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Community Health Centers are nonprofit, health care practices located in medically underserved areas that provide high quality, primary health care in a culturally appropriate manner to anyone seeking care. In 2006, Connecticut Community Health Centers provided comprehensive, community-based, primary and preventative health care for over 230,000 persons. Also known as Federally-Qualified Health Centers (FQHCs) or FQHC look-alikes, they are located in areas where care is needed but scarce, and they improve access to care for thousands of CT residents regardless of their insurance status or ability to pay. They offer services, such as transportation, translation, and culturally sensitive healthcare that many other providers do not.
Affordable: Community Health Centers are open to everyone, with sliding scale fees based on income and family size.
Appropriate: Community Health Centers offer primary health, oral and mental health/substance abuse services, and preventive health care, as well as supportive services such as translation, transportation, case management, health education, and social services.
Accessible: Services that include primary and preventive care, outreach and dental care, must be available to all residents of their service areas to help ensure access to care and continuity of care.
Accountable: A community board, the majority of whose members are patients of the health center, governs Community Health Centers.
For a history of Community Health Centers, please link to the HRSA, Bureau of Primary Health Care, Health Center Program Expectations page at: http://bphc.hrsa.gov/policy/pin9823/
What Services do Community Health Centers Provide?
Community Health Centers offer core health care services, either directly or though a contractual arrangement, including:
- Preventive and Primary Care
- Diagnostic services (lab and x-ray)
- Family Planning
- Prenatal and Perinatal Care
- Well child care and Immunizations
- Screening for elevated blood levels, communicable diseases, and cholesterol
- Eye, ear and dental screening for children
- Preventive dental services
- Emergency medical and dental services
- Hospitalization
- Pharmacy services
Who receives health care services at Community Health Centers?
In Connecticut, Community Health Centers provide health care to anyone who needs it, regardless of income or insurance status.
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Health centers serve as the family doctor and medical home for over 230,000 patients or 6.6% of the CT population who receive care at over 110 sites in rural and urban areas across the state.
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More than three out of four (77%) health center patients have family incomes under 100% of the Federal Poverty Level ($19,350 per year for a family of four).
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Forty-nine percent (49.5%) of health center patients are Hispanic/Latino, 24% are African American, 24% are White, and 2.1% are Asian/Pacific Islander. More than 85,698 (40%) are best served in a language other than English.
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Nearly half (46%) of health center patients are Medicaid beneficiaries and 28% are uninsured.
For more details, please link to CT CHC Data page.
History of Connecticut Community Health Centers
The State of Connecticut has long recognized the need to provide comprehensive primary health care services for the medically underserved. Community Health Centers (CHCs) have been the critical source of health care for the poor, underserved, vulnerable, and at risk for poor health status, in many communities throughout the state for almost 40 years. CHCs were first funded by the Federal Government as part of the Johnson administration’s War on Poverty in the mid 1960s. Initially named neighborhood health centers, these clinics were created to provide health and social service access points in poor and medically underserved communities and to promote community empowerment. In return for providing needed medical care and enabling services, Community Health Centers received federal funds for start-up costs and received operating subsidies that allowed them to function in environments where most patients had limited means to pay for care. By the early 1970s, about 100 neighborhood health centers had been established under the Economic Opportunity Act (EOA). In 1975, Congress enacted legislation that authorized neighborhood health centers as “Community Health Centers”. In the 1970’s, prior to the dissolution of the EOA, the health center program was moved to the US Dept, of Health & Human Services (DHHS). Within DHHS, the Health Resources & Services Administration (HRSA), Bureau of Primary Health Care (BPHC) currently administers the program. In 1989, Congress passed Section 4161 of the Omnibus Budget Reconciliation Act (OBRA), which created the special designation of Federally Qualified Health Centers (FQHC), thus the use of the acronym FQHC, often used to describe Community Health Centers. OBRA made federally qualified health center services required services under Medicaid. Health Centers refer to all the diverse public and non-profit organizations and programs that receive federal funding under Section 330 of the Public Health Service Act, as amended by the Health Centers Consolidated Act of 1996 and the Safety Net Amendment of 2002. They include community health centers, migrant health centers, health care for the homeless health centers, primary care public housing health centers and school based health centers. Federally Qualified Health Centers that do not receive Section 330 funding may receive FQHC Look-Alike status if they meet a majority of the FQHC program requirements. Today, federally qualified health centers serve over 14 million individuals and families annually in 50 state and territories. In Connecticut, there are 10 Federally Qualified Health Centers and three Federally Qualified Health Centers look-a-likes who serve 230,000 patients annually at over 110 sites throughout Connecticut. Among the 10 FQHCs, six receive funds to support health care for the homeless health centers, two receive funds for school based health centers, and one receives funds for primary care public housing. The first Community Health Center to receive federal funds for start-up costs was established in Connecticut in 1968. The following table shows the history of the establishment of community health centers in CT.
Community Health Center Timelines
Date*
CHC Timeline
Year FQHC Status Rec'd.
For a history of Community Health Centers, please link to the HRSA, Bureau of Primary Health Care, About Health Centers: Health Center Program History page: http://bhpr.hrsa.gov/kidscareers/community_hc_program.htm
Understanding Federally Qualified Health Centers (FQHC)
Federally Qualified Health Centers (FQHC) are health centers that receive Public Health Service (PHS) Act, Section 330 funds, and provide primary care services in underserved, urban and rural communities. FQHC is a federal designation from the U.S. Dept. of Health & Human Services, Health Resources & Services Administration (HRSA), Bureau of Primary Health Care (BPHC), and the Center for Medicare and Medicaid Services (CMS) that is assigned to private non-profit or public health care organizations that serve predominantly uninsured or medically underserved populations.
The primary purpose of Federally Qualified Health Centers is to expand access to primary health care for uninsured and underserved populations, who experience financial, geographic or cultural barriers to care and who live in or near federally designated health professional shortage areas (HPSAs) and medically underserved areas (MUAs). FQHCs are also called Community/Migrant Health Centers (C/MHC), Community Health Centers (CHC) and Section 330 Funded Clinics.
To meet federal requirements, a FQHC must meet certain statutory requirements specified by the Bureau of Primary Health Care for funding authorized by Section 330 of the Public Health Service Act.
These five essential elements differentiate them from other providers. A FQHC must:
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Be located in a federally designated medically underserved area (MUA) or serve a federally designated medically underserved population (MUP);
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Provide comprehensive primary care services, referrals, and other services needed to facilitate access to care, such as case management, translation, and transportation;
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Provide services to all in the service area regardless of ability to pay and offer a sliding fee schedule that adjusts according to income.
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Have nonprofit, public, or tax exempt status;
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Have a governing board, the majority of whose members are patients of the health center.
The Section 330 Grant Program is subdivided into separate grant competitions thereby allowing communities to tailor applications to their particular need. They include Community Health Centers, Migrant Health Centers, Health Care for the Homeless, Federal School Based Health Centers, and Public Housing grantees. The BPHC also reviews applications from health centers that are seeking to qualify as a FQHC- Look-Alike because they meet the statutory requirements for these programs but do not receive Section 330 grant-funding.
Under the FQHC program, health centers are automatically eligible for certification as a Medicare and Medicaid FQHCs, receiving cost-based reimbursements for Medicaid and Medicare patients.
For more information on FQHC and Look-Alike Programs, please link to the HRSA, Bureau of
Primary Health Care, Health Center Program Expectations page:
http://bphc.hrsa.gov/policy/pin9823/
For more information about MUAs and MUPs, please link to the DPH Health Professional Shortage Areas page: http://www.ct.gov/dph/cwp/view.asp?a=3132&q=388118
The Uniform Data System (UDS) is a nationally recognized method of reporting patient data to the Health Resources & Services Administration (HRSA), Bureau of Primary Health Care (BPHC). The BPHC requires that all Section 330 health centers submit data electronically each year. Aggregate information on health center patients, staff size, and composition, utilization, financing and other characteristics is available through the Uniform Data System (UDS) on a calendar year basis. FQHC Look-Alikes and tribal FQHC are not required to report data to the BPHC and do not participate in the UDS. In Connecticut, there are (10) FQHCs that submit data on an annual basis to HRSA and three (3) FQHC Look-alikes that are not required to submit data.
For more information on UDS, please link to HRSA, Bureau of Primary Health Care, Health Center Data, Uniform Data System (UDS) website: http://bphc.hrsa.gov/uds/
Community Health Center Requirements
Federally Qualified Health Centers (FQHC) must comply with Section 330 program expectations/requirements and all applicable federal and state regulations. All FQHC are required to provide the following services directly or through a written contractual agreement:
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Primary Care
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Dental
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Mental Health
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Substance Abuse
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Diagnostic Lab and X-Ray
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Prenatal and Perinatal
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Cancer and Other Disease Screening
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Blood Level Screenings
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Lead Levels
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Communicable Disease
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Cholesterol
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FQHC clinical services requirements include:
- FQHC provide “A “Continuum of Care”. Patients must have access to all required services, access to specialty and hospital services, and after-hours coverage.
- The Health Center location must be physically located on or near a major road or public transportation stop to ensure accessibility.
- The Health Center hours of operation must facilitate access to care by having early morning, evening or weekend hours.
- The Health Center must ensure the appropriate mix of services for the target population to minimize duplication of services and maximize financial resources.
- The Health Center should have written agreements with other service providers for those required services not directly provided by health center.
- FQHC must establish and update health care goals and objectives to address the highest priority of health care needs of patients.
- The Health Center must have a Medical Director that supervises all clinical activities and medical doctors that are licensed and residency trained. Other clinicians must have appropriate licensure.
To receive Section 330 federal funding, a Community Health Center must meet the program expectations of the Bureau of Primary Health Care. These expectations describe aspects of organizational structure and processes that are associated with successful health center programs. Every CHC should have a sound infrastructure able to respond to the needs of its community within the constraints of its resources, and should develop processes and procedures designated to ensure the provision of high quality services supported by strong management and governance.
The four parts of the program expectations are as follows:
1. Mission and Strategy
Community Health Centers are required to address the importance of adapting to health care trends and remain financially viable, while fulfilling the health center mission of providing preventive and primary care services.
2. Clinical Program/Health Services
Community Health Centers are required to operate a system of care that ensures access to primary and preventive services as well as facilitate access to comprehensive health and social services. Services must be responsive to the defined health care needs and culture of the community.
3. Governance
Community Health Centers are required to have a board of directors, which assumes full authority and oversight responsibility for the health center. The board of directors, 51% of whom must be consumers of the health center, should govern within the context of a long-term strategic mission and goals, as well as an annual operating budget.
4. Management and Finance
Community Health Centers are required to have a management team that implements the health centers’ mission and strategic objectives. Strong personnel, financial, information and clinical systems must support the health center management.
For more information on FQHC and Look-Alike Programs, please link to the HRSA, Bureau of Primary Health Care, Health Center Program Expectations page:
Each year, the second week of August is a special week dedicated to recognizing the services and contributions of Community, Migrant, Homeless and Public Housing Health Centers, sponsored by the National Association of Community Health Centers, Inc. In 2006, over 1,000 community health centers in the United States received federal funds.
For a list of the Community Health Center Week Events taking place in Connecticut, please link to the National Association of Community Health Centers webpage:
http://www.nachc.org/default.cfm