Community and Nurse-Managed Health Centers: Getting Them Started and Keeping Them Going

Community and Nurse-Managed Health Centers: Getting Them Started and Keeping Them Going

Community and Nurse-Managed Health Centers: Getting Them Started and Keeping Them Going

Community and Nurse-Managed Health Centers: Getting Them Started and Keeping Them Going


"This book provides a step-by-step guide to starting and sustaining a community health center, with an emphasis on nurse-managed centers. The authors share their firsthand knowledge with readers, including information on developing a mission statement, pulling together an advisory board, writing a business plan, and getting funding. The process for obtaining Federally Qualified Health Center Status (and thus federal funding) is described. The Appendix provides examples including sample bylaws, a full policy and procedure manual, physician and nurse practitioner collaborative agreements, job descriptions, a contract with a local agency, and outcome and assessment guidelines" - Provided by the Publisher.


There are a number of funding options for health centers, including federal, state, local, and private grants, state and local contracts, third-party reimbursement, and feefor-service. There are advantages and disadvantages to each option. Because there is not a single model to depend on in establishing a viable financial base, it is important for nurse-managed health centers to cultivate multiple funding streams to support the best possible cash flow. Most nurse-managed centers are supported by a patchwork of public and private funding sources. The financial development process requires a great deal of flexibility and creativity.


Obtaining a major grant can secure the finances of a health center for the length of the grant. Such funding can enhance the health center's public image and may leverage other funding as well. If a health center qualifies as a FQHC, it can receive ongoing funding through the HRSA Community Health Care funding stream. Other time-limited funding includes HRSA, Division of Nursing funding.

If it is an option and a health center has a significant number of Medicare or Medical Assistance clients, FQHC status can assure cost-based reimbursement for Medical Assistance primary care visits and an augmented rate for Medicare. This can make the difference between a capitation rate of $9.00 per member per month and a pervisit reimbursement rate of $120 per visit, depending on the center's actual cost per visit. HRSA also provides opportunities for FQHC centers to obtain funding that will allow for service expansions, facility improvements, or special projects focused on the reduction of health disparities.

The disadvantage to public grants is that they generally come with significant degrees of oversight and regulation and a number of stipulations. Also, grant writing requires a great deal of time and energy and any resulting award is uncertain.


Contracts with public entities or other organizations may provide reliable and predictable income for the health center as payment for specific services. Again, public contracts usually come with a great deal of oversight and regulation, and contracts with private organizations, such as other agencies, businesses, unions, city and state governments, or housing authorities, must be constructed carefully to assure that they are specific about services that are covered and those that may be separate from the contract. Contracts cover the ways that disputes are negotiated, and they detail the ways in which services are paid for. Contracts are binding and must be adhered to even if resources or staffing declines, unless both parties renegotiate the terms. See Appendix G for a sample of a contract with a local agency.

Family Planning Contracts

It can be worthwhile to have a contract with the local Family Planning Council if one exists in the area. In Pennsylvania, such a contract awards an annual capitation fee to provider organizations for each patient enrolled in the Family Planning program. The Councils also do the billing to Medical Assistance for contracted family planning providers. Fees are a carve-out fee-for-service arrangement from the managed care Medicaid HMO. The . . .

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