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.
Recruitment and Retention
- CHAMPS provides an array of recruitment and hiring tools, retention and staff orientation resources: Click here to access the resource.
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.
The BPHC website has a variety of resources related to credentialing and privileging.
Accessible Hours and Locations
Compliance Manual Chapter 6; formerly Health Center Program Requirement 4.
Coverage for Medical Emergencies During and After Hours
Continuity of Care and Hospital Admitting
Sliding Fee Discount Program
This 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.
- Details about how CHCs are reviewed for compliance with this requirement are found in the Site Visit Protocol.
- The Discounted/Sliding Fee Schedule Information Package, from the National Health Service Corps (NHSC), provides an overview of a sliding fee discount program, and sample language for policies, fee schedules, eligibility applications and signage.
- BPHC’s Samples and Templates Resource Center also includes a sample sliding fee discount eligibility form and a sample payment agreement form.
- Further billing and collections resources that can assist with complying with this requirement can be found in the Management and Finance section of CCHN’s Online Resource Center.
- Dental Sliding Fee Schedules Webinar
Compliance Manual Chapter 10: Quality Improvement/Assurance: 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.
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.
- “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.
Developing a Quality Improvement Plan Resources
- Quality Improvement Plan Template and Quality Improvement Plan Template Number 2: These are editable templates that CHCs can use to develop their organizational Quality Improvement Plan.
- Resource for Developing a Quality Improvement Workplan: This is a template that CHCs can use to develop a chronic disease management workplan such as for diabetes. It allows CHCs to identify their goal and develop a quality improvement and measurement plan to achieve that goal.
- Meeting the National Standards – A Crosswalk for Health Centers: Developed by the Association of Asian Pacific Community Health Organizations, this crosswalk aims to assist CHCs better understand how and where the CHC progarm and NCQA PCMH standards align with National CLAS standards.
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 Required and Additional Services can be found in HRSA’s resources for Scope of Project, which details the services a CHC provides to patients and how these services are delivered. In particular:
- Services Descriptors for Form 5A: Services Provided outlines the general elements for all required and additional services, including detailing what the minimum is for a required service. As well, this document cites the statute and regulation behind why a particular service is required as part of the Health Center Program.
- Service Delivery Methods for Form 5A outlines how a CHC may provide access to a service within the CHC or by a formal referral arrangement in which the CHC covers a portion or all of the cost for any services provided, or by a formal referral arrangement where the CHC does not cover the cost of the service. In all cases, a CHC should ensure that it is complying with Compliance Manual Chapter 9: Sliding Fee Discount Program.
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.
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:
- Role of Leadership
- Team-Based Care
- Patient Centeredness
- Transformative Access
- Community Resources and Partnerships
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
- 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:
- 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.
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.
- 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).
- 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.
- Patient Advisory Councils: this piece of the toolkit centers upon the development, implementation, and sustainability of Patient Advisory Councils at a CHC.
- 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.