Securing a hospital agreement, whether it be for ER visits, inpatient admissions or outpatient services can often be a challenge for many health centers.  First and foremost, it is essential for you to notify your Health Resources and Service Administration (HRSA) Project Officer (PO) that the hospital is presenting barriers to formalizing an arrangement.  Keep all documentation of your efforts and ensure it is available for the VOSV team and HRSA Federal Representative to review. 

When attempting to negotiate with the hospital, make it clear that HRSA requires you to have a formal arrangement in place to continue to receive funding.  Oftentimes, a finding of non-compliance occurs before the hospital understands the severity of the situation and is willing to formalize the arrangement.  

Keep in mind there is certain language that is required to be included in the agreement, depending on the service provisions and the structure of the agreement.  For example, if the agreement is a formal, written referral arrangement for all services, language supporting continuity of care must be included.  If the agreement is structured as a formal written contract, where the health center pays, the agreement must also address how the health center will pay for the service and how the service will be documented in the patient’s medical record.  In both cases, provisions demonstrating appropriate credentialing and privileging of providers must be included.  As with any agreement, you should consult with legal counsel.  

Health centers should follow the guidance outlined in “Chapter Eight – Continuity of Care and Hospital Admitting” of the HRSA Health Center Compliance Manual (Chapter 8: Continuity of Care and Hospital Admitting) for requirements related to hospital agreements for ER visits and inpatient admissions.  Additionally, health centers should follow the guidance outlined in “Chapter 4 – Required and Additional Health Services” of the HRSA Health Center Compliance Manual (Chapter 4: Required and Additional Health Services) for guidance related to hospital agreements that include provisions for Required/Additional outpatient services.  Health centers can conduct a self-evaluation of compliance by answering the questions in the aforementioned sections of the HRSA Site Visit Protocol (Health Center Program Site Visit Protocol ).