What is a Federally Qualified Health Center (FQHC)?

What is a Federally Qualified Health Center (FQHC)?

The Federally Qualified Health Center (FQHC) is focused on providing primary care to patients in underserved areas that may not have insurance or the ability to pay their medical bills. The Centers receive funding from the Health Resources & Services Administration (HRSA), an agency of the Department of Health and Human Services (DHHS), that is the “primary federal agency for improving health care to people who are geographically isolated, economically or medically vulnerable.”

FQHCs are also known as Community Health Centers and can be found in every state in the US as well as in the US territories. In fact, there are “nearly 1,400 health center organizations with more than 11,000 locations in urban, suburban and rural communities across the country.” FQHCs must meet a stringent set of requirements to be able to meet the needs of the underserved in their communities and receive funding from the HRSA.

FQHCs:

  • Qualify for funding under Section 330 of the Public Health Service Act (PHS).
  • Qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits (the FQHC benefit under Medicare was added effective October 1, 1991)
  • Serve an underserved area or population
  • Offer a sliding fee scale
  • Provide comprehensive services (either on-site or by arrangement with another provider), including:
    • Preventive health services
    • Dental services
    • Mental health and substance abuse services
    • Transportation services necessary for adequate patient care
    • Hospital and specialty care
  • Have an ongoing quality assurance program
  • Have a governing board of directors that must include FQHC as a majority of the members

Specifically, FQHC services include:

  • Physician services
  • Services and supplies incident to the services of physicians
  • Nurse practitioner (NP), physician assistant (PA), certified nurse-midwife (CNM), clinical psychologist (CP), and clinical social worker (CSW) services
  • Services and supplies incident to the services of NPs, PAs, CNMs, CPs, and CSWs
  • Medicare Part B-covered drugs furnished by and incident to services of an FQHC practitioner
  • Visiting nurse services to the homebound in an area where CMS determined there is a shortage of home health agencies
  • 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