FQHC - Federally Qualified Health Centers

A simple mnemonic to be used as an outline for understanding FQHCs federally qualified health centers. Use FQHC letter to understand

Federally, Fees based on ability to pay

Qualified, quality health care for all, FQHC have shown to have good outcomes and high patient satisfaction

Health, health professional team for caring for adult checks ups, childcare, complex care of chronic conditions

Center: community controlled, usually the board consists of community members

As of the end of 2014, there are 1,287 health center organizations currently providing services throughout the United States. These health centers operate in every state, including the District of Columbia, Puerto Rico, Guam, American Samoa, the Marshall Islands, the Northern Mariana Islands, the Federated States of Micronesia, and the US Virgin Islands. With more than 9,000 sites, they cater to over 22.87 million unique patients.

Health centers play a crucial role in ensuring access to preventive and primary healthcare for millions of individuals who have public insurance, such as Medicaid or the Children's Health Insurance Program. Additionally, they provide care to those who are uninsured or have low incomes. Without these health centers, these individuals would have limited access to necessary healthcare services and might be compelled to seek care in more expensive settings, such as emergency departments.

It is worth noting that health centers consistently achieve high-quality health outcomes while maintaining costs well below national averages.

What is a health center? 

Requirements as of July 2021: 

- Provide comprehensive services and have a quality assurance program

- safety requirements

- Not be approved as a rural health clinic

- Serve medically unserved areas or populations.

- be scale to patients with incomes below to 100% federal poverty level

- Be governed by board of directors majority of them are FQHC patients

- Core staff of train primary care providers

Health centers primarily serve medically underserved populations by providing essential primary and preventive healthcare services. However, their scope of services extends beyond medical care. Health centers are also responsible for providing or arranging dental care, behavioral health services, and "enabling" services. Enabling services include wraparound care such as case management, interpretation services, and transportation assistance, all of which help patients access the care they require.

One distinctive aspect of health centers is their focus on not only the health of individual patients but also the overall health of the community they serve. This community-oriented approach sets health centers apart from other healthcare delivery models. It entails conducting needs assessments, developing programs, evaluating outcomes, and defining the concept of "community" in terms of both its assets and needs, in addition to individual patient health.

Furthermore, health centers are encouraged to attain recognition as Patient-Centered Medical Homes (PCMH). This designation signifies that the center delivers care in a coordinated manner, with a primary focus on ensuring that patients have access to the care they need. Patient-centered medical homes emphasize a comprehensive and coordinated approach to healthcare delivery, with a strong emphasis on patient engagement and care coordination.

Health centers are commonly referred to as Federally-Qualified Health Centers (FQHCs) because they have obtained approval to participate in reimbursement programs under Medicare and Medicaid. However, it's important to note that FQHC is a reimbursement model rather than a physical location.

To achieve FQHC recognition, organizations must meet rigorous standards in terms of governance, access to care, quality of care, service delivery, and cost. In return for meeting these requirements, Medicare and Medicaid provide reimbursement to these organizations on a cost-based or cost-derived basis, which is typically higher than the published fee schedules.

Additionally, FQHCs have the opportunity to extend their reimbursement benefits to managed care enrollees under Medicaid. This allows FQHCs to negotiate payment arrangements with managed care organizations, ensuring that they receive adequate financial support for the services they provide.

Overall, the designation of FQHC carries significant implications for the reimbursement and financial sustainability of health centers, enabling them to better serve individuals covered by Medicare, Medicaid, and managed care plans.

Health Centers typically provide care for certain populations such as those with Medically underserved areas/populations, health professional shortages, special populations, and the community at large.

Abbreviations used: MUA: Medically Underserved Area; MUP: Medically Underserved Population; PCO: Primary care office; HPSA: Health Professional Shortage Area; NHSC: national Health Service Corps

Health centers are required to serve at least one Medically Underserved Area (MUA) or Medically Underserved Population (MUP), as designated by the federal government. These designations play a crucial role in identifying areas and populations that have limited access to healthcare services. While detailed information on applying for these designations will be provided later in this guide, it is important to provide some background on MUA and MUP at this stage.

The designation of MUA is determined based on four specific criteria. Firstly, it takes into account a low ratio of primary care physicians to the population, indicating a shortage of primary care providers in the area. Secondly, it considers a high infant mortality rate, highlighting the need for improved healthcare services to address this issue. Thirdly, it considers a high percentage of the population living below the federal poverty level, indicating socioeconomic challenges that impact access to healthcare. Lastly, it considers a high percentage of the population aged 65 and over, recognizing the healthcare needs of an aging population.

These criteria collectively help identify areas and populations that are medically underserved, and by requiring health centers to serve at least one MUA or MUP, the aim is to ensure that healthcare services reach those who need it the most.

Areas with a health professional shortage:

A Health Professional Shortage Area (HPSA) is a federal designation that indicates a documented shortage of healthcare professionals, similar to MUA/MUP. HPSA designation is used to allocate resources, including educational loan forgiveness, repayment, or scholarships for health professionals through the National Health Service Corps (NHSC). While not mandatory for health center status, HPSA designation is considered valuable in assessing the need within a community and can impact the approval of a health center application. HPSAs receive a score based on the level of need, determining priority for assistance. There are three main types of HPSAs: Primary Care, Dental, and Mental Health, each indicating shortages in their respective areas. Health centers can also obtain automatic HPSA designation, though with the lowest priority score, making it beneficial to seek geographic or population HPSA designations.

Community at large:

Services provided by a FQHC

Physician services: FQHCs offer primary care services provided by licensed physicians. These services typically include routine check-ups, diagnosis and treatment of illnesses and injuries, and preventive care.

Services and supplies incident to the services of physicians: This refers to additional services and supplies that are necessary for the diagnosis and treatment provided by physicians. Examples include laboratory tests, X-rays, medical equipment, and other services performed by non-physician staff under the supervision of a physician.

Nurse practitioner (NP), physician assistant (PA), certified nurse-midwife (CNM), clinical psychologist (CP), and clinical social worker (CSW) services: FQHCs employ a multidisciplinary team that may include NPs, PAs, CNMs, CPs, and CSWs. These healthcare professionals provide a range of services, such as primary care, preventive care, mental health services, counseling, and patient education.

Services and supplies incident to the services of NPs, PAs, CNMs, CPs, and CSWs: Similar to services provided by physicians, these non-physician practitioners may require additional services and supplies to support their care. These could include diagnostic tests, treatments, and other services provided by non-physician staff under their supervision.

Medicare Part B-covered drugs furnished by and incident to services of an FQHC practitioner: FQHCs can provide certain medications that are covered under Medicare Part B when they are necessary for the treatment or management of a patient's condition. These medications are typically administered or supervised by FQHC practitioners.

Visiting nurse services to the homebound in an area where CMS determined there is a shortage of home health agencies: FQHCs may offer visiting nurse services to patients who are homebound and live in areas with a shortage of traditional home health agencies. These services aim to provide necessary medical care and support to individuals who cannot easily access a healthcare facility.

Outpatient diabetes self-management training (DSMT) and medical nutrition therapy (MNT) for patients with diabetes or renal disease furnished by qualified practitioners of DSMT and MNT: FQHCs may provide outpatient programs for individuals with diabetes or renal disease. These programs typically involve education and training on self-management techniques, such as blood glucose monitoring, medication management, and dietary counseling provided by qualified practitioners.

It's important to note that while these services are commonly provided by FQHCs, the specific services available may vary between different FQHCs based on their resources, staffing, and community needs.A Health Center refers to a community-based organization that provides primary care and other healthcare services to individuals, families, and communities. It involves a range of factors that include:

Establishing community support through engaging and involving community members in the development and implementation of health programs.

Broad Community Support: 

The community leadership is considering establishing a health center to address the lack of accessible primary care for specific high-need populations. They have a vision of how to meet this need. The primary goal of a health center is to improve the health of individuals and the overall community. Unlike other healthcare providers, a health center must prioritize the community's needs and design its programs accordingly. This necessitates thorough understanding of the community and active citizen participation in the planning and implementation of the health center.

Before embarking on garnering support for a new health center, it is important to take the time to understand the community and its composition. Communities are not solely defined by geographical or municipal boundaries, but also by cultural, ethnic, and social factors. Additionally, the community's access to healthcare and common health needs play a role in defining it. To ensure broad community engagement, leaders and planners must also involve the larger social system and health service network in which the health center will function. Defining the service area of the health center is the initial step in identifying the community it will serve.Conducting a needs assessment and planning for health services that meet the specific needs of the community.

A comprehensive analysis of the community involves creating a social "map" that provides a detailed understanding of its various sectors. Table 1 serves as a guide, listing suggested sectors such as business, labor, government, religious institutions, healthcare providers, voluntary/civic organizations, and more. It is important to tailor the map to the specific characteristics of the community, ensuring it represents a thorough depiction of the people and organizations that could potentially be involved in the health center. The goal is to gain a broad perspective of the community, allowing for a clear assessment of its needs and the available options to address those needs. This process should be inclusive, involving all relevant stakeholders.

Once the sectors are identified, it is crucial to compile a comprehensive list of the individuals, groups, and organizations within each sector. For example, this could include all schools and school districts within the education sector. This step helps in identifying the key influencers within each sector, such as influential individuals, prominent organizations, and noteworthy political and social trends.

Finally, it is important to recognize which components of the community may act as barriers or facilitators to the establishment of a new health center, and understand the reasons behind these dynamics. By identifying potential challenges and support systems within the community, the planning process for the health center can be better informed and strategic.

The objective of this process is to ensure comprehensive inclusiveness. It is crucial to include economically disadvantaged groups, politically underrepresented individuals, and other "invisible" segments of the community in the analysis. These groups should be identified alongside the prominent individuals and institutions that hold influence. Avoid the assumption that these groups lack organized influences. It could be a religious institution, community center, labor organization, or other community-based entities that have familiar and respected individuals or organizations. Similarly, do not solely focus on disadvantaged groups simply because they are more likely to be potential users of a health center. Remember that the Chamber of Commerce and other business groups are integral parts of the community as well. When identifying influential individuals, consider both their formal power derived from their positions and their informal power gained through reputation, community involvement, wealth, social connections, or other "unofficial" sources.

A community analysis involves a combination of brainstorming and gathering information. The initial community map can be generated through the efforts of the group or coalition working on the health center. However, engaging community leadership and conversing with community members will help ensure a complete map. Thus, the community analysis serves as an opportunity to involve more people and increase community participation in the process.

It is of utmost importance to engage with healthcare providers who hold prominence in the community or are already involved in addressing the needs of underserved populations. By contacting these providers early on, even if they do not eventually participate in the planning process, it demonstrates respect and ensures they do not feel overlooked. Here are several strategies that can help involve the professional healthcare community:

Seek support from existing health centers located in or near the neighborhood. Convincing an established health center to establish a new location may be a more feasible approach to initiating a health center.

Reach out to health departments, hospital administrators, professional societies, and state Medicaid agencies. These entities can provide valuable insights and information about physicians currently serving Medicaid and low-income patients. Hospital administrators, in particular, can play a significant role in rural areas.

Most medical and dental societies, typically organized at the county level, have "uncompensated care" committees that can be engaged for support and guidance.

Emphasize the involvement of primary care providers, including physicians, dentists, nurse practitioners, midwives, physician assistants, dental hygienists, psychiatrists, psychologists, clinical social workers, and pharmacists. These professionals are vital in delivering comprehensive primary care services.

Establish connections with providers in the community through healthcare provider organizations, professional associations, and continuing education programs. These platforms offer opportunities to engage with and involve healthcare providers in the planning and implementation of the health center.

By actively involving healthcare providers and leveraging their expertise and support, the likelihood of success in establishing a new health center can be significantly enhanced.

Needs Assessment and Planning:

To effectively plan and implement a health center, it is crucial to conduct a comprehensive needs assessment. While there may be a consensus about the lack of access to primary care in the community or for specific populations, such as the uninsured or Medicaid patients, this information alone is insufficient for planning purposes. Good program planning requires a thorough needs assessment, and the NACHC publication "Community Needs Assessment and Data Supported Decision Making: Keys to Building Responsive and Effective Health Centers" can be a valuable resource in this process.

The needs assessment involves defining the target population(s) and service area for the health center. It then entails identifying the specific service needs that the health center should be prepared to address based on the target population(s). Once these questions are answered, the planning process involves prioritizing the identified health needs, developing growth and resource plans to address those needs, and implementing the plans.

HEALTH DISPARITIES = WHAT SERVICES ARE NEEDED 

ACCESS LIMITATIONS = HOW MANY OF WHAT TYPES OF PROVIDERS ARE NEEDED 

BARRIERS TO CARE = SERVICE DELIVERY STRATEGY

Establishing an organizational model that allows for efficient and effective delivery of health services.

Different Organizational Models: 

Considering physical space requirements for the health center, such as location, design, and equipment.

Space Considerations: 

Developing community governance structures that ensure accountability, transparency, and sustainability of the health center.

Development of Community Governance:

Planning for the financial sustainability of the health center through business planning and developing partnerships with funding agencies and other stakeholders.

Business planning: 

Meeting healthcare standards and regulations to ensure the provision of high-quality and safe health services.

Meeting Health Standards:

Addressing human resource requirements, including staffing, training, and retention.

Human Resource Requirements: 

Implementing information technology systems to support efficient health service delivery and data management.

Information Technology: 

Drawing conclusions and identifying areas for continuous improvement to ensure the health center's ongoing success in meeting community health needs.

Conclusions: 

Commonly used abbreviations:

ADA: Americans with Disabilities Act; AHRQ: Agency for Healthcare Research and Quality; BBA: Balanced Budget Act; BHPr: Bureau of Health Professions; BPHC: Bureau of Primary Health Care; CDC: Centers for Disease Control; CHIP: Children's Health Insurance Program; CMS: Centers for Medicare & Medicaid Services (Formerly Health Care Financing Administration); DHHS: Department of Health and Human Services; FQHC: Federally Qualified Health Center; FLSA: Fair Labor Standards Act; FTCA: Federal Tort Claims Act; GME: Graduate Medical Education; HCPC Code: Health Care Financing Administration Common Procedure Coding System; HIPAA: Health Insurance Portability and Accountability Act; HMO: Health Maintenance Organization; HPSA: Health Professions Shortage Area; HRSA: Health Resources Services Administration; ISDI: Integrated Service Delivery Initiative; ISDN: Integrated Services Delivery Network; JCAHO: Joint Commission Formerly Joint Commission on Accreditation of Healthcare Organizations; MCH: Maternal and Child Health; MCO: Managed Care Organization; MSO: Management Service Organization; MUA: Medically Underserved Area; MUP: Medically Underserved Population; NHSC: National Health Service Corps; OIG: Office of Inspector General; OPA: Office of Pharmacy Affairs; ORO: Office of Regional Operations; PACE: Program of All-Inclusive Care for the Elderly; PCA: Primary Care Association; PCMH: Patient-Centered Medical Home; PCO: Primary Care Office; PDPA: Prescription Drug Purchase Assistance Program; PHS: Public Health Service; PSO: Provider Sponsored Organization; RHC: Rural Health Clinic; ROR: Reach Out and Read; SCHIP: State Child Health Insurance Program; UDS: Uniform Data System; USAID: United States Agency for International Development; WIC: Women, Infants, and Children Program

Some descriptions of acronyms: 

ADA: Americans with Disabilities Act - Legislation that prohibits discrimination against individuals with disabilities and ensures equal opportunities in employment, public accommodations, transportation, and other areas. AHRQ: Agency for Healthcare Research and Quality - An agency within the U.S. Department of Health and Human Services that conducts research and provides evidence-based information to improve the quality, safety, and effectiveness of healthcare. BBA: Balanced Budget Act - Legislation passed in 1997 that made significant changes to healthcare financing and regulations, including the creation of the Children's Health Insurance Program (CHIP). BHPr: Bureau of Health Professions - A division of the Health Resources and Services Administration (HRSA) that supports the training, education, and development of healthcare professionals to meet the needs of underserved populations. BPHC: Bureau of Primary Health Care - A division of HRSA responsible for improving access to comprehensive primary healthcare services for underserved and vulnerable populations through the support of Federally Qualified Health Centers (FQHCs) and other programs. CDC: Centers for Disease Control - A national public health agency that focuses on preventing and controlling diseases, promoting health, and conducting research to inform public health policies and practices. CHIP: Children's Health Insurance Program - A state and federal partnership program that provides health insurance coverage to eligible children from low-income families, ensuring access to necessary healthcare services. CMS: Centers for Medicare & Medicaid Services - A federal agency within the Department of Health and Human Services responsible for administering the Medicare and Medicaid programs, which provide healthcare coverage to eligible individuals, including seniors, people with disabilities, and low-income populations. DHHS: Department of Health and Human Services - A federal department that oversees various health and social service programs and initiatives aimed at protecting the health and well-being of Americans. FQHC: Federally Qualified Health Center - Community-based healthcare centers that receive federal funding to provide comprehensive primary care services to underserved populations, regardless of their ability to pay. FLSA: Fair Labor Standards Act - Federal legislation that establishes minimum wage, overtime pay, recordkeeping, and child labor standards for employees in the private and public sectors. FTCA: Federal Tort Claims Act - Legislation that allows individuals to sue the federal government for personal injury, wrongful death, or property damage caused by the negligence of government employees. GME: Graduate Medical Education - Training programs for medical school graduates to further develop their clinical skills and knowledge in a specific medical specialty or subspecialty. HCPC Code: Health Care Financing Administration Common Procedure Coding System - A coding system used to identify medical procedures, services, and supplies for billing and reimbursement purposes. HIPAA: Health Insurance Portability and Accountability Act - Federal legislation that protects the privacy and security of individuals' health information and establishes standards for electronic healthcare transactions. HMO: Health Maintenance Organization - A managed care organization that provides healthcare services through a network of contracted healthcare providers and emphasizes preventive care and cost containment. HPSA: Health Professions Shortage Area - Designation given to areas with a shortage of healthcare professionals, particularly in primary care, which may qualify for certain federal programs and incentives to attract providers. HRSA: Health Resources Services Administration - A federal agency that works to improve access to healthcare for underserved populations, enhance the quality of healthcare, and support the training and development of the healthcare workforce. ISDI: Integrated Service Delivery Initiative - An initiative that aims to improve coordination and integration of healthcare services to provide comprehensive and patient-centered care. ISDN: Integrated Services Delivery Network - A network of healthcare providers, organizations, and facilities that work together to deliver coordinated and integrated healthcare services to a defined population. JCAHO: Joint Commission (formerly Joint Commission on Accreditation of Healthcare Organizations) - An independent, nonprofit organization that accredits and certifies