Required services include:
Pediatric/Well Child Care; Immunizations
Internal Medicine/Geriatric Services
Obstetrics/Prenatal & Perinatal Services
Emergency & Preventive Dental Services
Diagnostic Laboratory & Radiology Services
Elevated blood lead levels
Communicable disease & cholesterol
**Programs receiving funding to serve homeless individuals and families also must provide substance abuse services. Substance abuse services include treatment for alcohol and/or drug abuse and may use a variety of treatment modalities such as: non-hospital and social detoxification, non-hospital residential treatment and case management and counseling support in the community. While these service requirements are specific to programs receiving funding for this special population, all health centers are encouraged to ensure access to these services for all their patients.
Federal guidelines also suggest that services beyond those required should be provided based on the needs and priorities of the community, the availability of other resources to meet those needs, and the resources of the health center. Thus, some CHCs may offer services that are missing in their immediate community, including:
- Podiatry/Foot Care
- Ophthalmology/Vision Care
- Ears, Nose & Throat
- Orthopedic Care
- Genetic Counseling
- Behavioral Health Services & Substance Abuse Counseling
Federal regulations require that Community Health Centers provide comprehensive and continuous care that includes care during hours in which the health center is closed. Some CHCs provide “Urgent Care” programs that extend far beyond the normal workday, thus allowing patients access to care in a primary care setting as opposed to a hospital emergency department.
Community Health Centers must be open at least 32 hours per week. Many of the health centers provide early morning, evening or weekend operating hours.
Community Health Centers must also provide after-hours physician coverage when the health center is closed, also known as “On Call Coverage services”. A health center clinician must be available 24 hours a day, 7 days a week. This typically entails use of an answering service after the normal business hours. As patients seek assistance during the off-hours, the answering service contacts the “On Call” clinician who in turn calls the patient and recommends a course of action.
As a part of their operating procedures, all health centers must have ongoing referral arrangements with one or more hospitals. Health center providers are required to have admitting privileges to at least one area hospital so that the providers can care for the health center patients when they are hospitalized. Health center clinicians should have firmly established arrangements for hospitalizing their patients, discharge planning and patient tracking.
For more information on After Hour Coverage and Hospitalization, please link to the HRSA, Bureau of Primary Health Care, Health Center Program Expectations, August 17, 1998, Policy Information Notice 98-23 webpage: http://bphc.hrsa.gov/policy/pin9823/
Many low-income, uninsured Americans face major barriers to obtaining prescription drugs. On a frequent basis they have to choose between using their limited resources for living expenses or lifesaving medications.
In 1992, Congress enacted Section 340B of the Public Health Service Act to help health centers make affordable prescription drugs available to their patients. Through the federal 340B discount drug program, health centers can receive significant discounts on outpatient prescription drugs. Section 340B requires that drug manufacturers provide outpatient drugs to eligible centers (also known as “covered entities”) at a reduced price.
The 340B Drug Pricing Program improves healthcare delivery in participating communities by using cost savings to:
Reduce the price of medications for patients
Expand the number of drugs in formularies
Increase the number of indigent patients served
The 340B price is a “ceiling price”. It is the highest discounted price a “covered entity” would pay for selected outpatient and over-the-cover drugs and the minimum savings a manufacturer must provide. The 340B price is at least as low as the price that state Medicaid agencies currently pay. Community Health Centers have reported savings that range from between 25-50% for covered outpatient drugs as a result of the low 340B prices.
The Office of Pharmacy Affairs of the U.S. Department of Health and Human Services/HRSA is responsible for administration of the 340B Program. Once the health center is notified of their 340B eligibility, prescription drugs are distributed through health center pharmacies or through contracted retail pharmacies.
Six Community Health Centers in Connecticut now participate in the 340B Drug Discount Pricing Program with 111 approved 340B facilities throughout the state.
For more information on Pharmacy Discount programs, please link to the HRSA, Office of Pharmacy Affairs, 340B Drug Pricing Program webpage:
A major goal in the United States is to eliminate health disparities and to ensure access to primary quality care for racial and ethnic minorities and other underserved populations. The disparity of health care for different minority populations, poor people and women, can lead to differences in death from heart disease, cancer, stroke and diabetes - the four top leading causes of death in the US- as well as other illnesses.
Started in 1999, the U.S. Department of Health and Human Services/HRSA has encouraged Community Health Centers to develop and participate in health disparities collaboratives as a means of educating clinicians, nurses, patients and families on how to recognize and manage chronic diseases.
As Community Health Centers see more patients with costly chronic conditions such as diabetes, asthma, obesity and cardiovascular diseases, an approach to improving care is one that focuses on a core set of prevention and chronic disease management measures. By promoting to strengthen the multidisciplinary health center team, by improving procedures to document and track health outcomes, by reaching out to patients and residents in the community, and by encouraging patients to participate in managing their own care, the collaboratives have proven to be effective in reducing the complications of specific chronic conditions.
The mission of the Health Disparities Collaboratives is to achieve excellence in practice through the following goals:
Generate and document improved health outcomes for underserved populations
Transform clinical, financial, and operational practice through models of care, improvement and learning in context of Community Oriented Primary Care
Develop infrastructure, expertise and multi-disciplinary leadership to support and drive improved health status
Build strategic partnerships
A population-based care model requires knowing which patients have an illness or need preventive services, assures delivery of evidence-based care, and actively helps patients and families to participate in their own care.
The HRSA Health Disparities Collaboratives is guided at the national level by a panel of experts in a variety of fields. HDC is further organized by dividing the nation into five geographic cluster of states, with a state Primary Care Association serving as the lead agency within each cluster. Connecticut is in the Northeast Cluster: Region I & II (Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, Vermont, Puerto Rico, and the Virgin Islands) with the Connecticut Primary Care Association serving as the lead organization for the Northeast Cluster.
Every eligible Community Health Centers in Connecticut participates in at least one collaborative. Most notably are the CHCs that participate in the collaboratives that focus on diabetes and asthma – two chronic diseases with high prevalence rates in Connecticut. On the strength of this success, health centers have expanded the changes in practice to additional topics, including cardiovascular disease, cancer, depression, and prevention services.
The Community Health Centers in Connecticut participating in the HDC agree to adopt and track national clinical measures, as well as local measures based on proven guidelines. The clinical measures are aligned with expert guidelines, external reporting requirements, such as Healthcare Effectiveness Data and Information Set (HEDIS) or other community standards of care. HEDIS is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. The Community Health Centers in Connecticut are achieving excellence in clinical practice through generating and documenting improved health outcomes for underserved populations.
For more information on Health Disparities Collaboratives, please link to the: HRSA, Health Disparities Collaboratives: http://www.healthdisparities.net/hdc/html/home.aspx
For more information on the Department of Public Health Initiatives in Asthma, Diabetes, Cardiovascular Disease or Cancer, please link to the DPH website: http://www.ct.gov/dph/cwp/view.asp?a=3115&q=387268&dphNav_GID=1601
Since 1987, the U.S. Department of Health and Human Services/HRSA has provided support to community-based organizations and hospitals for health care services specifically targeted to vulnerable individuals and families experiencing homelessness.
The Stewart B. McKinney Homeless Assistance Act of 1987 recognized that mainstream health care was not addressing the multitude of health problems faced by homeless individuals. Homeless individuals suffer from health care problems at more than double the rate of individuals with stable housing.
Congress reauthorized the HealthCare for the Homeless Program (HCH) in 1996 via the Health Centers Consolidation Act (HCCA), which amended the PHS Act by consolidating the HCH program with other community-based health programs. The HCCA was re-authorized in 2002.
There are seven (7) federally funded Health Care for the Homeless Programs in Connecticut:
Charter Oak Health Center, Hartford, CT
Community Health Center, Inc. Middletown, CT
Generations Family Health Center, Willimantic, CT
Hill Health Center, New Haven, CT
Optimus Health Care, Bridgeport, CT
Southwest Community Health Center, Bridgeport, CT
StayWell Health Care, Waterbury, CT
Health Care for the Homeless Programs emphasize a multi-disciplinary approach to delivering care to homeless persons, combining aggressive street outreach with integrated systems of primary care, mental health and substance abuse services, case management, and clinical advocacy. Emphasis is place on coordinating efforts with other community health providers and social service agencies.
In 2006, the majority of clients in Connecticut (53%) were male. Most, 45 percent, were between ages 20 – 44, followed by individuals between ages 45-64 (27%). Children and youth up to age 19 accounted for 25%. People over age 65 comprised 3% of clients. The clients served are some of our states most neediest, with 33% living in shelters, 8% in transitional housing, 9% doubling up, and 48% Other/Unknown. More than 76% of the clients live below the Federal Poverty Level ($9,800 for 1 person). Thirty percent (30%) have no public or private health insurance.
For more information on Health Care for the Homeless programs, please link to the HRSA, Health Care for the Homeless Information Resource Center homepage: