Health Center Regulatory Issues, Uncategorized

HRSA Issues New Health Center Site Visit Guide

Recently, HRSA issued a new Health Center Site Visit Guide, incorporating changes to the Nineteen Key Health Center Program Requirements as well as some modifications in terminology. In general, the changes to the Program Requirement align the language of the Program Requirements with applicable requirements set forth in Section 330 of the Public Health Service Act, the implementing regulations at 42 C.F.R. Part 51c, and the HHS administrative regulations at 45 C.F.R. Part 74 as well as adding appropriate citations to statutory and regulatory authority for each Program Requirement. Specifically, the following changes were made (new language is underlined):

  1. Requirement #5: After Hours Coverage – revised to require health centers to provide professional coverage for medical emergencies during hours when the center is closed, consistent with the language of the applicable regulatory requirement. The previous guide did not include the phrase “for medical emergencies. 
  2. Requirement #7: Sliding Fee Discounts – added a bullet to reflect the statutory requirement in 330(k)(3)(G)(iii) that no patient be denied services due to an inability to pay for such services and that health centers must waive or reduce fees/payments as necessary to assure that this requirement is met. The previous guide did not include this last bullet.
  3. Requirement #9: Key Management Staff – revised to require health centers to obtain HRSA’s prior approval when changing the center’s CEO/ED, consistent with the prior approval requirement set forth in 45 CFR Part 74. The previous guide required HRSA’s prior review of final candidates for CEO/ED.
  4. Requirement #11: Collaborative Relationships – modified the language to reflect HRSA’s “new” terminology regarding the use of “health center” versus “FQHC,” clarifying that health centers must secure letters of support from existing health centers (section 330 grantees and FQHC Look-Alikes) located in the same service area or provide an explanation as to why the letters could not be obtained. The previous guide required such letters from existing “FQHCs” rather than from “health centers.”
  5. Requirement #18: Board Composition – clarified that the requirement that board members represent the demographics of the patient population applies solely to the consumer board members, stating that the board should be “composed of individuals, a majority of whom are being served by the center and, this majority as a group, represent the individuals being served by the center in terms of demographic factors ….” The previous guidance stated that the board should be composed of individuals, a majority of whom are consumers and “who as a group” represent the individuals served in terms of demographic factors.

Appendices C and D were updated as follows: (1) Appendix C (Performance Measures) was updated to reflect CY 2012 UDS reporting measures that include 3 new performance measures; and (2) Appendix D (Capital and Other Grant Progress review) was updated to include information  for capital grants awarded under the Affordable Care Act. Finally, HRSA clarified that going forward New Start health centers (organizations receiving first time Section 330 funds through a New Access Point) will be referred to as “Newly Funded grantees.”

While the majority of these revisions are minimal in substance, additional clarification is needed with regard to the change to Requirement #9. It is unclear whether the new language is intended to require HRSA’s approval of a particular CEO/ED candidate chosen by the Board of Directors or that health centers inform HRSA about the recruitment process so that the agency can provide input into whether the process is reasonableness, thus ensuring that a qualified individual isselected. If the former, NACHC believes that such prior approval could be construed as usurping the Board’s proscribed authority (set forth in 42 C.F.R. §51c.304(d)) to select the health center’s CEO/ED.  NACHC will discuss with HRSA this clarification, as well as additional issues thatcontinue to arise in connection with the on-site operational assessments.

For more information, see the new site visit guide and please don’t hesitate to let us know if you have any questions.

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