FQHC “Look Alikes” Benefits
- Access to favorable drug pricing under Section 340B of the PHS Act, which allows FQHCs (including "look-alikes") to purchase covered outpatient prescription pharmaceuticals for health center patients at substantially discounted prices for distribution either directly by a health center pharmacy or through contract with a retail pharmacy.
- Access to reimbursement under the Prospective Payment System (“PPS”) or other state-approved alternative payment methodology (which is predicated on a cost-based reimbursement methodology) for Medicaid services and cost-based reimbursement for services provided under Medicare. Available under the Medicaid program even if FQHC is a subcontractor to a managed care plan.
- Absent an alternative approved by the Centers for Medicare and Medicaid Services (“CMS”), right to have State Medicaid agencies outstation Medicaid eligibility workers on FQHC site. FQHCs can also contract with State Medicaid agencies for FQHC staff to carry out (and be reimbursed for) outstationing activities at FQHC sites.
- Reimbursement by Medicare for "first dollar" of services rendered to Medicare beneficiaries, i.e. deductible is waived.
- Safe harbor under the Federal anti-kickback statute for waiver of co-payments to the extent a patient is below 200% of Federal income poverty guidelines and therefore entitled to a discount based on the health center's application of its schedule of discounts.
- Access to providers through the National Health Service Corps if the health center's service area is designated a Health Professional Shortage Area (“HPSA”).
- Access to the Federal Vaccine For Children program, which distributes to FQHCs (and other eligible providers) vaccinations at no charge for either the vaccine or its delivery to FQHCs to be provided by the FQHC to uninsured children. FQHCs are also eligible to participate in the Pfizer Sharing the Care Program.
FQHC "Look Alike" Application Guidance (pdf)