FQHCs

FQHCs

GW currently represents many Federally Qualified Health Centers, Federally Qualified Health Center Look-Alikes and FQHC subgrantees (collectively, “FQHCs”) in the tri-state area, providing advice and representation on a wide range issues. Examples include:

Establishment of FQHC

  • Assisting organizations in establishing FQHCs, including spin-offs
  • Advising on compliance issues, including governance and Board structure
  • Assisting with preparation of necessary FQHC legal documents and FQHC application
  • Advising on, and negotiating subgrantee agreements

Governance/Corporate Structure

  • Updating and revising bylaws (e.g., board composition, board responsibilities, etc.)
  • Preparing and/or reviewing conflict of interest policy
  • Advising FQHCs on Board actions
  • Attending Board meetings and preparing board resolutions
  • Advising subgrantees on requirements relating to relationship with sponsoring FQHCs.
  • Providing training and educational updates to Board members

Compliance with FQHC Requirements/Operational Assistance

  • Advising regarding compliance with HRSA 19 elements for an FQHC
  • Participating in strategic planning sessions with executive staff and Board
  • Advising FQHCs of opportunities for grants and/or other sources of revenue
  • Assisting in communications with HRSA

Responding to Notice of Grant Award (“NGA”) Conditions

  • Preparing submissions to Bureau of Primary Health Care responding to NGA conditions
  • Assisting in meeting NGA conditions

HRSA On-Site Visits

  • Conducting pre-HRSA visit surveys and assisting with preparation for the visit
  • Participating in HRSA on-site visits
  • Assisting with corrective actions and responses regarding HRSA findings

HIPAA/HITECH Compliance

  • Providing updates on new rules and regulations
  • Assisting in ensuring compliance with applicable standards
  • Providing practical advice for avoiding patient breaches
  • Assistance with breach mitigation and notification requirements
  • Responding to subpoenas and other legal process

FTCA Coverage

  • Ensuring malpractice claims receive coverage through the Federal Tort Claims Act
  • Assisting in ensuring that the manner in which services are provided meets the regulatory requirements for FTCA coverage
  • Drafting/submitting requests for particularized determinations to ensure FTCA Coverage
  • Structuring cross-coverage and other on-call arrangements
  • Preparing agreements to document relationships that afford FTCA Coverage
  • Responding to claims made directly against the organization which should be handled through FTCA-specific procedures and notifying HRSA

Contracts and Service Agreements

  • Structuring arrangements with health care providers, business associates and vendors
  • Assisting in ensuring that the FQHC continues to comply with the extensive fraud and abuse and specific service requirements imposed by Federal laws and regulations
  • Preparing and/or reviewing all types of contracts and services agreements, including, but not limited to:
 
  • Employment agreements
  • Professional services agreements, including coverage agreements
  • Administrative services agreements
  • Collaboration agreements
  • Leases
  • Business associate agreements
  • Consulting agreements
  • License agreements
  • Grant agreements
  • Loan agreements
  • Referral arrangements (for services FQHC is required to arrange for because it does not provide them directly)
 


Affiliation Agreements
. Reviewing and/or preparing affiliation agreements to ensure they deal with the complexities inherent in achieving compliance with the governance and fraud and abuse requirements, while still establishing a substantial and meaningful affiliation.

340(b) Pharmacy Programs

  • Assisting FQHCs in evaluating whether to pursue 340(b) programs and related issues
  • Reviewing and negotiating agreements with 340(b) administrators, vendors and pharmacies

Corporate Compliance

  • General audit and investigation services
  • Performing FQHC-specific compliance risk assessments
  • Developing a compliance work plan

Human Resources

  • Development/update of manuals
  • Employee discipline issues
  • Hiring and firing issues
  • Employee complaints
  • Federal benefit related issues

Approvals/Grants. On an ongoing basis, GW assists FQHCs in ensuring that they are compliant with all the organizational requirements, as well as in preparing and organizing the legal aspects relating to its FQHC status, applications/re-applications and grant applications. GW also assists FQHCs in complying with grant requirements relating to various grants, including construction grants.

Site/Service Changes. GW works with FQHCs to add or remove sites or services through the change in scope process and coordinating with HRSA to facilitate this process.

Reimbursement Issues. GW assists FQHCs with regard to various reimbursement issues relevant FQHC’s and the right to be paid appropriately for FQHC services.

Billing Audits/Investigations. GW represents and defends FQHCs in federal and state investigations, audits and enforcement actions. GW has considerable experience with state Medicaid agencies, such as the OIG, and all levels of the CMS, including its national, regional and local intermediary/carrier offices. We regularly provide guidance in relation to compliance with Federal reimbursement rules. We also assist FQHCs with Medicare and Medicaid audits and resolving billing and reimbursement issues through corrective action plans and, if necessary, voluntary disclosures and refunds to regulatory authorities.

Finance and Real Estate

  • Space leases
  • Loan documents for third party financing
  • Construction agreements
  • Equipment leases and software agreements

Managed Care

  • Review and negotiation of participation agreements with third-party payors
  • Advice and representation in contract and payment disputes with third-party payors
  • Assistance with responses to audits by third-party payors

Litigation & Arbitration

  • Reimbursement disputes
  • Employment/HR issues
  • Governmental (OIG/DOH) investigations and payor audits
  • Disputes with vendors, service providers, landlord, etc.