In 1999 the federal government issued its first guidance related to granting FQHC designation to public entity health centers. In doing so, the federal government explicitly recognized that it may not be possible for public health centers to meet all of the governance requirements for health centers because government agencies are subject to strict laws and regulations regarding personnel and financial controls. These differences are outlined in the following two documents:
- Implementation of the Balanced Budget Act Amendment of the Definition of FQHC Look-Alike Entities for Public Entities
- Implementation of the Balanced Budget Act Amendment of the Definition of FQHC Look-Alike Entities for Private Nonprofit Entities
Requirement |
Public Entity Look-Alike |
Public Entity 330 FQHC |
Private 330 FQHC |
| Must serve in whole or part MUA or MUP |
Yes |
Yes |
Yes |
|
Eligible for Section 330 grant, up to $650,000 annually, to offset the cost of caring for the uninsured |
No |
Yes |
Yes |
|
Eligible for free tort protection under the Federal Torts Claims Act (FTCA) |
No |
Yes |
Yes |
|
Executive Director must be employed by FQHC entity |
May be employed by public entity |
May be employed by public entity |
Yes |
|
Organization has established collaborative and coordinated delivery system |
Yes |
Yes |
Yes |
|
Must serve and bill Medicaid, Medicare, private insurance, uninsured |
Yes |
Yes |
Yes |
|
Eligible for cost-based reimbursement from Medicare and Medicaid, with “wrap around” payments for individuals enrolled in Medicaid or Medicare managed care plans |
Yes |
Yes |
Yes |
|
May be paid “above cost” for Medicaid reimbursement under alternative methodology (depending upon state reimbursement methodology), subject to federal approval. |
No |
No |
Yes |
|
Must provide primary health care, x-ray, lab, preventive health services, case management
|
Yes |
Yes |
Yes |
|
Must provide or arrange for pharmacy services to complete treatment (with access to 340b drug pricing), emergency services, transportation |
Yes |
Yes |
Yes |
|
Must have core staff of full-time PCPs that are employed by FQHC entity |
May be employed by public entity |
May be employed by public entity |
Yes |
|
Must submit annual Uniform Data Set (productivity, cost ratios, clinical benchmarks, etc.) |
No |
Yes |
Yes |
|
Services provided without regard of ability to pay and use a sliding fee scale that meets BPHC guidelines |
Yes |
Yes |
Yes |
|
No service limitations by age/gender |
Yes |
Yes |
Yes |
|
Must provide or arrange for preventive dental services |
Yes |
Yes |
Yes |
|
24 hour telephone coverage to access in-house PCP provider (answering service and calling ER does NOT meet requirement) |
Yes |
Yes |
Yes |
|
Must provide or referral arrangements in place to provide mental health and substance abuse services for full continuum of care |
Yes |
Yes |
Yes |
|
Must have on-going Quality Assurance program that identifies problems/action to remedy |
Yes |
Yes |
Yes |
|
Must conduct annual audit complying fully with OMB Circular A-133 requirements |
No (may comply with public audit requirements) |
No (may comply with public audit requirements) |
Yes |
|
Site must have referral arrangements in place for hospitalization and discharge planning |
Yes |
Yes |
Yes |
|
Local governing Board consisting of 9 to 25 members |
Yes |
Yes |
Yes |
|
Board must have fifty-one percent membership users of health center |
Yes |
Yes
|
Yes |
|
No more than one-half of non-user members may derive more than 10% of income from health care industry |
Yes |
Yes |
Yes |
|
Board must meet 12 times a year |
Yes |
Yes |
Yes |
|
Board must be incorporated as 501 (c) (3) or other not profit incorporation status |
No |
No |
Yes |