Service Descriptors for Form 5A: Services Provided
Background
Services are one of five elements that comprise the scope of project, as described in the Bureau of Primary Health Care’s (BPHC) scope of project
policy (PIN 2008-01: Defining Scope of Project and Policy for Requesting Changes). Specifically, the scope of project defines the approved service sites,
services, providers, service area(s) and target population(s) which are supported (wholly or in part) under the total budget approved for the health
center.
Health centers are required to provide a set of primary health care services described in statute and regulations. Health centers may also provide
additional health services, beyond those required by statute or regulations, as appropriate to meet the needs of the population served by the health
center, including certain specialty services.
Any service, whether required or additional, may be provided directly by the health center or through
established (formal) arrangements.
The term “established arrangement” means an arrangement where a service is provided through a formal written
contract or cooperative arrangement (section 330(a)(1) of the PHS Act). All services within the approved Health Center Program scope of project must
be appropriately recorded on Form 5A: Services Provided (Form 5A) in the HRSA Electronic Handbooks Scope Module.
Health centers should keep in mind the following requirements and considerations related to the delivery of services.
• The specific amount and level or intensity of services may vary by health center based on a number of factors including, but not limited to: the
population served, demonstrated unmet need in the community, provider staffing, collaborative arrangements and/or State licensing
requirements.
• Services provided by a health center are defined at the grantee/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.
• Once a service is included in the approved scope of project, it must be available to all patients regardless of ability to pay and be discounted in
accordance with the health center’s sliding fee discount program.
• Health centers should assure services are provided in a culturally and linguistically appropriate manner based on the target population(s). In
assuring that services are appropriate for the needs of the patient population served, the health center must take reasonable steps to provide
meaningful access to health center services for patients with limited English proficiency.
NOTE: HRSA considers specialty services to be within the broad category of “additional” health services, defined in section 330 as services that are not
included as required primary health care services and that are (1) necessary for the adequate support of primary health services and (2) appropriate to
meet the health needs of the population served by the health center. Refer to PIN 2009-02: Specialty Services & Health Centers’ Scope of Project.
Service Descriptors for Form 5A: Services Provided
2
Overview
The Form 5A service descriptors outline the general elements for all services, both Required and Additional, to assist in accurate recording of the approved
Health Center Program scope of project.
The descriptors are broadly written to acknowledge the variety of staff and provider types that may deliver any one service and to ensure individual
health centers understand where and how to appropriately record the services they provide within the Health Center Program scope of
project on Form 5A. For example, in the case of obstetrical care, the service may be provided by a family practice physician, certified nurse midwife,
OB/GYN physician, and/or other appropriate provider. Additionally, both clinical and non-clinical workers (e.g., physician assistants,
registered nurses, promotoras, community workers, doulas) may provide or support the delivery of a service. All providers must be properly
credentialed and privileged (i.e., appropriately trained and licensed) to perform any service(s), activities and/or procedures on behalf of the health center.
(For further information, review the Health Center Program Compliance Manual, Chapter 5: Clinical Staffing.) In addition, health centers must ensure
that any/all Federal, State and local standards/accreditation requirements of the facility where the service is provided have been met.
NOTE: Key benefits that health centers should consider and/or actively plan to address prior to requesting a change in scope include Medicaid and
Medicare FQHC reimbursement, FTCA coverage (eligible to grantees only), and 340B Drug Pricing benefits for a specific service, as appropriate. While
identification within a scope of project is required for participation in these programs, it is not a guarantee that these benefits will be realized. Each of
these programs has a specific application process and a comprehensive set of requirements, of which scope of project is only one
Descriptors for Required Services
Health centers are required to provide, either directly or through an established arrangement, a set of primary health care services. The descriptors for
the Required Services provide a “floor” for what elements, at a minimum, are included for a particular service. In addition, where applicable the
descriptors:
• Provide detail as to what “may” (but is not required to) be included for a particular service to account for health centers that may provide a more
expansive or an intense level of a service. In these instances, a separate change in scope (CIS) request is not needed.
• Identify a “ceiling” that clarifies what is not included in a particular service and thus where a separate change in scope request is required.
Descriptors for Additional Services
When considering what additional services to provide, health centers should thoroughly investigate the costs, benefits, and risks before making such
decisions. In general, a health center must prioritize making required primary health services available to all patients before proposing to add additional
health services, including additional specialty services. Each health center must determine whether adding additional services as part of approved scope
of project is appropriate for the population served, demonstrated unmet need, and other relevant factors.
The descriptors for Additional Services:
• Provide detail as to what “may” (but is not required to) also be included for a particular service to account for health centers that may provide
a more expansive or an intense level of a service. In these instances, a separate change in scope request is not needed.
Service Descriptors for Form 5A: Services Provided
3
• Identify a “ceiling” that clarifies what is not included in a particular service and thus where a separate change in scope request is required.
Specialty Services are recorded under Additional Services, on Form 5A.
• When a proposed specialty service change in scope request is approved, only those aspects of the specialty service, described within the change
in scope request, will be included within the approved scope of project.
Service Descriptors for Form 5A: Services Provided
4
Table of Contents
Service Descriptors for Form 5A: Services Provided .......................................................................................................................................................................................1
Background ..................................................................................................................................................................................................................................................1
Overview......................................................................................................................................................................................................................................................2
Descriptors for Required Services ...............................................................................................................................................................................................................2
Descriptors for Additional Services .............................................................................................................................................................................................................2
REQUIRED SERVICES ....................................................................................................................................................................................................................................6
General Primary Medical Care ....................................................................................................................................................................................................................6
Diagnostic Laboratory .................................................................................................................................................................................................................................7
Diagnostic Radiology ...................................................................................................................................................................................................................................8
Screenings....................................................................................................................................................................................................................................................9
Coverage for Emergencies During and After Hours ................................................................................................................................................................................. 10
Voluntary Family Planning ........................................................................................................................................................................................................................ 11
Immunizations .......................................................................................................................................................................................................................................... 11
Well Child Services ................................................................................................................................................................................................................................... 12
Gynecological Care ................................................................................................................................................................................................................................... 12
Obstetrical Care ........................................................................................................................................................................................................................................ 13
• Prenatal Care .................................................................................................................................................................................................................................... 13
• Intrapartum Care (Labor & Delivery) .................................................................................................................................................................................................. 14
• Postpartum Care ................................................................................................................................................................................................................................ 14
Preventive Dental ..................................................................................................................................................................................................................................... 15
Pharmaceutical Services ........................................................................................................................................................................................................................... 15
HCH Required Substance Use Disorder Services (Health Care for the Homeless only) ........................................................................................................................... 16
Case Management .................................................................................................................................................................................................................................... 17
Eligibility Assistance.................................................................................................................................................................................................................................. 17
Health Education ...................................................................................................................................................................................................................................... 18
Service Descriptors for Form 5A: Services Provided
5
Outreach ................................................................................................................................................................................................................................................... 19
Transportation .......................................................................................................................................................................................................................................... 19
Translation ................................................................................................................................................................................................................................................ 20
ADDITIONAL SERVICES.............................................................................................................................................................................................................................. 21
Additional Dental Services........................................................................................................................................................................................................................ 21
Behavioral Health Services ....................................................................................................................................................................................................................... 21
• Mental Health Services .................................................................................................................................................................................................................... 22
• Substance Use Disorder Services ..................................................................................................................................................................................................... 23
Optometry ................................................................................................................................................................................................................................................ 24
Recuperative Care Program Services ....................................................................................................................................................................................................... 24
Environmental Health Services ................................................................................................................................................................................................................ 25
Nutrition ................................................................................................................................................................................................................................................... 26
Occupational Therapy .............................................................................................................................................................................................................................. 26
Physical Therapy ....................................................................................................................................................................................................................................... 26
Speech-Language Pathology/ Therapy ..................................................................................................................................................................................................... 26
Complementary and Alternative Medicine .............................................................................................................................................................................................. 27
Additional Enabling/ Supportive Services ................................................................................................................................................................................................ 27
Service Descriptors for Form 5A: Services Provided
6
REQUIRED SERVICES
5A Service Service Descriptor Statute Reference Regulation Reference
General Primary
Medical Care
General primary medical care services are comprehensive
and address prevention as well as acute and chronic
conditions.
At a minimum, these services include assessment,
diagnosis, screening, education and treatment; referrals;
and follow- up of such services.
Any referrals are based on the provider’s documented
assessment of the health center patient, indicating the
medical necessity for referral(s) to other health-related
services (including but not limited to specialty, mental
health and substance use disorder services). Follow-up of
services includes the medical coordination of ongoing
treatment involved with the transfer or discharge planning
of health center patients in various settings.
Section 330(b)(1)(A) “(i)Basic
Health Services:
(I) Health services related to
family medicine, internal
medicine, pediatrics, obstetrics
or gynecology, that are
furnished by physicians and
where appropriate, physician
assistants, nurse practitioners,
and nurse midwives; (ll)
diagnostic laboratory and
radiologic services; (III)
preventive health services,
including-- ..."
42 CFR, Part 51c.102(h)
“Primary health services
means: (1) Diagnostic
treatment, consultative,
referral, and other services
rendered by physicians, and,
where feasible, by physicians'
extenders, such as physicians'
assistants, nurse clinicians, and
nurse practitioners;”
Service Descriptors for Form 5A: Services Provided
7
5A Service Service Descriptor Statute Reference Regulation Reference
Diagnostic
Laboratory
Diagnostic laboratory services are screening and diagnostic
tests ordered by health center providers to provide
information for the assessment of health center patients.
At a minimum, these services include the specimen
collection, processing and interpretation of the result, and
must include access to a combination of: a) Clinical
Laboratory Improvement Amendments (CLIA) waived
tests; and b) moderate complexity laboratory tests, which
are appropriate for the treatment and management of
common conditions of the patient population.
Services may also include access to high complexity
laboratory tests in the support of basic health services,
ordinarily provided by a certified reference laboratory.
Section 330(b)(1)(A)
“(i) Basic Health Services:…
(II) Diagnostic Laboratory and
Radiologic Services”
42 CFR, Part 51c.102(h)
“Primary Health Services
means:…(2) Diagnostic
laboratory services and
diagnostic radiologic services”
Service Descriptors for Form 5A: Services Provided
8
5A Service Service Descriptor Statute Reference Regulation Reference
Diagnostic
Radiology
Diagnostic radiology services are the processing and
interpreting of radiologic images to guide the health
center provider’s subsequent care and/or treatment of a
patient.
At a minimum, these services are inclusive of plain medical
films.
All other types of advanced diagnostic radiology
(e.g., CT, MRI, diagnostic mammogram, advanced
ultrasound, advanced imaging or nuclear medicine) are
considered specialty services.
NOTE: Other service descriptors reference associated
diagnostic radiology services that are included in the scope
of project of the related service. For instance, screening
mammography is considered a screening service; basic
obstetrical ultrasounds are a prenatal service; basic
gynecology imaging (i.e., ultrasound) is a gynecology
service; and dental x-rays are part of preventive and
additional dental services.
Section 330(b)(1)(A)
“(i) Basic Health Services:…
(II) Diagnostic Laboratory and
Radiologic Services”
42 CFR, Part 51c.102(h)
“Primary Health Services
means:…(2) Diagnostic
laboratory services and
diagnostic radiologic services”
Service Descriptors for Form 5A: Services Provided
9
5A Service Service Descriptor Statute Reference Regulation Reference
Screenings
Screening services are performed based on identified risk
factors in the patient population and/or communities to
evaluate, treat, and educate a health center patient.
At a minimum, these services include all of the following:
cancer, communicable disease, cholesterol and blood lead.
Cancer screenings at a minimum must include, but are not
limited to, screening for breast, cervix, and colorectal
cancers (e.g., mammography, Pap testing, fecal occult
blood testing, sigmoidoscopy, colonoscopy).
Communicable disease screenings at a minimum must
include, but are not limited to, testing for tuberculosis,
HIV, Hepatitis B and C, and other sexually transmitted
diseases/infections based on a patient’s identified risk
factors.
Cholesterol screenings are blood tests used to assess and
understand a patient’s risk for cardiovascular disease.
Blood lead screenings at a minimum must comply with
recommendations of state and/or local health departments
for children at-risk for elevated blood lead levels.
Additional communicable disease screenings that are
appropriate for special populations may also be included
(e.g., screening for parasitic infections in migratory and/or
seasonal agricultural worker populations).
Section 330(b)(1)(A)
“(i) Basic Health Services:…
(III) Preventive Health Services,
including--(aa) prenatal and
perinatal services; (bb)
appropriate cancer screening;
(cc) well- child services; (dd)
immunizations against vaccine-
preventable diseases; (ee)
screenings for elevated blood
lead levels, communicable
diseases, and cholesterol”
Not described
Service Descriptors for Form 5A: Services Provided
10
5A Service Service Descriptor Statute Reference Regulation Reference
Coverage for
Emergencies
During and After
Hours
During the health center’s regularly scheduled hours, at a
minimum, health centers must have clearly defined
processes and arrangements to respond to patients
presenting with emergencies and to transfer patients to a
more appropriate setting for additional health care
services when appropriate.
After the health center’s regularly scheduled hours, at a
minimum, after hours coverage includes the provision of
telephone access through clearly defined written
arrangements, to an individual who has the qualification
and training (consistent with licensing requirements in the
health center’s jurisdiction) to exercise professional
judgment in assessing a health center patient's need for
emergency medical care and if appropriate, who can then
refer patients to a covering physician or licensed or
certified independent practitioner, and/or to locations
such as emergency rooms or urgent care facilities for
further assessment or immediate care. A patient’s need
for emergency medical care might arise from an emergent
physical, oral, behavioral and/or other health need and
therefore, the health center’s after hours arrangement
must have the capacity to address comprehensive
emergent health situations.
The coverage arrangement must include provisions to
facilitate follow-up by the health center for patients
accessing after hours coverage, as appropriate.
Section 330(b)(1)(A)
“(i) Basic Health Services… (IV)
emergency medical services”
42 CFR, Part 51c.102(h)
“Primary Health Services
means:...(4) Emergency medical
services, including provision,
through clearly defined
arrangements, for access of
users of the center to health
care for medical emergencies
during and after the center’s
regularly scheduled hours;”
Service Descriptors for Form 5A: Services Provided
11
5A Service Service Descriptor Statute Reference Regulation Reference
Voluntary Family
Planning
Delivery of voluntary family planning and related services
is a required primary health service under section
330(b)(1)(A) of the Public Health Service Act for Health
Resources and Services Administration’s (HRSA)-supported
health centers. Voluntary family planning services are
preventive health services that include: counseling on family
planning options; contraceptive services, such as the full
range of U.S. Food and Drug Administration (FDA)-approved,
-granted, or -cleared contraceptives; effective family
planning practices; sterilization procedures that are
determined by an individual and the individual’s medical
provider to be medically appropriate; and management of
patient care related to such services.
Section 330(b)(1)(A)
“(i) Basic Health Services…
(III) Preventive Health Services,
including...(gg) voluntary family
planning services”
42 CFR, Part 51c.102(h)
“Primary Health Services
means…(3) Preventive health
services, including medical
social services, nutritional
assessment and referral,
preventive health education,
children's eye and ear
examinations, prenatal and
post-partum care, prenatal
services, well child care
(including periodic screening),
immunizations, and voluntary
family planning services;”
Immunizations
Immunization services are the provision of age appropriate
preventive vaccines.
These services may also include any immunizations
recommended by Federal, state or local authorities to
address an outbreak.
Section 330(b)(1)(A)
“(i) Basic Health Services...
(III) Preventive Health Services,
including--…(dd) immunizations
against
vaccine-preventable diseases,”
42 CFR, Part 51c.102(h)
“Primary Health Services
means…(3) Preventive health
services, including medical
social services, nutritional
assessment and referral,
preventive health education,
children's eye and ear
examinations, prenatal and
post-partum care, prenatal
services, well child care
(including periodic screening),
immunizations,
and voluntary family planning
services;”
Service Descriptors for Form 5A: Services Provided
12
5A Service Service Descriptor Statute Reference Regulation Reference
Well Child Services
Well child services are age appropriate preventive care
and treatment for newborns through adolescents.
At a minimum, these services must include regular/periodic
physical exams and measurements; appropriate screenings
and tests to assess vision, hearing, oral health, growth and
development, and immunization status; and health
education and counseling.
Section 330(b)(1)(A)
“(i) Basic Health Services:…
(III) Preventive Health Services,
including...(cc) well- child
services”
42 CFR, Part 51c.102(h)
“Primary Health Services
means… (3) Preventive health
services, including medical
social services, nutritional
assessment and referral,
preventive health education,
children's eye and ear
examinations, prenatal and
post-partum care, prenatal
services, well child care
(including periodic screening),
immunizations, and voluntary
family planning services;”
Gynecological Care
Gynecological services include pelvic and breast exams,
cervical cancer screening, and the review of menstrual and
reproductive history, gynecological symptoms, and basic
gynecological ultrasounds. Such services may also include
common gynecological procedures required to ensure
continuity of care for health center patients (e.g.,
colposcopy, hysterectomy, and fibroid removal). Advanced
gynecological services, such as gynecologic oncology,
urogynecology, reproductive endocrinology, and infertility,
are considered specialty services.
Pursuant to existing law and consistent with Executive
Order 13535 (75 FR 15599), health centers are prohibited
from using federal funds to provide abortions, except in
cases of rape or incest or if the patient’s life is in danger.
Section330(b)(1)(A) “(i)Basic
Health Services:
(I) Health services related to
family medicine, internal
medicine, pediatrics, obstetrics
or gynecology, that are
furnished by physicians and
where appropriate, physician
assistants, nurse practitioners,
and nurse midwives; (ll)
diagnostic laboratory and
radiologic services; (III)
preventive health services,
including-..."
42 CFR, Part 51c.102(h)
“Primary health services
means: (1) Diagnostic
treatment, consultative,
referral, and other services
rendered by physicians, and,
where feasible, by physicians'
extenders, such as physicians'
assistants, nurse clinicians, and
nurse practitioners;”
Service Descriptors for Form 5A: Services Provided
13
5A Service Service Descriptor Statute Reference Regulation Reference
Obstetrical Care
Obstetrical services include the clinical assessment,
management/treatment, and coordination of services and
referrals to care for people planning pregnancy, during
their pregnancy, during labor and delivery, and after they
give birth. Such services can be divided into three
components: 1) prenatal; 2) intrapartum (labor and
delivery); and 3) postpartum. These services should be
consistent with the individual health center provider's
licensure, credentials, and privileging.
Section330(b)(1)(A) “(i)Basic
Health Services:
(I) Health services related to
family medicine, internal
medicine, pediatrics, obstetrics
or gynecology, that are
furnished by physicians and
where appropriate, physician
assistants, nurse practitioners,
and nurse midwives; (ll)
diagnostic laboratory and
radiologic
services; (III) preventive health
services, including-- ..."
• Prenatal
Care
Prenatal care includes regular screening (including labs
and basic ultrasounds), ongoing monitoring of uterine and
fetal growth, risk assessment, and counseling.
Maternal-fetal medicine (i.e., perinatology) is considered a
specialty service.
Section 330(b)(1)(A)
“(i) Basic Health Services:…
(III) Preventive Health Services,
including...(aa) prenatal and
perinatal services”
42 CFR, Part 51c.102(h)
“Primary Health Services
means…(3) Preventive health
services, including medical
social services, nutritional
assessment and referral,
preventive health education,
children's eye and ear
examinations, prenatal and
post-partum care, prenatal
services, well child care
(including periodic screening),
immunizations, and voluntary
family planning services;”
Service Descriptors for Form 5A: Services Provided
14
5A Service Service Descriptor Statute Reference Regulation Reference
• Intrapartum
Care (Labor
& Delivery)
Intrapartum care includes birthing care and care for the
newborn during labor and birth and ongoing assessment
and potential transfer to an appropriate delivery and/or
postnatal care setting.
Maternal-fetal medicine (i.e., perinatology) is considered
a specialty service.
Section 330(b)(1)(A): “(i)Basic
Health Services:
(I) Health services related to
family medicine, internal
medicine, pediatrics, obstetrics
or gynecology, that are
furnished by physicians and
where appropriate, physician
assistants, nurse practitioners,
and nurse midwives; (ll)
diagnostic laboratory and
radiologic
services; (III) preventive health
services, including-- ..."
• Postpartum
Care
Postpartum care includes postpartum checkup(s), along
with appropriate follow-up treatment and education, for
up to a year.
Section 330(b)(1)(A): “(i)Basic
Health Services:
(I) Health services related to
family medicine, internal
medicine, pediatrics, obstetrics
or gynecology, that are
furnished by physicians and
where appropriate, physician
assistants, nurse practitioners,
and nurse midwives; (ll)
diagnostic laboratory and
radiologic
services; (III) preventive health
services, including--..."
42 CFR, Part 51c.102(h)
“Primary Health Services
means…(3) Preventive health
services, including medical
social services, nutritional
assessment and referral,
preventive health education,
children's eye and ear
examinations, prenatal and
post-partum care, prenatal
services, well child care
(including periodic screening),
immunizations, and voluntary
family planning services;”
Service Descriptors for Form 5A: Services Provided
15
5A Service Service Descriptor Statute Reference Regulation Reference
Preventive Dental
Preventive dental services prevent diseases of the oral
cavity and related structures.
At a minimum, these services include all of the following:
basic dental screenings and recommendations for
preventive intervention;
oral hygiene instruction and related oral health education
(e.g., prevention of oral trauma and oral cancer);
oral prophylaxis, as necessary; and
topical application of fluorides (e.g., fluoride varnishes)
and the prescription of fluorides for systemic use when not
available in the water supply.
Services may include application of sealants, and
diagnostic screening for caries and periodontal disease
through the use of dental x-rays.
Section 330(b)(1)(A)
“(i) Basic Health Services:…
(III) Preventive Health Services,
including...(hh) preventive
dental services”
42 CFR, Part 51c.102(h)
“Primary Health Services
means…(6) Preventive dental
services provided by a licensed
dentist or other qualified
personnel, including (i) oral
hygiene instruction; (ii) oral
prophylaxis, as necessary; and
(iii) topical application of
fluorides, and the prescription
of fluorides for systemic use
when not available in the
community water supply.”
Pharmaceutical
Services
Pharmaceutical services provide access to prescribed
medications.
These services may include a broad spectrum of functions
ranging from the dispensing and tracking of medications to
pharmacist-delivered patient care services (e.g., disease
state management, medication reconciliation, therapeutic
monitoring, wellness promotion, and disease prevention).
Section 330(b)(1)(A)
“(i) Basic Health Services:…
(V) pharmaceutical services as
may be appropriate for
particular centers”
42 CFR, Part 51c.102(j)
“Supplemental health services
means health services which
are not included as primary
health services and which are:
… (9)Pharmaceutical services,
including the provision of
prescription drugs;”
Service Descriptors for Form 5A: Services Provided
16
5A Service Service Descriptor Statute Reference Regulation Reference
HCH Required
Substance Use
Disorder Services
(Health Care for
the Homeless only)
Substance use disorder services are screening, diagnosis,
and treatment services for substance use disorders (e.g.,
abuse of alcohol, tobacco, prescription drugs).
At a minimum, these services include:
age appropriate, harm/risk reduction and age appropriate
counseling to address identified risk factors, support
abstinence, and/or decrease negative consequences of
substance use disorder;
detoxification to manage withdrawal symptoms associated
with substance use disorder; and
treatment/rehabilitation, to include individual and/or
group treatment, counseling and case management.
Treatment may occur in out-patient or short-term
residential settings and may include medication-assisted
treatment (e.g., buprenorphine products, methadone,
naltrexone).
Section 330(h) – Health Care for
the Homeless only
"(5)(B) Substance use disorder
services. The term "substance
use disorder services" includes
detoxification, risk reduction,
outpatient treatment,
residential treatment, and
rehabilitation for substance
abuse provided in settings
other than hospitals."
Service Descriptors for Form 5A: Services Provided
17
5A Service Service Descriptor Statute Reference Regulation Reference
Case Management
Case management services are the coordination of support
and enabling services to meet the ongoing needs of a
patient.
At a minimum, these services include an assessment of
factors affecting health (e.g., medical, social, housing, or
educational), counseling and referrals to address identified
needs and periodic follow-up of services.
Section 330(b)(1)(A) “ (iii)
Patient case management
services (including counseling,
referral, and follow-up services)
and other services designed to
assist health center patients in
establishing eligibility for and
gaining access to Federal, State,
and local programs that provide
or financially support the
provision of medical, social,
housing, educational, or other
related services;”
Eligibility
Assistance
Eligibility assistance services are support to health center
patients to establish eligibility for and gain access to
appropriate federal, state and local programs that provide
or financially support the provision of medical, social,
educational, housing, or other related services (e.g.,
Medicaid, Veteran’s benefits, the Special Supplemental
Nutrition Assistance Program, Legal Aid).
Section 330(b)(1)(A) “…(iii)
Patient case management
services
(including counseling, referral,
and follow-up services) and
other services designed to
assist health center patients in
establishing eligibility for and
gaining access to Federal, State,
and local programs that provide
or financially support the
provision of medical, social,
housing, educational, or
other related services;”
Service Descriptors for Form 5A: Services Provided
18
5A Service Service Descriptor Statute Reference Regulation Reference
Health Education
Health education services are a variety of learning
experiences designed to help individuals improve their
health.
At a minimum, these services include education regarding
the availability and appropriate use of health services.
Services may include primary prevention and/or targeted
education on self-managed care and other health
promoting behaviors for patients with identified risk
factors or conditions (e.g., tobacco cessation). These
services may also include education on injury prevention
and unique needs and risks of special populations (e.g.,
education to prevent common exposures experienced by
migratory and/or
seasonal agricultural workers).
Section 330 (b)(1)(A)
“…(V) education of patients and
the general population served
by the health center regarding
the availability and proper use
of health services”
42 CFR, Part 51c.102(j)
"…(13) Health education
services"
Service Descriptors for Form 5A: Services Provided
19
5A Service Service Descriptor Statute Reference Regulation Reference
Outreach
Outreach services are a broad range of culturally and
linguistically appropriate activities focused on recruiting
and retaining patients from the target population/service
area.
At a minimum, these services must promote awareness of
the health center’s services and support entry into care.
These services do not involve direct patient care where a
provider is generating a face-to-face visit with a patient,
documenting the care in a patient medical record, or
exercising clinical judgment in the provision of services to
a patient.
Section 330(b)(1)(A) “…(iv)
Services that enable individuals
to use the services of the health
center (including outreach and
transportation services and, if a
substantial number of the
individuals in the population
served by a center are of
limited English- speaking ability,
the services of appropriate
personnel fluent in the
language spoken by a
predominant number of such
individuals);”
42 CFR, Part 51c.102(j)
“…(14) services, including the
services of outreach workers,
which promote and facilitate
optimal use of primary health
services and services….if a
substantial number of
individuals in the population
served by the center are of
limited English-speaking ability,
the services of outreach
workers and other personnel
fluent in the language or
languages spoken
by such individuals.”
Transportation
Transportation services are services that enable patients
to access health center services when transportation
would otherwise be a barrier to care (e.g., providing
transport vans, bus tokens or vouchers for public
transportation, or linkages to other community
transportation programs).
Section 330 (b)(1)(A) “…(iv)
Services that enable
individuals to use the services
of the health center (including
outreach and transportation
services and, if a substantial
number of the individuals in the
population served by a center
are of limited English- speaking
ability, the services of
appropriate personnel fluent in
the language spoken by a
predominant number of such
individuals);”
42 CFR, Part 51c.102(h)
“Primary Health Services
means…(5) Transportation
services as needed for
adequate patient care,
sufficient so that residents of
the catchment area served by
the center with special
difficulties of access to services
provided by the center receive
such services;”
Service Descriptors for Form 5A: Services Provided
20
5A Service Service Descriptor Statute Reference Regulation Reference
Translation
Translation services are services to make care linguistically
accessible and culturally responsive for individuals with
limited English proficiency and/or a disability impacting
communication.
At a minimum, these services includes the timely
availability of professional translation (written) and
interpretation (oral) services (e.g., access to bilingual
providers, onsite interpreters, language telephone line)
based on the primary language(s) spoken by a substantial
number of individuals in the health center's target
population and service area.
These services also include auxiliary aids to ensure
effective communication with individuals who have
disabilities.
Section 330 (b)(1)(A) “…(iv)
Services that enable
individuals to use the services
of the health center (including
outreach and transportation
services and, if a substantial
number of the individuals in the
population served by a center
are of limited English- speaking
ability, the services of
appropriate personnel fluent in
the language spoken by a
predominant number of such
individuals);”
42 CFR, Part 51c.102(j)
“…(14) services, including the
services of outreach workers,
which promote and facilitate
optimal use of primary health
services and services...if a
substantial number of
individuals in the population
served by the center are of
limited English-speaking ability,
the services of outreach
workers and other personnel
fluent in the language or
languages spoken
by such individuals.”
Service Descriptors for Form 5A: Services Provided
21
ADDITIONAL SERVICES
5A Service Service Descriptor Statute Reference Regulation Reference
Additional
Dental Services
Additional dental services are basic services at a general
practice level to diagnose and treat disease, injury, or
impairment in teeth and associated structures of the oral
cavity and include any diagnostic x-rays or imaging.
These services may include: fillings and single unit crowns;
non-surgical-endodontics, extractions, periodontal therapies,
bridges or dentures.
Complex dental services (e.g., oral surgery, surgical
endodontics, orthodontics) are considered specialty services.
Not described 42 CFR, Part 51c.102(j)
“…(6) Dental services other
than those provided as primary
health services”
Behavioral
Health Services
Behavioral health services encompass a wide array of services
that address both mental health and substance use disorder.
Section 330(b)(2)
"…(A) behavioral and mental
health and substance use
disorder services;”
42 CFR, Part 51c.102(j)
“…(5) Mental health services,
including services of
psychiatrists, psychologists, and
other appropriate mental
health professionals;”
Service Descriptors for Form 5A: Services Provided
22
5A Service Service Descriptor Statute Reference Regulation Reference
• Mental
Health
Services
Mental health services are the prevention, assessment,
diagnosis, treatment/intervention, and follow-up of mental
health conditions and disorders (e.g., depression, anxiety,
attention deficit and disruptive behavior disorders) including
care of patients with severe mental illness who have been
stabilized.
These services may include treatment and counseling for
health center patients such as individual or group
counseling/psychotherapy, cognitive-behavioral therapy or
problem solving therapy, 24-hour crisis services, and case
management services.
Psychiatry is considered a specialty service.
Section 330(b)(2)
"…(A) behavioral and mental
health and substance use
disorder services;”
42 CFR, Part 51c.102(j)
“…(5) Mental health services,
including services of
psychiatrists, psychologists, and
other appropriate mental
health professionals;”
Service Descriptors for Form 5A: Services Provided
23
5A Service Service Descriptor Statute Reference Regulation Reference
• Substance
Use
Disorder
Services
Substance use disorder services are screening, diagnosis, and
treatment services for substance use disorders (e.g., abuse of
alcohol, tobacco, prescription drugs).
These services may include:
age appropriate, harm/risk reduction and age appropriate
counseling to address identified risk factors, support
abstinence and/or decrease negative consequences of
substance use disorder;
detoxification to manage withdrawal symptoms associated
with substance use disorder; and/or
treatment/rehabilitation, to include individual and/or group
treatment, counseling and case management.
Treatment may occur in out-patient or in short-term
residential settings and may include medication-assisted
treatment (e.g., buprenorphine products, methadone,
naltrexone).
NOTE: Health centers that do not receive HCH funding or
designation, record substance use disorder services under the
Additional Services section of Form 5A, under Behavioral Health
Services. Health centers receiving Healthcare for the Homeless
(HCH) funding or designation through 330(h) must record
substance use disorder services under the Required Services
section of Form 5A. For HCH health centers that also receive
funding or designation to serve an additional population (e.g.,
330(e)), substance use disorder services are only recorded once,
under Required Services.
Section 330(b)(2)
"…(A) behavioral and mental
health and substance use
disorder services;”
Service Descriptors for Form 5A: Services Provided
24
5A Service Service Descriptor Statute Reference Regulation Reference
Optometry
Optometry services assess the health of the eyes and related
structures.
These services include conducting routine eye exams,
prescribing glasses/contacts, identifying related systemic
conditions affecting the eye, and treating injuries and
disorders of the visual system.
Ophthalmology and surgical procedures of the eye (e.g., laser
surgery) are considered specialty services.
Not described 42 CFR, Part 51c.102(j)
“…(7) Vision services, including
routine eye and vision
examinations and provision of
eyeglasses, as appropriate and
feasible;”
Recuperative
Care Program
Services
Recuperative care program services are short-term care and
case management provided to individuals recovering from an
acute illness or injury that generally does not necessitate
hospitalization, but would be exacerbated by their living
conditions (e.g., street, shelter or other unsuitable places).
Section 330(b)(2)
“(B) recuperative care services”
Not described
Service Descriptors for Form 5A: Services Provided
25
5A Service Service Descriptor Statute Reference Regulation Reference
Environmental
Health Services
Environmental health services prevent, detect and mitigate
unhealthy environmental conditions (e.g., contaminated
water supply, chemical and pesticide exposures, air quality,
exposure to lead, poor field sanitation, rodent and parasitic
infestation, and aging or over-crowded housing).
Section 330(b)(2)
“(C ) environmental health
services including--(i) the
detection and alleviation of
unhealthful conditions
associated with--(I) water
supply; (II) chemical and
pesticide exposures; (III) air
quality; or (IV) exposure to
lead; (ii) sewage treatment;
(iii) solid waste disposal; (iv)
rodent and parasitic
infestation; (v) field sanitation;
(vi) housing; and (vii) other
environmental factors related
to health; and”
42 CFR, Part 51c.102
“…(d) Environmental health
services means the detection
and alleviation of unhealthful
conditions of the environment
of the catchment area, such as
problems associated with water
supply, sewage treatment, solid
waste disposal, rodent and
parasite infestation, and
housing conditions. For the
purposes of this part, the
detection and alleviation of
unhealthful conditions of the
environment includes the
notification of and making of
arrangements with appropriate
Federal, State, or local
authorities responsible for
correcting such conditions.”
Service Descriptors for Form 5A: Services Provided
26
5A Service Service Descriptor Statute Reference Regulation Reference
Nutrition
Nutrition services prevent and treat diseases and conditions
through nutritional assessment, diagnosis and treatment.
These services may include medical nutrition therapy,
nutrition education and counseling, and other interventions
to enhance knowledge and impact behaviors related to
healthy eating, nutrition and health.
These services may include the nutrition services of a WIC
program, if the WIC program is within the scope of project.
Not described 42 CFR, Part 51c.102(h)
“…(3) Preventive health
services, including medical
social services, nutritional
assessment and referral,
preventive health education,
children's eye and ear
examinations, prenatal and
post-partum care, prenatal
services, well child care
(including periodic screening),
immunizations, and voluntary
family planning services;"
Occupational
Therapy
Occupational therapy services provide assessment and
treatment services to assist patients in their ability to perform
activities of daily living.
Not described 42 CFR, Part 51c.102(j)
“…(4) Rehabilitative services
(including physical and
occupational therapy) and
long-term physical medicine;”
Physical Therapy
Physical therapy services provide assessment and treatment
services to assist patients to maintain, restore, and improve
physical activity and functioning while ensuring safety.
Not described 42 CFR, Part 51c.102(j)
“…(4) Rehabilitative services
(including physical and
occupational therapy) and
long-term physical medicine;”
Speech-
Language
Pathology/
Therapy
Speech-language pathology/therapy services provide
assessment and treatment services to assist patients to
improve and optimize their ability to communicate and
swallow.
Not described Not described
Service Descriptors for Form 5A: Services Provided
27
5A Service Service Descriptor Statute Reference Regulation Reference
Complementary
and Alternative
Medicine
Complementary and alternative medicine services are the
assessment, diagnosis and non-conventional treatment of
disorders/conditions used together with or in place of
conventional medicine to support health and well-being of
the mind and body (e.g., chiropractic care, acupuncture,
meditation, and massage therapy).
Not described Not described
Additional
Enabling/
Supportive
Services
Additional enabling/supportive services are beyond any
required case management services and support a health
center patient’s access to non-medical, social, educational or
other related services (e.g., child care, food banks/meals,
employment and education counseling, legal services/legal
aid).
Not described Not described
