Health centers, both Federally Qualified Health Centers,
which receive Federal funding, and Federally Qualified
Health Center Look-Alikes, which do not, must meet
a strict set of requirements; the following list provides
a summary. For additional information on these requirements,
please review:
- Health Center
Program Statute: section 330 of the Public Health
Service Act (42 U.S.C. §254b)
- Program Regulations (42 CFR Part 51c and 42 CFR
Parts 56.201-56.604 for Community and Migrant Health
Centers)
- Grants Regulations (45 CFR Part 74)
1. Needs Assessment: Demonstrate
and document the needs of the target population, including
updating their service area, when appropriate. (Section
330(k)(2) and Section 330(k)(3)(J) of the PHS Act)
2. Medically Underserved Area (MUA)/Medically
Underserved Population (MUP) Designation: Serve,
in whole or in part, a designated MUA/MUP. (Section
330(a) of the PHS Act) (Requested, not required for
HCH, PHPC, or MHC applicants)
3. Required and Additional Services:
Provide all required primary, preventive, enabling
health services and additional health services as
appropriate and necessary, either directly or through
established written arrangements and referrals per
program requirements. (Section 330(a) of the PHS Act)
Note: Applicants requesting funding to serve homeless
individuals and their families must provide substance
abuse services among their required services. (Section
330(h)(2) of the PHS Act)
4. Staffing Requirement: Maintain
a core staff as necessary to carry out all required
primary, preventive, enabling health services and
additional health services as appropriate and necessary,
either directly or through established arrangements
and referrals. (Section 330(a)(1) and (b)(1), (2)
of the PHS Act)
5. Accessible Hours of Operation/Locations:
Provide services at times and locations that
assure accessibility and meet the needs of the population
to be served. (Section 330(k)(3)(A) of the PHS Act)
6. After Hours Coverage: Provide
professional coverage during hours when the center
is closed. (Section 330(k)(3)(A) of the PHS Act)
7. Hospital Admitting Privileges and Continuum
of Care: Physicians have admitting privileges
at one or more referral hospitals, or other such arrangement
to ensure continuity of care. In cases where hospital
arrangements (including admitting privileges and membership)
are not possible, applicant must firmly establish
arrangements for hospitalization, discharge planning,
and patient tracking. (Section 330(k)(3)(L) of the
PHS Act)
8. Sliding Fee Discounts: A system
in place to determine eligibility for patient discounts
adjusted on the basis of the patient’s ability
to pay. This system must provide a full discount to
individuals and families with annual incomes at or
below the poverty guidelines (only nominal fees may
be charged) and for those with incomes between 100
percent and 200 percent of poverty, fees must be charged
in accordance with a sliding discount policy based
on family size and income. No discounts may be provided
to patients with incomes over 200 percent of the Federal
poverty level. (Section 330(k)(3)(G) of the PHS Act
and 42 CFR Part 51c.303(f))
9. Quality Improvement/Assurance Plan:
Ongoing Quality Improvement/Quality Assurance (QI/QA)
program that includes clinical services and management
and maintains the confidentiality of patient records;
the QI/QA program must include:
- A focus of responsibility to support the quality
improvement/assurance program and the provision
of high quality patient care;
- Periodic assessment of the appropriateness of
the utilization of services and the quality of services
provided or proposed to be provided to individuals
served by the applicant; and
- Such assessments shall: be conducted by physicians
or by other licensed health professionals under
the supervision of physicians; be based on the systematic
collection and evaluation of patient records; and
identify and document the necessity for change in
the provision of services by the applicant and result
in the institution of such change, where indicated.
(Section 330(k)(3)(C) of the PHS Act and 42 CFR
51c.303(c)(1-2))
10. Collaborative Relationships:
Establish and maintain collaborative relationships
with other health care providers, including other
health centers, in the service area of the center.
Interested section 330 applicants must secure a letter
of support from the existing health center(s) in the
service area or provides an explanation for why such
a letter of support cannot be obtained. (Section 330(k)(3)(B)
of the PHS Act)
11. Affiliation Agreements: Appropriate
oversight and authority over all contracted services.
Section 330(k)(3)(I)(ii) and 42 CFR Part 51c.303(n),
(t))
12. Key Management Staff: Maintain
a fully staffed health center management team as appropriate
for the size and needs of the center. Prior review
of final candidates for Project Director/Executive
Director/CEO position is required. (Section 330(k)(3)(H)(ii)
of the PHS Act and 45 CFR Part 74.25 (c)(2), (3))
13. Financial Management and Control Policies:
Accounting and internal control systems are appropriate
to the size and complexity of the organization reflecting
Generally Accepted Accounting Principles (GAAP) and
separates functions appropriate to organizational
size to safeguard assets. Assures that an annual independent
financial audit is performed in accordance with Federal
audit requirements, addressing all reportable/material
weaknesses in the Audit Report. (Section 330(k)(3)(D),
Section 330(q) of the PHS Act and 45 CFR Part 74.21)
14. Program Data Reporting Systems:
Systems which accurately collect and organize data
for program reporting and which support management
decision making. (Section 330(k)(3)(I)(ii) of the
PHS Act)
15. Billing and Collections: Systems
in place to maximize collections and reimbursement
for costs related to providing health services, including
written billing, credit, and collection policies and
procedures. (Section 330(k)(3)(F) and (G) of the PHS
Act)
16. Budget: Reflects the costs of
operations, expenses, and revenues (including the
Federal grant) necessary to accomplish the service
delivery plan. (Section 330(k)(3)(D), Section 330(k)(3)(I)(i),
and 45 CFR Part 74.25)
17. Service Level: Maintain funded
scope of project (i.e., projected number of patients
to be served, including any increases based on recent
New Access Point/Expanded Medical Capacity awards).
(45 CFR Part 74.25)
18. Board Authority: Governing board maintains appropriate
authority to oversee the operations of the center,
including:
- holding monthly meetings (May be waived for eligible
applicants. See Form 6- B),
- approval of the health center’s grant application
and budget,
- selection/dismissal and performance evaluation
of the health center CEO,
- selection of services to be provided and the
health center’s hours of operations,
- establishment of general policies for the health
center. Note: Some fiscal and personnel policies
may be retained in the case of public centers (also
referred to as “public entities”). (Section
330(k)(3)(H) of the PHS Act)
19. Conflict of Interest Policy:
Bylaws or written corporate board-approved policy
include provisions that prohibit conflict of interest
or the appearance of conflict of interest by board
members, employees, consultants, and those who furnish
goods or services to the health center. No board member
shall be an employee of the health center or an immediate
family member of an employee. The Chief Executive
Officer may serve only as an ex-officio member of
the board. (45 CFR Part 74.42 and 42 CFR Part 51c.304(b),
when applicable)
20. Board Composition (May be waived
for eligible section 330 applicants. See Form 6- B):
Governing board must be composed of individuals, a
majority of whom are being served by the center and,
who as a group, represent the individuals being served
by the center. Interested section 330 applicants that
receive/request targeted funding to serve migrant
and seasonal farmworkers, individuals experiencing
homelessness, and/or residents of public housing,
must have appropriate representation on the board
from these populations. (Section 330(k)(3)(H) of the
PHS Act)
21. Waiver of Board Requirements
(Applicants requesting targeted funding under sections
330(g), 330 (h), and/or 330(i) but not requesting
330(e) funds): Upon a showing of good cause the Secretary
shall waive, for the length of the project period,
all or part of the requirements of this subparagraph
in the case of a health center that receives a grant
pursuant to subsection (g), (h), (i), or (p). Such
eligible applicants may request a waiver of the Board
Composition and/or Monthly Meeting requirement(s).
(Section 330(k)(3)(H) of the PHS Act)
22. Board Size (for CHC and MHC):
Governing board has at least 9 but no more than 25
members, as appropriate for the complexity of the
organization. (42 CFR Part 51c.304)
23. Board Expertise (for CHC and
MHC ): Remaining members of the board shall be representative
of the community in which the center's catchment area
is located and shall be selected for their expertise
in community affairs, local government, finance and
banking, legal affairs, trade unions, and other commercial
and industrial concerns, or social service agencies
within the community. (42 CFR Part 51c.304)
24. Non-Consumer Board Member Income (for
CHC and MHC ): No more than one-half (50%) of the
non-consumer board members may derive more than 10
percent of their annual income from the health care
industry. (42 CFR Part 51c.304)
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