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;
(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;
(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.
Official Publication of the State of Minnesota
Revisor of Statutes