of a transforming health care environment; and
• the delivery of high quality clinical services which have a demonstrated impact on health outcomes.

Health centers have been a critical component of our country's health care safety net for more than 30 years and will continue to be essential for the foreseeable future. The Program Expectations are intended to ensure that health centers not only survive but thrive as they move into the twenty-first century.

The Program Expectations recognize that health centers serve culturally and linguistically diverse populations. Some health centers receive funding for the specific purpose of providing services to a distinct underserved population such as homeless people, migratory and seasonal farmworkers, or residents of public housing. The expectations state that all health centers must provide services which are culturally and linguistically appropriate for the diverse populations they serve.

Health centers which receive funding to serve a defined special population, however, have additional requirements they must meet, and these are identified in the expectations.

The Program Expectations address requirements of law and regulation as well as BPHC policies. In general,

• Expectations that have a basis in law 1 and regulation 2 are indicated in the document by the word "must" and must be met for entities to be eligible for funds.
• Expectations that reflect BPHC priorities and preferences for program funding or elements associated with successful programs are referred to by "should" or similar wording.

In evaluating new and continued funding applications, consideration will be given to the extent to which applicants comply with those expectations identified by "should."

Most importantly, the expectations highlight aspects of health center programs associated with success. The Program Expectations provide the basis for other BPHC processes and documents including the grant application instructions, grant review criteria, and program reviews, including the Primary Care Effectiveness Review (PCER).

Policy Information Notices (PIN) and Program Assistance Letters (PAL), which are issued periodically by the Bureau, provide additional detail and guidance on selected topics addressed in the expectations.

In addition, these expectations may be supplemented for classes of health centers whose unique organizational/operational style demand that the expectations be adapted to their way of doing business (e.g., school-based health centers).

The Program Expectations comprise four sections:

• Section I: Mission and Strategy, addresses the importance of adapting to health care trends and remaining financially viable, while fulfilling the essential health center mission of providing preventive and primary care services which improve the health
• Section II: Clinical Program, highlights the services, staffing and systems which contribute to the provision of high quality health care.
• Section III.: Governance, summarizes the structure, composition and responsibilities of health center governing bodies.
• Section IV: Management and Finance, describes the management team, systems and infrastructure which lead and support the health center in the pursuance of its mission. Because all components work together to make a health center successful, the Program Expectations should be reviewed in their entirety. However, a table of contents is provided to assist with reference to a particular section.

Issued and Last Revised: August 17, 1998