The webbased technologies supporting these state agency compliance efforts were significantly improved, reducing the number of manual steps in various compliance processes. Summary of comments and hrsa responses on the draft health. Nov 22, 2016 if the chapter on ftca is finalized, the ftca manual and future annual deeming application pals should reference the requirements in chapter 21 of this compliance manual, and include no. The compliance manual is the principal resource to assist health centers in. Feb 27, 2020 the hrsa site visit protocol asks, do the health centers privileging procedures require verification of the following for all clinical staff lips, olcps, and other clinical staff who are health center employees, individual contractors, or volunteers upon hire and on a recurring basis. Hrsa does not require or mandate staffing ratios as this is a health center decision. The hrsa site visit protocol is the document used to assess compliance for health centers. Leveraging the health center program compliance manual and. Health center program site visit protocol bureau of primary. Demystifying the compliance manual ftlf learning center.
Federal register request for public comment on draft. The compliance manual also addresses hrsas approach to determining eligibility for and exercising. When hrsa determines that a health center is not demonstrating compliance with one or more of the health center program requirements, a conditions is placed on its notice of awardlookalike designation. Credentialing and privileging requirements for federally. Compliance today may 2019 credentialing and privileging. The health center governing board and meeting hrsa s continuous compliance expectations session 2. Included in this list are pin 200116, credentialing and privileging of health care practitioners and pin 200222, clarification of bphc credentialing and privileging policy outlined in pin 200116. Board preparation for the hrsa operational site visit. Health center program site visit report alameda county health.
The compliance manual identifies requirements found in the health center. Clinical staffing of the health center program compliance manual. Ocs includes clinical staff members that provide services in a state, territory or other jurisdiction that does not require licensure, registration, or certification. A case study where you will get a chance to be a surveyor.
Hrsa clearly outlines in the health center program compliance manual, under related considerations, that the health center determines its staffing composition. These audits should be conducted internally, in advance of the osv and ambulatory reaccrediting visits, if any midcourse performance corrections are warranted. May 15, 2019 this is not a chapter by chapter training on the compliance manual. Chapter 5 clinical staffing the health center ensures that it has clinical staff andor has contracts or formal referral arrangements in place with other providers or provider organizations to carry out all required and additional services included in the hrsaapproved scope of project. With the release of the health resources and services administration hrsa compliance manual hrsa compliance manual, a number of pins and pals were eliminated. The health center must request prior approval from hrsa for a change in the key. Surveyors are to use the state operations manual som, chapter 5 complaint procedures and appendix g guidance for surveyors. The service definition for use in this manual and as provided to clients will be as described below. Health center program oversight of the compliance manual, hrsa will withdraw support through termination of the award.
In particular, the governance guide includes hyperlinks to the compliance manual, which are best utilized when reading an electronic version of this. Within hrsa, the bureau of primary health care bphc oversees section 330. The compliance manual identifies requirements found in the health center programs. Lists the applicable statutory and regulatory citations. Ensure all credentialing and privileging files contain current copies of documented tb tests or screenings demonstrating continuous hrsa compliance. The rationale and format of an operational site visit. Structure of the health center program compliance manual. These service definitions are in compliance with hrsa clarification notices 1502 and 1602. Essential osv documentation for health center boards session 3. The compliance manual also addresses hrsas approach to determining. Hrsas bureau of primary health care bphc health center program. Awards uniform regulations5 require hrsa to manage and administer the.
Hrsa staff use the compliance manual to determine health centers. Health center program compliance manual, chapter 5. Hrsa has clarified in the compliance manual that health centers are eligible for fqhc reimbursement rates as a result of their health center program funding or. Health center compliance manual chapters in the compliance manual are generally organized as follows.
This document is laid out by chapter with various elements for each section. In addition, the results of these efforts can now be viewed on a u. Dec 04, 2018 in late december 2017, hrsa issued a new site visit protocol the svp, which aligns with the manual and reflects a more objective compliance assessment tool. The hrsa covid19 uninsured program is a claims reimbursement program for health care providers which does not meet the definition of a health plan as defined in section 1171 5 of the social security act and in 45 c. Billing and collections for more information on waiving or reducing charges due to a patients inability to pay. The manual, which supersedes most but not all prior guidance, incorporates a new approach to everyday compliance. To consolidate many pins and pals into one document to provide guidance for understanding of the program requirements to describe how you can demonstrate compliance with the program requirements.
If not met the areas of non compliance and how to become compliant will be explained take great notes during the osv and exit to be certain. The hrsa program guidelines within the new compliance manual and how they apply to dental. Includes chapter on hrsa bphcs oversight process for monitoring compliance. Describe the specific documentation and assessment process necessary to demonstrate compliance and areas where health centers retain discretion. Mastering the compliance manual ftlf learning center.
Effective august 28, 2017, updated august 20, 2018. Faqs for covid19 claims reimbursement to health care. What is the purpose of the health center program compliance manual. A deeper dive into the sliding fee schedule discount. This chapter contains language that was revised based on the bipartisan. Hrsa notice of grant award or fqhc lookalike designation that includes an. Unresolved conditions related to chapter 5, clinical staffing compliance manual chapter 5 and chapter 10, quality improvementassurance compliance manual chapter 10 of the hrsa compliance manual have the ability to impact ftca deeming, if they are not resolved at the time hrsa makes annual deeming decisions. Health center program compliance manual frequently asked. Board composition, compliance manual chapter 20 session 6. Health center program compliance manual provides a consolidated resource to assist health centers in. Staytuned to reglanterns blog for the most uptodate guidance.
Key management staff bureau of primary health care. Hrsa issued current version of the health center program site visit protocolprotocol federal expectation that health centers will be fully compliant at all times in order to obtain and maintain 3year project period compliance with the compliance manual and protocol is. Compliance resolution opportunity cro for osv structured. You then have 90 days to become compliant or issue a 120 day plan for compliance 60 days is second noticepleasedont get here. If your sac application is selected for funding, you must attest on the. Clinical staffing bureau of primary health care hrsa. The compliance manual also addresses hrsa s approach to determining eligibility for and exercising oversight over the health center program and details the requirements for o btaining deemed phs employee status under section 224 gn and q of the phs act. Health center program oversight of the compliance manual, which includes the option of alternative means, hrsa will withdraw support through termination of the award. Summary of comments and hrsa responses on the draft health center program compliance manual. This chapter includes evaluation of the initial and recurring credentialing and privileging procedures the health center has in place.
Hrsa compliance manual kyle 91919 hrsa compliance manual kyle 91919 chapter 5. View a summary pdf 791 mb of the comments for each section and chapter and hrsa s responses to these comments. The bphcs compliance manual outlines the following series of requirements for fqhcs. Health center program compliance manual introduction bureau of. Summary of comments and hrsa responses on the draft health center. Once you have collected the documents per the naming convention, cross reference with the elements in each chapter to be able to answer the questions that are asked. All health centers should complete to the weekly hrsa bphc covid19 survey. Hrsa announced the availability of the draft health. Because the compliance manual has been revised since the issuance of this summary, comments and response summaries marked with an asterisk and in italics no longer reflect current compliance manual language. Other clinical staff ocs is a new category of staff that was developed with the release of the health resources and services administration hrsa compliance manual hrsa compliance manual. Identify the elements of the hrsa program requirements addressed in the manual and the protocol. Cro provides health centers an opportunity to address non compliance findings prior to hrsa issuing the site visit report and placing conditions on the awarddesignation due to a failure to demonstrate. Resource details health center resource clearinghouse. Each health center is unique with different needs, service areas and populations served.
Health center program compliance manual bureau of primary. Clinical staffing authority sections 330a1, b12 of the phs act. Cms and the office of the national coordinator for health information technology onc have established standards and other criteria for structured data that electronic health records ehrs must use in order to qualify for cms incentive programs. The reglantern team commonly receives questions in regard to hrsa site visit protocol, chapter 5. The compliance manual also addresses hrsas approach to. Clinical staffing explicitly supersedes pins 200116 and 200222 credentialing and privileging of health center practitioners, and clarification no longer requires primary source verification of education and training of licensed independent practitioners in states where licensing boards utilize primary source verification. Board authority, compliance manual chapter 19 part 1 session 4. A health centers sliding fee discount program consists of the schedule of discounts that is applied to the fee schedule and adjusts fees based on the patients ability to pay. Board authority, compliance manual chapter 19 part 2 session 5. The pd or ao can respond to the correspondence request in the ehbs to provide details addressing noncompliant elements. Hrsa will update or amend the compliance manual as needed to provide further clarification of program policies.
Lookalikes do not receive federal funding under section 330 of the phs act. Major policy changes in the draft bphc compliance manual. Federally qualified health centers fqhcs and the health center. If your health center was providing that service directly column i and your policies would require you to credential and privilege those employees, then you also need to have documented assurances. Describes how health centers would demonstrate to hrsa their compliance with the requirements by fulfilling all. Clinical staffing credentialing and privileging assurances for contractedreferral arrangements read more. In the past few years, hrsa has transitioned its compliance efforts for federally qualified health centers fqhcs from multiple policy guidance documents to the health center program compliance manual, a consolidated resource to assist fqhcs in understanding, demonstrating and operationalizing compliance. Aug 20, 2018 the compliance manual also addresses hrsas approach to determining eligibility for and exercising oversight over the health center program and details the requirements for o btaining deemed phs employee status under section 224 gn and q of the phs act. The uses a library of standard conditions that follows its progressive action policy and process, which fully aligns with the compliance manual. To move your health center now into continuous hrsa compliance, we recommend each health center develop a road map to get to that defined end result in the form of. Hrsa requires health centers to have operating procedures for granting and renewing privileges to its providers. Over the last few years, hrsa has significantly increased its scrutiny of health centers compliance, first with development of the nineteen 19 health center program requirements and now with the recent issuance of the health center program compliance manual. How to use the compliance manual, the most recent site visit protocol and other hrsa issued compliance guidance to prepare for your osv, including discussion of the elements of the programmatic requirements and the documentation and assessment methodologies required to verify compliance with each, as well as areas where health centers retain.
With the release of the health resources and services administration hrsa compliance manual hrsa compliance manual, a number of pins and pals were eliminated included in this list are pin 200116, credentialing and privileging of health care practitioners and pin 200222, clarification of bphc credentialing and privileging policy outlined in pin 20. The hrsa site visit protocol and hrsa compliance manual are not clear on this, but this is my trusty ruleofthumb that has not let me down yet. The hrsa compliance resolution opportunity, or cro, supports the timely resolution of areas of non compliance found onsite during an osv. The compliance manual also addresses hrsas approach to determining eligibility for and exercising oversight over the health center program and details the requirements for o btaining deemed phs employee status under section 224 gn and q of the phs act. Includes chapter on hrsabphcs oversight process for monitoring compliance. Credentialing and privileging requirements for federally qualified. Program compliance manual compliance manual september 2018. Health center program site visit protocol bureau of. Clinical staffing authority requirements demonstrating compliance related considerations footnotes health center compliance manual quick. In the past few years, hrsa has transitioned its compliance efforts for federally qualified health centers fqhcs from multiple guidance documents for ensuring adherence to health center program requirements to the health center program compliance manual, a consolidated resource to assist fqhcs in understanding, demonstrating and operationalizing compliance. Clinical staffing, demonstrating compliance element c. Board authority for more information on the health center governing boards role in approving policies. With the hrsa program requirements now being clearly spelled out in the hrsa compliance manual and the hrsa site visit protocol, health centers have a defined end result.
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