Service – CHC Resource Page

Chapter 4, 5, 6, and 7 in the Compliance Manual set forth how and when services will be provided to health center patients as well as staff qualifications needed to administer care.

Required and Additional Services

Required and Additional Services: Community Health Center (CHC) provides all required primary, preventive, enabling health services, and additional health services as appropriate and necessary, either directly or through established written arrangements and referrals. (Section 330(a) of the PHS Act)


A primary resource for understanding Health Center Program Requirement 2: Required and Additional Services can be found in HRSA’s resources for Health Center Program Requirement 16: Scope of Project, which details the services a CHC provides to patients and how these services are delivered. In particular:


The Illinois Primary Health Care Association explored this requirement in detail in Examining Requirement 2: Required and Additional Services, which explores provides a description of this requirement and performance improvement suggestions.


Dental Health Resources:

Operations Manual for Oral Health: Published by the National Network for Oral Health Access (NNOHA), this manual consists of six chapters on a range of topics covering the basics of operating a CHC Dental Program.


Dental Program Management Resources: Offered by the National Network for Oral Health Access (NNOHA), this web page offers resources on oral health program start up and expansion, health information technology, and financial management.


Dental Forms Library: Offered by the National Network for Oral Health Access (NNOHA), this website shares forms that safety net clinics nationwide have shared with NNOHA for dental program use. Forms are available in these categories: consent forms, dental practice policies and procedures, guidelines and instructions, human resources, and quality.


“Oral Health: An Essential Component of Primary Care:” Published by Qualis Health, this white paper outlines a framework for integrating oral health into primary care settings.


“Integration of Oral Health with Primary Care in Health Centers: Profiles of Five Innovative Models:” Published by the National Association of Community Health Centers (NACHC), this report describes the importance of integrating oral health with primary care, and outlines successful CHC integration models from around the country.


The Oral Health Integration Manual: provides information about successful methodologies for integration of oral health into a CHC. The manual details barriers and solutions, challenges and successes, and provides a framework for oral health integration. The framework and concepts posed therein are largely based upon the patient centered medical home standards for integration of care: a natural complement to the work Colorado CHCs have already embarked upon. The manual is comprised of six sections:

  1. Role of Leadership
  2. Team-Based Care
  3. Patient Centeredness
  4. Data
  5. Transformative Access
  6. Community Resources and Partnerships


Dental Sliding Fee Schedules Webinar


Continuity of Care Resource:

Cancer Survivorship E-Learning Series: Launched in April 2013, The National Cancer Survivorship Resource Center’s E-Learning Series is designed to heighten the awareness of the ongoing needs of cancer survivors and gives primary care providers free continuing education credits with first-hand patient experiences, presentations by national leaders on survivorship issues, and case studies. The goals of the series are to: To provide information on how to tailor care to cancer survivors and to teach primary care providers the skills they need to provide follow-up care for cancer survivors.


Special Populations Resources

  • CDC Steadi Toolkit for Falls Prevention in Older Adults: CDC’s Injury Center created the STEADI Tool Kit for health care providers who see older adults in their practice who are at risk of falling or who may have fallen in the past. The STEADI Tool Kit gives health care providers the information and tools they need to assess and address their older patients’ fall risk
  • Prevention and Training Center National HIV Resource: Key STD clinical resource  
  • List of Colorado Providers offering HIV treatment by region
  • Health Resources and Service Administration (HRSA) offers a variety of special population resources ranging from clinical care to public housing programs.
  • NACHC Ag Worker Access 2020 Campaign: NACHC has just established a Learning Community for the Ag Worker Access 2020 Campaign on My NACHC Learning Center.  This is a way for you to learn all about the Ag Worker Access 2020 campaign to locate materials and resources, upcoming training and webinars, effective community outreach strategies and learn what health centers, PCAs and other stakeholders are doing to increase access to care for farmworkers.  The Ag Worker Access 2020 Learning Community is for anyone to join the campaign, learn from each other and network with your colleagues with an interest in improving care for farmworkers.It is easy and fast to get involved by following these easy steps:
    2. Enter your NACHC ID and password
      • If you do not have an NACHC id click on the “Sign Up” link
    3. Once successfully logged in go click on NACHC Communities
    4. Choose “Ag Worker Access 2020 Campaign” from the Explore Communities drop down
  • Migrant Clinicians Network (MCN) Health Network: provides services to facilitate continuity of care and treatment completion regardless of the patient’s physical location. Offerings include comprehensive case management, medical records transfer, and follow-up services for mobile patients. 


Care Coordination Resource

Template for Memorandum of Agreement With Specialists: Template is available to provide an example of purpose, agreement and level of care consideration. This template may be edited and use for your needs.                                 


Social Determinants of Health Resources

  • “Community Health Centers Leveraging Social Determinants of Health” Handout: Institute for Alternative Futures: An abridged description of a newly released study from the Institute for Alternative Futures that discusses the ways in which CHCs are extending beyond the scope of medical care to include disparities that exist primarily within the social and culture aspects of patients’ lives.
  • “Community Health Centers Leveraging Social Determinants of Health”Institute for Alternative Futures: A 2012 study conducted by the Institute for Alternative Futures and supported by the Kresge Foundation that identifies current efforts on the part of CHCs to address the social, economic, and physical barriers to health care for its patient population. The report depicts the inclinations of the current health care system and offers successful methodologies used by CHCs to mitigate these obstacles.
  • “Community Health Centers Leveraging Social Determinants of Health” Case Studies from the Institute for Alternative Futures: These supplemental case studies detail the current efforts of CHCs nationwide to address social determinants of health, using viable, tangible, and sustainable systems for diminishing disparities.
  • Health Equity and Race and Ethnicity Data  From the Colorado Trust: This report observes the importance and rationale behind collecting race and ethnicity data within health care, and offering practical solutions for doing so when limited data is available. The report discusses best practices for data collection, new federal requirements based upon the Patient Protection and Affordable Care Act and Culturally and Linguistically Appropriate Services, and ways to ensure CHC staff is successful in meeting these standards.
  • The Patient Engagement Toolkit: is a resource for CHCs to gauge patient engagement. The toolkit presents qualitative and quantitative tools for the CHC to measure the patient experience and facilitate opportunities for patient engagement.
    1. Data for Quality: the first piece of the toolkit details how to design and implement a data for quality project at a Community Health Center (CHC).
    2. Patient Experience Data: the second part of the toolkit utilizes pieces of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey as a quantitative data collection mechanism for patient engagement.
    3. Patient Advisory Councils: this piece of the toolkit centers upon the development, implementation, and sustainability of Patient Advisory Councils at a CHC.
    4. Social Determinants of Health: the final section of the toolkit presents resources for increasing patient and staff understanding of social determinants of health.
  • Social Determinants of Health Needs Assessment Tool: This tool may be used by CHC patients, whether or not the CHC has a PAC forum, to identify SDH barriers and assets within the CHC community. This tool may be disseminated electronically, in-person, or over the telephone.

Staffing Requirements

Staffing Requirements: CHCs are required to maintain (recruit and retain) a core staff as necessary to carry out all required primary, preventive, enabling health services and additional health services as appropriate and necessary, either directly or through established arrangements and referrals.  Staff must be appropriately credentialed and licensed.

  • Examining Requirement 3: Staffing: The Illinois Primary Health Care Association has published a document that discusses HRSA’s Program Requirement 3: Staffing. This resource provides and in-depth look at this requirement and provides questions that CHCs should examine to ensure they are meeting this requirement.


Recruitment and Retention 

  • CHAMPS provides an array of recruitment and hiring tools, retention and staff orientation resources: Click here to access the resource.
  • NACHC provides a web based toolkit that summarizes the importance of key workforce aspects – recruitment, on-boarding and retention – and provides links to access applicable resources. Learn more about aspects of hiring, training and retaining staff by clicking here.


Credentialing and Privileging 

All CHCs are required to credential and privilege clinical staff.


Credentialing is important for CHCs to be compliant with the 19 key requirements. ECRI provides CHCs with a wide array of credentialing information including policies, procedures, templates and a toolkit. Click here to access the toolkit. You must be an ECRI member to access this resource.


On January 9, 2015, CCHN partnered with MedCreds Plus to provide Colorado CHCs with practical knowledge pertaining to staff credentialing and privileging. To access resources shared during this event, including sample policies and procedures and templates, click here.


The BPHC website has a variety of resources related to credentialing and privileging. Additionally, links  to all credentialing and privileging PINs and PALs are provided below.

Templates from Colorado CHCs can be provided by contacting Tanah Wagenseller at

Accessible Hours and Locations

Accessible Hours and Locations : Chapter 6 in the Compliance Manual; formerly Health Center Program Requirement 4. This is the first time BPHC has provided specific guidance beyond what is detailed in the Health Center Site Visit Guide. The CHC can demonstrate compliance by assess any barriers to access, including physical and distance/time barriers, and respond to patient needs related to hours of operation. The Scope of Project has been eliminated as a separate requirement (formerly requirement #16) in the Compliance Manual. Findings on inaccuracies with Form 5B will be documented here instead. Services are defined at the awardee/designee level and not all sites have to have all services, but rather “must have reasonable access to the full complement of services offered by the center as a whole, either directly, or through formal written established arrangements.” This is a new level of clarification.

After Hours Coverage

After Hours Coverage: NACHC provides an informational bulletin that presents BPHC’s expectations regarding after-hours coverage; explores how CHCs can reasonably satisfy the expectations and maintain compliant with the terms of the CHC grant award; and provides guidance concerning risk management/liability limiting policies and/or practices that a CHC should adopt in implementing an after-hours coverage arrangement. Click here to access that bulletin.


Examining Requirement 5: After Hours Coverage: The Illinois Primary Health Care Association has published this document to examine HRSA’s Program Requirement 5: After Hours Coverage. This resource outlines questions that CHCs should examine during discussions about program improvements for their After Hours Coverage.

Hospital Admitting Privileges / Continuum of Care

Hospital Admitting Privileges/Continuum of Care: Examining Requirement 6: Hospital Admitting Privileges and Continuum of Care: The Illinois Primary Health Care Association published this description of HRSA’s Program Requirement 6: Hospital and Admitting Privileges and Continuum of Care. This article provides and in depth look at Program Requirement 6, including questions to consider during performance improvement discussions. 

Sliding Fee Scale

Health Center Program Requirement #7: The Sliding Fee Discount Program is a cornerstone of CHC program and dictates that a CHC provide services regardless of the patient’s ability to pay. This is done through the establishment of a sliding fee discount program that reduces the patient’s cost based on certain eligibility criteria.


The basics of this requirement are that a CHC has:

  • A fee schedule that is designed to cover the reasonable costs of providing health care services outlined within the CHC’s approved scope of project. These fees must also be is consistent with what is charged by other local providers for the services.
  • A corresponding sliding fee discount schedule (SFDS) that allows for eligible patients with incomes below 200 percent of the Federal Poverty Guidelines (FPG) to receive a discount on services provided by the CHC.
  • Policies that are regularly reviewed and approved by the CHC’s governing board, and associated operation procedures that guide how the CHC establishes the fee schedule, determines patient eligibility for the SFDS, bills for services and collects payments.


BPHC provides guidance on this requirement in PIN 2014-02: Sliding Fee Discount and Related Billing and Collections Program Requirements and within the document detailing comments and responses to the draft version of the Sliding Fee Discount PIN.


PIN 2014-02 was released in September 2014. The following resources were posted prior to the final issuance of PIN 2014-02 and may need updating if used by a CHC after the final PIN was posted.


Quality Improvement Plan

CHC has an ongoing Quality Improvement/Quality Assurance (QI/QA) program that includes clinical services and management, and that maintains the confidentiality of patient records.


Patient Centered Medical Home (PCMH) Resources

Presentation about PCMH Transformation and the NCQA PCMH Application:  This presentation developed by CCHN highlights the change concepts that can be used to facilitate PCMH Transformation/


Data for Quality Resources

  • “Developing Appropriate Clinical Data Measures and Goals” Colorado Community Health Network. This document serves as a collection of resources for national and statewide data comparisons, including measures from National Committee for Quality Assurance (NCQA), Uniform Data System (UDS), Healthy People 2020, and the Colorado Business Group. Links to data sets and summaries can be found within the document as well.
  • Managing Data for Performance Improvement HRSA: HRSA’s guide for managing data for performance improvement provides and in-depth discussion of the collection, tracking, analysis and interpretation, and activation of data. Additional resources can be found here.
  • “Turning Data into Usable Information for Performance Improvement” CCHN.  This presentation discusses the ways in which a CHC can successfully use data as a means to inform quality improvement processes, such as performance improvement. Methodology for collecting data, a step-by-step validation guide and tool, along with recommendations for presenting your data are included.
  • Establishing Measures: From IHI: This page describes different types of measures for the purpose of learning and process improvement.
  • How to display data: This presentation highlights various ways to display data beyond excel spreadsheet and explains how to get started on the path to better data presentation.


Developing a Quality Improvement Plan Resources