A health center’s scope of project lays out approved service sites, services, providers, service area(s) and target population(s) that are supported by the Section 330 project budget. These activities are identified in the health center scope documents. Federal regulations require health centers to maintain their funded scope of project including any increases based on recent grant awards.
Are your health center scope documents up to date?
It is important to note that a health center’s scope of project may change over time. An expansion of services or the addition of a new site is often funded through new grant awards; a reduction in services may be the result of staff changes, or site closures. Health centers can find their current list of services and site locations on Forms 5A, 5B and 5C in the Electronic Handbook (EHB). At least annually health centers should review the scope forms with their board of directors and document in the meeting minutes that the scope forms are accurate, or if changes are required document the board’s approval. Policy Information Notices (PINs) and Program Assistance Letters (PALs) on the HRSA website provide guidance on how and when to submit a change in scope request to HRSA.
Health center scope documents: Form 5A Services
Health centers are required to provide a set of primary care services – as defined by statute – and may offer additional services to meet the needs of the population. HRSA’s Form 5A service descriptors outline the general elements for all services – required and additional. The descriptions enable accurate recording of each service. Because of the wide variety of health centers, the descriptors are broadly written to allow for differences in the type of staff and service providers needed to carry out each service. One thing that does not vary is the requirement that all providers must be properly credentialed, trained and licensed to perform any service(s), activities and/or procedures on behalf of the health center.
For all types of health center services, where applicable, health centers may identify what additional elements could be included in a particular in-scope service that provide a more complete level of a service. Such enhancements may not require a change in scope submission. Health centers should also identify what is not included in a service and thereby draw a line for when a separate change in scope request is required. When a change in scope request is approved, only those aspects of the specialty service, as described in the change in scope request, will be included within the approved scope of project.
Health centers must offer all of the twenty “required services” as defined by statute and regulation. These services include general primary care, diagnostic labs and imaging, screenings, coverage for emergencies, preventive services, well child, OB/GYN services, pharmaceuticals and enabling services. “Health Care for the Homeless” providers must also provide substance abuse services – harm reduction, detox and treatment.
HRSA defines general dentistry, mental health, substance abuse, optometry, nutrition, alternative medicine and specific therapies (occupational, physical, speech) as “additional services.” A health center should prioritize primary health services before deciding on which additional services to offer their target population. Health centers should make the decision to add additional services only after they have studied their costs, benefits and risks, and whether they are appropriate for the population served and meet an unmet need.
Specialty services require prior approval from the project officer before adding to scope. Generally health centers must make a case based on service population need to add a specialty service. Common specialties found in health centers include psychiatry, oral surgery, podiatry and dermatology.
Health center scope documents: Form 5B Service Sites
In order to ensure that health centers are providing services at times and locations that assure accessibility and meet the needs of the population to be served, all sites participating in the health center’s approved scope of project must be appropriately recorded on Form 5B: Service Sites in the HRSA EHB scope module.
A service site is defined as any location where primary health care services are provided to a defined service area or target population. This may be accomplished either directly or through a sub-recipient or contract.
Whether seasonal, permanent, mobile or intermittent a location can be called a service site as long as it meets all of the following criteria:
- Documented face to face visits between patients and providers
- Providers are empowered to use their judgment in the provision of services to the patient
- Health services are provided either directly by or on behalf of the grant awardee
- The health center’s governing board retains control and authority over the provision of the services at the service site
- Services are provided on a regular schedule (i.e., daily, weekly, the second Friday of each month)
When reviewing Form 5B for accuracy, make sure the total hours of operation are noted correctly and that the zip codes listed reflect your patients’ place of residence.
Health center scope documents: Form 5C – Other Activities/Locations
Other activities include services provided off-site by health center staff. Generally Form 5C includes hospital admissions, medical rounds at hospitals or nursing homes, home visits, health fairs, patient education and non-clinical outreach services.
Updating any of the scope forms requires submitting a change in scope in the EHB. For assistance with change in scope applications contact Health Center Solutions.
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