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Approve an updated Federally Qualified Health Center Co-Applicant Agreement with the Solano County Community Healthcare Board in accordance with the Health Resources and Services Administration guidelines
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Published Notice Required? Yes _____ No __X__
Public Hearing Required? Yes _____ No __X__
DEPARTMENTAL RECOMMENDATION:
The Department of Health and Social Services recommends that the Board of Supervisors approve an updated Federally Qualified Health Center Co-Applicant Agreement with the Solano County Community Healthcare Board in accordance with the Health Resources and Services Administration guidelines.
SUMMARY:
In 2004, Health and Social Services (H&SS) received a federal grant from the Health Resources and Services Administration (HRSA) under the Health Care for the Homeless (HCH) program and became a Federally Qualified Health Center (FQHC) under a Public Services Act 330(h) designation. This designation permitted the County’s Family Health Services (FHS) clinics to provide services to homeless individuals and also concurrently limited Solano County’s authority to provide clinical services to non-homeless individuals. In 2013, the Board of Supervisors approved an expansion of the FQHC designation and authorized H&SS to pursue federal qualification of its clinics as a Community Health Center with 330(e) grant designation under 42 U.S.C. §1395x(aa) (3), including the establishment of a co-applicant Community Healthcare Board (CHB) to provide oversight of the FQHC clinics in accordance with the HRSA requirements.
The CHB was formed in 2015, and H&SS is now requesting that the Board of Supervisors approve the 2024 FQHC Co-Applicant Agreement (Attachment A), which has been updated from its last revision in 2023 in accordance with recent HRSA audit instructions, to better define the role of each party in the governance of the FQHC Community Health Care Centers in Solano County. With the execution of the updated HRSA-compliant agreement, the County will maintain its status as a FQHC, allowing the drawdown of federal funding for the provision of primary health care services to the medically underserved communities in the County-operated family health clinics.
FINANCIAL IMPACT:
The costs associated with preparing this agenda item and drafting the agreement are nominal and absorbed by the Department’s FY2023/24 Working Budget. There is no additional impact to the County General Fund.
DISCUSSION:
Federally Qualified Health Centers, or FQHCs, are considered “safety net” providers tasked with enhancing the provision of primary care services in underserved urban and rural communities. They offer access to comprehensive care regardless of a patient’s ability to pay. A significant benefit associated with being an FQHC is to allow the County’s Family Health Services (FHS) to establish and be compensated at higher reimbursement rates from Medi-Cal and Medicare, as a condition of “safety net” status.
In 2015, HRSA approved the Community Health Center (330e) designation, and the Board of Supervisors approved an agreement with the CHB to define the respective roles and responsibilities in the operation and oversight of the FQHC. That agreement indicated that the County was responsible for financial oversight of the clinics and for fiscal and personnel policies and procedures governing FHS. The CHB was responsible for operational and strategic oversight, including selection and evaluation of the Project Director, mix of services provided, clinic hours for client services, ratification of policies and procedures, etc. There was a shared responsibility for the approval of the budget. The agreement and associated CHB bylaws indicated the requirements for CHB membership, executive officers, committees, meeting frequency, and training requirements. The CHB consists of between 11 to 15 members, the majority of whom are consumer members.
In 2023, as a result of an HRSA Operational Site Visit (OSV), County of Solano dba/County of Solano Family Health Services, located in Fairfield, CA, was found to be out of compliance with the Co-Applicant Agreement, resulting in a “Not Met for Board Authority-90-a: Maintenance of Board Authority Over Health Center Project." Within 90 days, FHS was to provide final, executed documentation that ensures its Governing Board maintains authority for oversight of the health center project. Specifically, the County was asked to provide final executed documentation of organizational or other changes that address finding(s) that 1) Another individual, entity, or committee reserves approval authority or has veto power over the health center Board concerning required authorities and functions; 2) Collaborations or agreements with another entity infringe or restrict the health center’s required authorities and functions; or, if applicable, 3) The Co-Applicant Agreement did not delegate required responsibilities of both the Co-Applicant Board and the Public Agency in carrying out the health center project. Based on a review of the HRSA audit findings, the Co-Applicant Agreement has been revised in 2024 to address the OSV deficiencies and findings, specific to detailing the CHB (BOARD) roles versus COUNTY roles, specific to sliding fee, Quality Assessment /Quality Improvement, Chief Executive Officer role, and Key Management, and day-to-day operations. The agreement must be finalized and signed by the Community Health Board and the Board of Supervisors to remain compliant.
The Board of Supervisors is now being asked to approve the 2024 HRSA-compliant Co-Applicant Agreement with the Community Healthcare Board that has been updated to address the findings and changes in the HRSA guidelines.
Non-submission of a revised HRSA-compliant Co-Applicant Agreement may result in losing federal grant funding, FQHC status, and related federal revenues.
ALTERNATIVES:
The Board of Supervisors may choose not to approve the agreement. However, this is not recommended because HRSA requires approval, and failing to execute will jeopardize FHS’s FQHC designation and funding.
OTHER AGENCY INVOLVEMENT:
County Counsel assisted with the drafting of the FQHC Co-Applicant Agreement and reviewed for legal sufficiency on behalf of both Solano County and the Solano County Community Healthcare Board. The Solano County Community Healthcare Board approved the agreement at their Governing Board Meeting held on April 17, 2024.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION