Services

 

Required and Additional Services

Health center provides all required primary, preventive, enabling health services and additional health services as appropriate and necessary, either directly or through established written arrangements and referrals.

Note: Health centers requesting funding to serve homeless individuals and their families must provide substance abuse services among their required services.

Clinical Resources tailored to Health Care for the Homeless

Review these pages to access clinical resources and information regarding various diseases and conditions, including but not limited to cardiovascular disease, diabetes, chronic pain, oral health, and substance use disorder. These resources are tailored to clinicians or individuals providing direct care.

Peer-support Network for Clinicians Working in Health Care for the Homeless

Learn about the Health Care for the Homeless Clinicians’ Network. Join the network. It’s free!

Outreach Resource Page

View the Council’s resource page dedicated to this non-clinical, HRSA-required service critical to homeless healthcare.

 

Staffing Requirement

Health center maintains a core staff as necessary to carry out all required primary, preventive, enabling health services and additional health services as appropriate and necessary, either directly or through established arrangements and referrals. Staff must be appropriately licensed, credentialed, and privileged.

2013 FTCA Deeming Application

PART 2 of this HRSA TA resource covers credentialing and privileging.

Credentialing Toolkit

ECRI works with HRSA to develop tools and has several resources on credentialing such as their credentialing toolkit, webinar with handouts, and a checklist with links to other resources. It’s free to become a member with ECRI and access their online resources.

Sample job descriptions for various HCH positions, licensing and credentialing policies and procedures are available. Please email TA staff with your requests for these documents: TA@nhchc.org

 

Accessible Hours of Operation/Locations

Health center provides services at times and locations that assure accessibility and meet the needs of the population to be served.

Enhancing Access

(2001) Pages from Organizing Health Services for Homeless People that describe strategies to address where, when and how services could be provided that responds to the obstacles individuals experiencing homelessness face in getting basic needs met including healthcare.

Street Medicine Institute

In 2008 Dr. Jim Withers launched the Street Medicine Institute to help facilitate and enhance the direct provision of health care to the street homeless where they live. Visit the website to learn about upcoming trainings and other learning opportunities.

FAQ

The grantee is currently implementing a street medicine program, and asked 1) Do we list this program within our scope with HRSA? 2) If we do list it within our scope, will we have the same clinical requirements of our fixed clinic locations? 3) How do other street medicine programs handle medications with the 340B program?

You should list Street Medicine on your scope especially if you are using your federal funds to support it. When you do, it becomes subjected to HRSA’s 19 program requirements. Of course, you should have already had these in place and expand what you are currently doing to the Street program. Be certain that your Board approves the Street program and the hours of operation. Medications going thru the 340B program should also use the rules of the health center. The only difference is that the staff may have to bring the medications to the patients in the field if they are unable to pick them up from your fixed location. You will need to develop policies and procedures for this new work flow.

Our Juvenile Hall medical program is provided as an extension of one of our County primary care clinics that is included in our 330h Scope of Services. Can we consider those patients as part of our 330h program?

Can this be done within HRSA’s 330 Program Requirements? Does anyone have experience with this?

See Reaching In to Help Out: Relationships Between HCH Projects and Jails.

 

After Hours Coverage

Health center provides professional coverage for medical emergencies during hours when the center is closed.

Questions to health centers needs to consider:

  • How are patients made aware of the availability of access to care after-hours?
  • How are patients informed of the procedures to access care after-hours?
  • For the responses to the above questions, are these tailored to the languages and literacy levels of your patient population?

Sample policies and procedures are available. Please email TA staff with your requests for these documents: TA@nhchc.org

 

Hospital Admitting Privileges and Continuum of Care

Health center physicians have admitting privileges at one or more referral hospitals, or other such arrangement to ensure continuity of care. In cases where hospital arrangements (including admitting privileges and membership) are not possible, health center must firmly establish arrangements for hospitalization, discharge planning, and patient tracking.

Discharge Planning Resource Page

View a list of resources on discharge planning specific to homeless healthcare including the Healing Hands article Tools to Help Clinicians Achieve Effective Discharge Planning.

Medical Respite Toolkit

Medical respite care is acute and post-acute medical care for homeless persons who are too ill or frail to recover from a physical illness or injury on the streets but are not ill enough to be in a hospital. Unlike “respite” for caregivers, “medical respite” is short-term residential care that allows homeless individuals the opportunity to rest in a safe environment while accessing medical care and other supportive services. Medical respite care is offered in a variety of settings including freestanding facilities, homeless shelters, nursing homes, and transitional housing.

Test Tracking and Follow-up Toolkit

ECRI works with HRSA to develop tools and has several resources on tracking and follow-up, which address needs in a health center’s Federal Tort Claims Act (FTCA) application. It’s free to become a member with ECRI and access their online resources.

Discharge planning and patient tracking policies and procedures and sample forms are available. Please email TA staff with your requests for these documents: TA@nhchc.org

FAQ

Do other HCH grantees use V60 code to track patients?

Yes, and we can get you connected to peers in the field that use this system to track patients. If you’re interested in peer-to-peer technical assistance on this topic and learn how your program can implement this tracking system based on the V codes, please contact staff at TA@nhchc.org.

 

Sliding Fee Discounts

Health center has a system in place to determine eligibility for patient discounts adjusted on the basis of the patient’s ability to pay.

This system must provide a full discount to individuals and families with annual incomes at or below 100% of the Federal poverty guidelines (only nominal fees may be charged) and for those with incomes between 100% and 200% of poverty, fees must be charged in accordance with a sliding discount policy based on family size and income.*

No discounts may be provided to patients with incomes over 200 % of the Federal poverty guidelines.*

No patient will be denied health care services due to an individual’s inability to pay for such services by the health center, assuring that any fees or payments required by the center for such services will be reduced or waived.

Note: Portions of program requirements notated by an asterisk “*” indicate regulatory requirements that are recommended but not required for grantees that receive funds solely for Health Care for the Homeless (section 330(h)) and/or the Public Housing Primary Care (section 330(i)) Programs.

 

Please review the HRSA Policy Information Notice on Sliding Fee Discount Scales released October 2014.

Presentation on Sliding Fee Scales in HCH

View Module 5 for a short, recorded presentation and discussion led by the late Karen Rotondo, who served eight years as a technical assistance and HCH expert for the Council.

Council staff is available to review and provide suggestions to your current Sliding Fee Discount Scales program. Sample policies and procedures and sliding fee scales are available. Please email TA staff with your requests: TA@nhchc.org.

 

Quality Improvement/Assurance Plan

Health center has an ongoing Quality Improvement/Quality Assurance (QI/QA) program that includes clinical services and management, and that maintains the confidentiality of patient records. The QI/QA program must include:

  • A clinical director whose focus of responsibility is to support the quality improvement/assurance program and the provision of high quality patient care;*

  • Periodic assessment of the appropriateness of the utilization of services and the quality of services provided or proposed to be provided to individuals served by the health center; and such assessments shall: *

  • Be conducted by physicians or by other licensed health professionals under the supervision of physicians;*

  • Be based on the systematic collection and evaluation of patient records;* and

  • Identify and document the necessity for change in the provision of services by the health center and result in the institution of such change, where indicated*

    Note: Portions of program requirements notated by an asterisk “*” indicate regulatory requirements that are recommended but not required for grantees that receive funds solely for Health Care for the Homeless (section 330(h)) and/or the Public Housing Primary Care (section 330(i)) Programs.

     

Webinar: Meeting QI/QA Requirements: Lessons Learned

(2012) This webinar (part one of two) will feature lessons learned from the San Francisco Health Care for the Homeless program. After this webinar, participants will be able to provide examples for how 330(h) program expectations can be operationalized into day-to-day quality infrastructure, describe ways health information technology and decision support tools can be used to report on HCH outcomes of interest, and analyze and compare known and emerging QI approaches. Participants will also learn to formulate a business case for how HCH QI work is relevant to PCMH activities.

Webinar: Meeting QI/QA Requirements: Action Steps

(2012) This webinar (part two of two) will feature perspectives from the San Francisco and Omaha Health Care for the Homeless programs. After this webinar, participants will be able to describe the effects of electronic medical records on clinic flow, illustrate how policies and procedures influence work performance, and feel confident in their abilities to locate and use available QI/QA resources including the Community Oriented Primary Care toolkit.

Clinical Performance for Health Care for the Homeless

This webpage contains several resources related to outcome measures, clinical measures, and improving clinical care.

Pages from Organizing Health Services for Homeless People

(2001) Pages from Organizing Health Services for Homeless People in Part V. Organizational Tools, Quality Improvement/ Quality Assurance and Program Evaluation.

You may request in-depth or personalized technical assistance on any of these topics. Visit our Get Assistance page.