Community Health Centers (CHCs) play a vital role in the health care safety net by providing access to affordable and quality primary medical, oral health, and behavioral health services to 18 million medically underserved Americans.

What is a Community Health Center?

The term community health center has both broad and narrow meanings.  In the broad sense, community health centers are providers of primary health care to medically underserved populations.  Unlike the medical model of healthcare delivery, community health centers focus not only on improving the health of individual patients, but on improving the health status of the entire community.  This community-oriented focus means community health centers differ from traditional health care providers in several ways.  Needs assessment, program development, and evaluation are all framed in terms of both community health needs and patient health.

The services of a community health center are accessible to the target population, comprehensive, and coordinated with other social services.  The health center is also accountable to the community it serves by involving members and health center users in program planning and organizational governance.

In a more narrow definition, the federal government uses the term “community health centers” to describe public or non-profit centers that receive federal funding under the Health Centers Consolidation Act of 1996 amended section 330 of the Public Health Service Act to provide comprehensive primary care services to medically underserved populations.  All individuals within the health center’s service area may receive health services at a community health center regardless of ability to pay.

Benefits to the Community

Community Health Centers have numerous benefits to the patients and communities they serve.  They are a health care home for underserved people, improving public health, reducing the burden on hospital emergency rooms, and providing needed services such as free immunizations for uninsured children. Through the consumer majority board of directors, communities are assured a voice in the operation of that health care home.

CHCs have access to numerous programs that ultimately benefit their patients. These programs include:

· PHS Drug Pricing Discounts for pharmaceutical products under the 340B Program;

· Access to medical malpractice coverage under Federal Tort Claims Act (FTCA);

· Prospective Payment System reimbursement for services to Medicaid patients;

· Cost-based reimbursement for services to Medicare patients;

· Federal loan guarantees for capital improvements;

· Access to on-site eligibility workers to provide Medicaid and State Child Health Insurance Program (SCHIP) enrollment services;

· Access to Vaccines for Children Program for uninsured children; and

· Access to National Health Service Corps (NHSC) medical, dental, and mental health providers.

Basic Requirements

Community Health Centers must:

· Be located in a medically underserved area or serve a medially underserved population;

· Provide comprehensive primary care (directly and/or by contract);

· Serve all patients regardless of age or income, within a defined service area;

· Have a schedule of discounts (sliding-fee schedule) based on the patient’s ability to pay;

· Be a public or not-for-profit organization; and

· Be governed by a community-based board of directors.  To be federally-funded, a majority of board members must use the health center and must represent the community served in terms of demographic factors such as race, ethnicity, sex, age, and socioeconomic status.

CHCs must also provide services and supports to ensure access is available to all in the community. These services may include language interpretation and translation, transportation, and case management.

Program Expectations

Because community health centers serve a wide range of communities, from inner cities to rural frontiers, there is no one model health center.  However, every community health center must have a sound infrastructure able to respond to the needs of its community within the constraints of its resources.  Each community health center should develop processes and procedures designated to ensure the provision of high quality health services supported by strong management and governance.

To receive federal funding a community health center must meet the program expectations of the U.S. Public Health Service.  Program expectations describe aspects of organizational structure and processes that are associated with successful health center programs.

Needs Assessment and Planning

Community Health Centers are required to assess the health needs of the population to be served and the resources available in the community to meet those needs.  From this assessment centers can identify and prioritize issues to be address through the planning process.  Centers are required to work closely with other safety net providers in defining and revising an appropriate role for the health center in addressing community health care needs.  Factors used to determine need are geographic, demographic, and economic.

Governance

The Community Health Center must be governed by a board of directors, which has full authority and responsibility to establish program policies.  The board of directors should govern within the context of a long-term strategic mission and goals, as well as an annual operating plan.  A majority of the board members must represent users of the center’s services.  A set of by-laws governing the organization should be maintained by the center.  The by-laws must describe the structure and functions of the board, and meet the requirements of federal, state, and local laws and regulations.

Management and Finance

To operate efficiently and effectively, the center must have appropriate management.  The long-term mission and goals of the organization should guide center management.  Management of a health center is a team process with well-defined lines of authority and responsibility.  Adequate infrastructure must be in place including finance, management information systems, and communications.

Clinical Program/Health Services

Community health centers are required by law to operate a system of care that contributes to the desired outcomes of availability, accessibility, quality, comprehensiveness, and coordination.  Centers must ensure that basic primary care services, coordinated with other levels of care, and support services appropriate to the communities defined health care needs are available and accessible.  CHCs must also have qualified providers and a clinical management system that ensures quality and continuity of care.

To ensure resources are being applied in the most effective way to meet identified needs, every health center is required to develop health care goals and objectives as part of the organization’s planning process.  The goals and objectives consider both the role of the center in the community’s overall system of care and the specific efforts the center will perform on behalf of its own user population and the community in general.