1997 Minnesota Statutes

     144.1486 Rural community health centers. 

    Subdivision 1.    Community health center.  "Community 
 health center" means a community owned and operated primary and 
 preventive health care practice that meets the unique, essential 
 health care needs of a specified population. 

    Subd. 2.    Program goals.  The Minnesota community 
 health center program shall increase health care access for 
 residents of rural Minnesota by creating new community health 
 centers in areas where they are needed and maintaining essential 
 rural health care services.  The program is not intended to 
 duplicate the work of current health care providers. 

    Subd. 3.    Grants.  (a) The commissioner shall provide 
 grants to communities for planning and establishing community 
 health centers through the Minnesota community health center 
 program.  Grant recipients shall develop and implement a 
 strategy that allows them to become self-sufficient and qualify 
 for other supplemental funding and enhanced reimbursement.  The 
 commissioner shall coordinate the grant program with the federal 
 rural health clinic, federally qualified health center, and 
 migrant and community health center programs to encourage 
 federal certification.  The commissioner may award planning, 
 project, and initial operating expense grants, as provided in 
 paragraphs (b) to (d). 

    (b) Planning grants may be awarded to communities to plan 
 and develop state funded community health centers, federally 
 qualified health centers, or migrant and community health 
 centers. 

    (c) Project grants may be awarded to communities for 
 community health center start-up or expansion, and the 
 conversion of existing practices to community health centers.  
 Start-up grants may be used for facilities, capital equipment, 
 moving expenses, initial staffing, and setup.  Communities must 
 provide reasonable assurance of their ability to obtain health 
 care providers and effectively utilize existing health care 
 provider resources.  Funded community health center projects 
 must become operational before funding expires.  Communities may 
 obtain funding for conversion of existing health care practices 
 to community health centers.  Communities with existing 
 community health centers may apply for grants to add sites in 
 underserved areas.  Governing boards must include 
 representatives of new service areas. 

    (d) Centers may apply for grants for up to two years to 
 subsidize initial operating expenses.  Applicants for initial 
 operating expense grants must demonstrate that expenses exceed 
 revenues by a minimum of ten percent or demonstrate other 
 extreme need that cannot be met using organizational reserves. 

    Subd. 4.    Eligibility requirements.  In order to 
 qualify for community health center program funding, a project 
 must: 

    (1) be located in a rural shortage area that is a medically 
 underserved, federal health professional shortage, or governor 
 designated shortage area.  "Rural" means an area of the state 
 outside the seven-county Twin Cities metropolitan area and 
 outside of the Duluth, St. Cloud, East Grand Forks, Moorhead, 
 Rochester, and LaCrosse census defined urbanized areas; 

    (2) represent or propose the formation of a nonprofit 
 corporation with local resident governance, or be a governmental 
 entity.  Applicants in the process of forming a nonprofit 
 corporation may have a nonprofit coapplicant serve as financial 
 agent through the remainder of the formation period.  With the 
 exception of governmental entities, all applicants must submit 
 application for nonprofit incorporation and 501(c)(3) tax-exempt 
 status within six months of accepting community health center 
 grant funds; 

    (3) result in a locally owned and operated community health 
 center that provides primary and preventive health care 
 services, and incorporates quality assurance, regular reviews of 
 clinical performance, and peer review; 

    (4) seek to employ midlevel professionals, where 
 appropriate; 

    (5) demonstrate community and popular support and provide a 
 20 percent local match of state funding; and 

    (6) propose to serve an area that is not currently served 
 or was not served prior to establishment of a state-funded 
 community health center by a federally certified medical 
 organization. 

    Subd. 5.    Review process, rating criteria, and point 
 allocation.  (a) The commissioner shall establish grant 
 application guidelines and procedures that allow the 
 commissioner to assess relative need and the applicant's ability 
 to plan and manage a health care project.  Program documentation 
 must communicate program objectives, philosophy, expectations, 
 and other conditions of funding to potential applicants. 

    The commissioner shall establish an impartial review 
 process to objectively evaluate grant applications.  Proposals 
 must be categorized, ranked, and funded using a 100-point rating 
 scale.  Fifty-two points shall be assigned to relative need and 
 48 points to project merit. 

    (b) The scoring of relative need must be based on proposed 
 service area factors, including but not limited to: 

    (1) population below 200 percent of poverty; 

    (2) geographic barriers based on average travel time and 
 distance to the next nearest source of primary care that is 
 accessible to Medicaid and Medicare recipients and uninsured 
 low-income individuals; 

    (3) a shortage of primary care health professionals, based 
 on the ratio of the population in the service area to the number 
 of full-time equivalent primary care physicians in the service 
 area; and 

    (4) other community health issues including a high 
 unemployment rate, high percentage of uninsured population, high 
 growth rate of minority and special populations, high teenage 
 pregnancy rate, high morbidity rates due to specific diseases, 
 late entry into prenatal care, high percentage geriatric 
 population, high infant mortality rate, high percentage of low 
 birth weight, cultural and language barriers, high percentage 
 minority population, excessive average travel time and distance 
 to next nearest source of subsidized primary care. 

    (c) Project merit shall be determined based on expected 
 benefit from the project, organizational capability to develop 
 and manage the project, and probability of success, including 
 but not limited to the following factors: 

    (1) proposed scope of health services; 

    (2) clinical management plan; 

    (3) governance; 

    (4) financial and administrative management; and 

    (5) community support, integration, collaboration, 
 resources, and innovation. 

    The commissioner may elect not to award any of the 
 community health center grants if applications fail to meet 
 criteria or lack merit.  The commissioner's decision on an 
 application is final. 

    Subd. 6.    Eligible expenditures.  Grant recipients may 
 use grant funds for the following types of expenditures: 

    (1) salaries and benefits for employees, to the extent they 
 are involved in project planning and implementation; 

    (2) purchase, repair, and maintenance of necessary medical 
 and dental equipment and furnishings; 

    (3) purchase of office, medical, and dental supplies; 

    (4) in-state travel to obtain training or improve 
 coordination; 

    (5) initial operating expenses of community health centers; 

    (6) programs or plans to improve the coordination, 
 effectiveness, or efficiency of the primary health care delivery 
 system; 

    (7) facilities; 

    (8) necessary consultant fees; and 

    (9) reimbursement to rural-based primary care practitioners 
 for equipment, supplies, and furnishings that are transferred to 
 community health centers.  Up to 65 percent of the grant funds 
 may be used to reimburse owners of rural practices for the 
 reasonable market value of usable facilities, equipment, 
 furnishings, supplies, and other resources that the community 
 health center chooses to purchase. 

    Grant funds shall not be used to reimburse applicants for 
 preexisting debt amortization, entertainment, and lobbying 
 expenses. 

    Subd. 7.    Special consideration.  The commissioner, 
 through the office of rural health, shall make special efforts 
 to identify areas of the state where need is the greatest, 
 notify representatives of those areas about grant opportunities, 
 and encourage them to submit applications. 

    Subd. 8.    Requirements.  The commissioner shall 
 develop a list of requirements for community health centers and 
 a tracking and reporting system to assess benefits realized from 
 the program to ensure that projects are on schedule and 
 effectively utilizing state funds. 

    The commissioner shall require community health centers 
 established through the grant program to: 

    (1) abide by all federal and state laws, rules, 
 regulations, and executive orders; 

    (2) establish policies, procedures, and services equivalent 
 to those required for federally certified rural health clinics 
 or federally qualified health centers.  Written policies are 
 required for description of services, medical management, drugs, 
 biologicals, and review of policies; 

    (3) become a Minnesota nonprofit corporation and apply for 
 501(c)(3) tax-exempt status within six months of accepting state 
 funding.  Local governmental or tribal entities are exempt from 
 this requirement; 

    (4) establish a governing board composed of nine to 25 
 members who are residents of the area served and representative 
 of the social, economic, linguistic, ethnic, and racial target 
 population.  At least 35 percent of the board must represent 
 consumers; 

    (5) establish corporate bylaws that reflect all functions 
 and responsibilities of the board; 

    (6) develop an appropriate management and organizational 
 structure with clear lines of authority and responsibility to 
 the board; 

    (7) provide for adequate patient management and continuity 
 of care on site and from referral sources; 

    (8) establish quality assurance and risk management 
 programs, policies, and procedures; 

    (9) develop a strategic staffing plan to acquire an 
 appropriate mix of primary care providers and clinical support 
 staff; 

    (10) establish billing policies and procedures to maximize 
 patient collections, except where federal regulations or 
 contractual obligations prohibit the use of these measures; 

    (11) develop and implement policies and procedures, 
 including a sliding scale fee schedule, that assure that no 
 person will be denied services because of inability to pay; 

    (12) establish an accounting and internal control system in 
 accordance with sound financial management principles; 

    (13) provide a local match equal to 20 percent of the grant 
 amount; 

    (14) work cooperatively with the local community and other 
 health care organizations, other grant recipients, and the 
 office of rural health; 

    (15) obtain an independent annual audit and submit audit 
 results to the office of rural health; 

    (16) maintain detailed records and, upon request, make 
 these records available to the commissioner for examination; and 

    (17) pursue supplemental funding sources, when practical, 
 for implementation and initial operating expenses. 

    Subd. 9.    Precautions.  The commissioner may withhold, 
 delay, or cancel grant funding if a grant recipient does not 
 comply with program requirements and objectives. 

    Subd. 10.    Technical assistance.  The commissioner may 
 provide, contract for, or provide supplemental funding for 
 technical assistance to community health centers in the areas of 
 clinical operations, medical practice management, community 
 development, and program management. 

    HIST: 1992 c 549 art 5 s 12; 1993 c 247 art 5 s 13; 1994 c 625 
 art 8 s 40; 1995 c 234 art 8 s 34