The Health Resources and Services Administration (HRSA) just issued a Funding Opportunity Announcement (FOA, which is HRSA-speak for RFP) for the New Access Points (NAP) program. There is $250,000,000 available and 350 grants up to $650/000/year for five years! The deadline is November 17. This the first NAP FOA in over three years, and the NAP program is the best way to fund primary health care and prevention for medically indigent folks. In other words, this is a great opportunity. The real question is, where has the NAP program been for the last three years?
I have no idea why HRSA has not issued any NAP FOAs lately, but it may have something to do with the change in administrations and the extended health care reform debate. The NAP program was greatly expanded during the Bush administration, and HRSA issued NAP FOAs frequently during the early and mid years of the decade. We wrote many funded NAP grants and became very familiar with the program in the process. Then funding for NAP was either not included in HRSA appropriations or HRSA slowed down the grant making process, causing NAP to disappear beneath the waves a year or so before President Obama assumed office. But NAP funding was included in the recently passed Health Reform Act of 2010. This Act authorizes dozens of new competitive federal grant programs, as well as some old friends like NAP, and voila, HRSA issues this enormous FOA, so it seems that the NAP program is once again in favor.
For those not in the know, to be eligible for a NAP grant, the applicant has to be, or agree to set-up, a nonprofit “Health Center” under Section 330 of the Public Health Service Act (42 USCS § 254b), or, as they are termed in the trade, a Section 330 provider. Older terms that are sometimes used, like Federal Qualified Health Centers (FQHC) or FQHC Look-Alikes. Without getting too far inside baseball, the intent of such health centers is to provide access to patients who are eligible for public insurance programs, such as Medicaid, Medicare and SCHIP, or have no insurance. Although services are nominally provided on a sliding scale and no one is supposed to be turned away, Section 330 providers have to keep the doors open and, like all health care providers, they prefer patients with third party payers.
The entire Section 330/FQHC/FQHC Look-Alike system grew up to replace the chaotic but never dull “free clinic” model of the late 1960s and 1970s, which was pioneered to serve assorted hippies, druggies, runaways and other youth by the Haight Ashbury Free Clinic and LA Free Clinic. When I moved to LA in 1974, I almost went to work for the LA Free Clinic’s founding Executive Director, Lenny Somberg, who was a very interesting guy but was unfortunately killed by an intruder a few months after I met him.
While I didn’t get the job, I eventually volunteered and served on the board of the Harbor Free Clinic in San Pedro*, another one of the original free clinics. The basic idea of free clinics was to use volunteer docs and allied health professionals to provide free health care while not accepting Medicaid or any other insurance. Although some organizations retain “Free Clinic” in their name, I don’t think any still use this model, having shifted long ago to some version of the Section 330/FQHC paradigm—in other words, they are primarily Medicaid/Medicare providers and use paid medical staff.
These days, if an organization wants to provide primary health care for the uninsured, publicly insured or underinsured, they become a Section 330 provider, and a NAP grant is the organization’s ticket into the Medicaid reimbursement world. This is the first opportunity to compete for a NAP grant in three years, so start writing f you’re eligible. Who knows when the next NAP FOA will pop up in the federal trough?
*Pronounced “Peedro” by residents, not “Paydro,” and often affectionately termed, “The city where the sewer meets the sea.” I lived in Pedro for a few years and can attest to its many charms. Among other things, Pedro often turns up as a locale in movies and TV, including the most recent episode of my favorite TV show, Mad Men, “The Good News.”
2 responses so far ↓
1 Is it Collaboration or Competition that HRSA Wants in the Service Area Competition (SAC) and New Access Points (NAP) FOAs? // Sep 6, 2010 at 4:41 pm
[...] process underway for the New Access Points (NAP) program, which I recently wrote about in “The Health Resources and Services Administration (HRSA) Finally Issues a New Access Points (NAP) FOA….” A quick search of the FOAs reveal that the term “collaboration” is used at [...]
2 Marty Hiller // Sep 20, 2010 at 2:32 pm
Well – contrary to your belief, the free clinic movement is alive and remarkably well. I spent nearly 30 years, twenty as Executive Director, of a large urban free clinic in Cleveland Ohio, which at its height, delivered nearly 50,000 patient visits annually. During those years I was a founding Board member and First President of the National Association of Free Clinics (http://www.freeclinics.us), a membership group today totaling nearly 600 members.
In this new world order, where healthcare reform has been defined as access to affordable insurance, care for the uninsured will be a critical issue for the foreseeable future – far beyond the current reform, even if fully implemented (does anyone believe that is even a remote possibility?). With the potential of adding 32 million Americans to the rolls of the insured, best estimates tell us there will be at least 23 million Americans who will remain without coverage at that point. And with “New Access Points” being created to serve the newly covered populace, the choice to serve those patients with no available reimbursement as a business decision, is no decision.
Enter free clinics! There is an obvious need. It is a model that has become much more quality driven than in the “flower child” era. Care provided to patients closely resembles that of an FQHC where services overlap. Free clinics have become – in the parlance of the day – “medical homes” for many of the uninsured.
The question, of course, in the face of the obvious need and despite having the appropriate model, how do they survive in the new world order?
Some free clinics will consider becoming a New Access Point. They will examine their current population and understand that many of those individuals will become insured in this first wave of reform. Medicaid or other opportunities for reimbursement for care to these specific individuals should be captured if the priority is to care for those patients who have been drawn to the free clinic as a medical home.
Other free clinics will focus upon their mission of service to the uninsured and providing services free of charge and will remain as a free clinic.
Clearly it is not an either/or choice. Many “hybrid” models will be created in an attempt to accommodate the uninsured while capturing reimbursement as a critical stream of operating revenue.
While the answer is not clear and will most certainly differ community to community – free clinics have a history of resilience and flexibility. Free clinics, among the 1500 or so in the country, that embrace those characteristics and become proactive and skilled in translating this need to their communities, will likely enjoy the level of philanthropic support that has enabled them to keep their doors open for service for decades. Those free clinics who do not, will not survive as that model. In fact, may have difficulty surviving at all.
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