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In this chapter:
Section 330(k)(3)(A) of the PHS Act; and 42 CFR 51c.303(a) and 42 CFR 56.303(a)
- The required primary health services of the health center must be available and accessible in the catchment [service] area of the center promptly, as appropriate, and in a manner which ensures continuity of service to the residents of the center’s catchment area.
A health center would demonstrate compliance with these requirements by fulfilling all of the following:
- The health center’s service site(s) are accessible to the patient population relative to where this population lives or works (for example, in areas immediately accessible to public housing for health centers targeting public housing residents, or in shelters for health centers targeting individuals experiencing homelessness, or at migrant camps for health centers targeting agricultural workers). Specifically, the health center considers the following factors to ensure the accessibility of its sites:
- Access barriers (for example, barriers resulting from the area's physical characteristics, residential patterns, or economic and social groupings); and
- Distance and time taken for patients to travel to or between service sites in order to access the health center’s full range of in-scope services.
- The health center’s total number and scheduled hours of operation across its service sites are responsive to patient needs by facilitating the ability to schedule appointments and access the health center’s full range of services within the HRSA-approved scope of project1 (for example, a health center service site might offer extended evening hours 3 days a week based on input or feedback from patients who cannot miss work for appointments during normal business hours).
- The health center accurately records the sites in its HRSA-approved scope of project2 on its Form 5B: Service Sites in HRSA’s Electronic Handbooks (EHB).
The following points describe areas where health centers have discretion with respect to decision-making or that may be useful for health centers to consider when implementing these requirements:
- The health center determines which methods to use for obtaining patient input on the accessibility of its service sites and hours of operation (for example, annual survey, focus groups, input from patient board members).
- The health center determines how to measure and consider distance and travel time to or between the health center’s sites when assessing its impact on patient access to the health center’s services.
- The health center determines how to support patient access to the various service sites included within its HRSA-approved scope of project (for example, whether to provide patient transportation between service sites or use mobile service sites). The health center also determines which service(s) to provide at each site within its HRSA-approved scope of project.
1. Services provided by a health center are defined at the awardee/designee level, not by individual site. Thus, not all services must be available at every health center service site; rather, health center patients must have reasonable access to the full complement of services offered by the center as a whole, either directly or through formal written established arrangements. See Scope of Project website for further details on scope of project, including services and column descriptors listed on Form 5A: Services Provided.
2. In accordance with 45 CFR 75.308(c)(1)(i), health centers must request prior approval from HRSA for a “Change in the scope or the objective of the project or program (even if there is no associated budget revision requiring prior written approval).” This prior approval requirement applies to the addition, deletion, or replacement of a service site. These changes require prior approval from HRSA and must be submitted by the health center as a formal change in scope request. See Scope of Project website for further details on scope of project.