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TECHNICAL MEMORANDUM
CRW Engineering Group, LLC
r
3940 Arctic Blvd., Suite 300
RW
(9 Anchorage, 99503
(907) 562-3252 phone (907) 561-2273 fax
ENGINEERING GROUP LLC www.crwenq.com
Project: North Seward Water Storage Tank (20204.00)
Date: March 22, 2011
Subject: Tank Sites Summary Memo (Rev. 1)
By: Pete Bellezza, P.E.
Introduction
CRW has been providing technical support to the City of Seward for the on-going site
selection effort for the new North Seward water storage tank. CRW has evaluated a
number of sites separately, and this memo provides a summary for each of these sites.
The summary includes a site description, advantages/disadvantages of each site, rough
order of magnitude project costs, and operation and maintenance costs.
The purpose of the new North Seward water storage tank is to provide additional storage
capacity at the north end of Seward, and to provide chlorine contact time for disinfection
of the City's water supply. The new tank can also accommodate the addition of fluoride to
the water supply.
The three sites evaluated are:
1) Kenai Peninsula Borough property West of Well House No. 6 (Appendix B, Sheet
1)
2) Gateway Subdivision — Northeast Corner (Appendix B, Sheet 2)
3) Gateway Subdivision — North of Unimak Circle (Appendix B, Sheet 3)
Development of the new water storage tank and associated facilities will require a site
area of approximately 1 to 1.5 acres. The water storage tank will have a capacity of
600,000 gallons (60 foot diameter/30 foot high tank) and will be constructed of welded
steel; the tank will be insulated to protect the water from freezing. An energy efficient
building will house controls, chlorination equipment, fluoridation equipment, and pressure
pumps as required for each site. In addition, piping will convey water from the wells
directly to the new tank. It has been assumed that each site will be developed with the
pressure pumps and piping necessary to eliminate the dated Swetmann Booster Station.
Existing Water System
The City of Seward's water source consists of five deep groundwater wells at the Fort
Raymond Well Field, which taps the Japanese Creek aquifer:
1) Well No. 2 — 800 gpm
2) Well No. 3 — 350 gpm
3) Well No. 4 — 1,300 gpm
North Seward Water Storage Tank
Tank Sites Summary Memo
March 22, 2011
Page 2 of 7
4) Well No. 5 — 850 gpm
5) Well No. 6 — 1,200 gpm
The current method of chlorination consists of chlorinating the water supply at the well
source. Each well house has a gaseous chlorination system that chlorinates the water as
it passes from the well directly into the distribution system. Because the treated water
passes through the distribution system prior to reaching the existing water storage tanks,
chlorine contact time is inadequate prior to the water reaching the first customer. The new
water storage tank project will collect and chlorinate the water from all wells, and provide
contact time prior to the water entering the distribution system.
The City's distribution system consists of 115,000 feet of water mains sized between 4-
inches and 16-inches in diameter. The well pumps pressurize the water which passes
through the distribution system and fills the two water storage tanks at Lowell Canyon.
The Lowell Canyon tanks "ride" on the water distribution system, that is, the wells pump
water through the distribution system and up into the tanks (serving customers along the
way). When the tanks are full, a signal is sent to the wells to shut them off, then the water
backflows from the tanks into the distribution system meeting water demands. Once the
water level in the tanks fall to a preset elevation, a signal is sent to the wells to start,
completing the cycle.
There are three pressure zones in the City's distribution system:
1) Pressure Zone 204 serves the majority of the City's lower elevations. The water
wells pump into this pressure zone and the Lowell Canyon tanks "ride" on Pressure
Zone 204.
2) Pressure Zone 343 generally serves the upper reaches of Gateway Subdivision.
Water to Pressure Zone 343 is supplied from Pressure Zone 204 by the Swetmann
Booster Station pumps.
3) Pressure Zone 295 serves the Forest Acres area of North Seward including the
Seward High School. This pressure zone is supplied by gravity from Pressure Zone
343 at two locations: the Swetmann PRV and the Forest Acres PRV.
There is a third water storage tank at Gateway Subdivision. The Gateway Subdivision
tank is supplied through the Pressure Zone 343 distribution system via the Swetmann
Booster Station, located near Swetmann Avenue and Benson Drive. Similar to the Lowell
Canyon tanks, the Gateway Subdivision tank "rides" on Pressure Zone 343. It is assumed
that the new North Seward water storage tank project will incorporate the necessary
pumps and piping so the dated Swetmann Booster Station may be eliminated.
The three water storage tanks have the following capacities:
1) Lowell Canyon Tank No. 1 — 200,000 gallons
2) Lowell Canyon Tank No. 2 —400,000 gallons
3) Gateway Subdivision Tank — 500,000 gallons
North Seward Water Storage Tank
Tank Sites Summary Memo
March 22, 2011
Page 3 of 7
Site No. 1: Kenai Peninsula Borough property near Well House No. 6
Site No. 1 is located north of the Seward Elementary School and west of Well House No.
6 (Appendix B, Sheet 1). The site has good access from Hemlock Street, and is adjacent
to the new distribution and well manifold piping constructed in 2010.
Site No. 1 (Lot 8A-1, Fort Raymond Subdivision Replat Number 2) is owned by the Kenai
Peninsula Borough (KPB). The proposed site would be 155 feet wide x 285 feet deep to
accommodate the tank, a building, and the necessary yard piping. This site is located
above the City's Fort Raymond Well Field aquifer and a future well could be developed at
the site.
The existing well manifold piping would convey water from the Fort Raymond Well Field to
the site, where it would be chlorinated and fluoridated prior to passing into the tank for
contact time. It may be feasible to connect the piping from all the wells through the Well
No. 6 well house to utilize the existing chlorinator in that facility. It may be necessary to
either throttle or replace the existing well pumps since they would be pumping against less
head than they see currently.
Since the elevation of Site No. 1 (88 feet) is below the elevation of the Lowell Canyon
tanks (177 feet), booster pumps would be required to pressurize the water from the new
tank into the Pressure Zone 204 distribution system (see Appendix A, Figure 1). The
booster pumps would allow good control of the pressure in the water system with
relatively simple controls: water would be pumped from the wells into the new tank as
required to keep the tank full; booster pumps would pump the treated water into the
distribution system until the Lowell Canyon tanks were full, then the booster pumps would
turn off; once the level of water in the Lowell Canyon tanks fell to the pre-set level, the
booster pumps would start again. A high demand pump would be installed to provide large
flows (such as during fire events) when the Lowell Canyon tanks are out of service for
maintenance.
A second set of pumps along with an additional 1,800 feet of transmission main piping
would be constructed to convey water from Site No. 1 to the Gateway Subdivision tank
(elevation 316 feet). Operation of these pumps would be controlled by the level of the
water in the Gateway tank, similar to the Lowell Canyon tank controls. These pumps and
piping would eliminate the Swetmann Booster Station.
The advantages of Site No. 1 are:
• Site control — the site is publicly owned by KPB
• Good access to the site
• Pressure Zone 204 distribution system piping is adjacent to the site
• Well manifold piping is adjacent to the site
• Site located over Fort Raymond Well Field aquifer for development of a future well
• Booster pumps allow good control of distribution system pressure with simple
controls
• High demand pump would allow both Lowell Canyon tanks to be taken out of
service at the same time for maintenance
North Seward Water Storage Tank
Tank Sites Summary Memo
March 22, 2011
Page 4 of 7
The disadvantages of Site No. 1 are:
• Booster pumps run continuously until Lowell Canyon tanks are full
• Tank elevation is below the Lowell Canyon tanks so storage volume is unavailable
during power outage without an emergency generator
• Existing well pumps would need to be throttled or replaced
Site No. 2: Northeast Corner of Gateway Subdivision
Site No. 2 is located at the northeast corner of Gateway Subdivision where the
North/South segment of Hemlock Street right of way terminates (Appendix B, Sheet 2).
Access to the site would be by a short section of new roadway from either Hemlock Street
or Afognak Avenue.
Site No. 2 (Tract C-1, Gateway Subdivision Addition No. 1) is owned by Adventure
Investment (Doug Lechner & Kurt Lindsey). The property owners have indicated a
willingness to sell a portion of their property for the project, but would prefer a site further
to the west.
The proposed site would be 250 feet x 250 feet to accommodate the tank, building and
yard piping. It is unknown if development of a municipal water well is feasible at this site.
Site No. 2 would require 2,100 feet of water transmission main to convey water from the
Fort Raymond Well Field to the site. An additional 2,100 feet of water main would be
required to convey the chlorinated and fluoridated water back to Hemlock Street at Cedar
Street to connect to the Pressure Zone 204 distribution system.
The elevation of Site No. 2 (200 feet) is above the elevation of the Lowell Canyon tanks
(177 feet), providing an additional 10-11 psi to the system, so water will flow by gravity
from the new tank to the Lowell Canyon tanks (see Appendix A, Figure 2). A control valve
will be necessary at the new tank to shut off the water when the Lowell Canyon tanks are
full.
Site No. 2 will require the water to be pumped an additional 26 feet above the elevation
that the wells currently pump to at the Lowell Canyon tanks. It is anticipated that the
existing well pumps will be capable of pumping water to Site No. 2 without any
modifications.
A set of pumps and an additional 600 feet of transmission main piping would be
constructed to convey water from Site No. 2 to the Gateway water tank (Pressure Zone
343). Operation of these pumps would be controlled by the surface elevation of the water
in the Gateway tank. These pumps and piping would eliminate the Swetmann Booster
Station.
The advantages of Site No. 2 are:
• Lowell Canyon tanks can be filled by gravity from the new tank
• No modifications necessary to existing well pumps
• Both Lowell Canyon tanks can be taken out of service at the same time for
maintenance
North Seward Water Storage Tank
Tank Sites Summary Memo
March 22, 2011
Page 5 of 7
The disadvantages of Site No. 2 are:
• Property must be acquired from private ownership
• Requires 2,100 feet of dual transmission mains to connect to well manifold piping
and Pressure Zone 204 distribution system piping
• Requires 500 feet of new roadway to access site
• Unknown potential for new well, but superior to Site No. 3 since is it further to the
east
Site No. 3: Gateway Subdivision — North of Unimak Circle
Site No. 3 is located north of Unimak Circle and south of the Japanese Creek levee
(Appendix B, Sheet 3). Access to the site would be from Unimak Circle.
Site No. 3 straddles property owned by the City of Seward (Tract A, Gateway Subdivision
Amended) and property owned by Adventure Investment (Tract C-1, Gateway Subdivision
Addition No. 1). As noted previously, Adventure Investment (Doug Lechner & Kurt
Lindsey) has indicated a willingness to sell a portion of this property for the project, and
would prefer Site No. 3 over Site No. 2.
The proposed site would be 250 feet x 250 feet to accommodate the tank, building, and
yard piping. It is unknown if development of a municipal water well is feasible at this site.
A water well siting study prepared by Golder Associates in July 2010 indicated this area
has potential for a high yielding well assuming:
• Bedrock is deep enough to have a significant thickness of loose alluvial deposits
• A shallow water table is present to create significant thickness of available
drawdown in the well
• Dense, finer sediment glacial deposits are not present before encountering bedrock
The further a well is placed to the east, such as near Site No. 2, the less likely it is to
encounter shallow bedrock and thus the more likely the potential for a high yielding well.
Site No. 3 would require 3,300 feet of water transmission main to convey water from the
Fort Raymond Well Field to the site. An additional 3,300 feet of water main would be
required to convey the chlorinated and fluoridated water back to Pressure Zone 204 on
Hemlock Street at Cedar Street.
The elevation of Site No. 3 (290 feet) is above the elevation of the Lowell Canyon tanks
(177 feet), so water will flow by gravity from the new tank to the Lowell Canyon tanks (see
Appendix A, Figure 3). A control valve will be necessary at the new tank to shut off the
water when the Lowell Canyon tanks are full. In addition, a new PRV station will be
required near the connection to Pressure Zone 204 (Hemlock Street at Maple Street) to
prevent over-pressurizing the distribution system.
The existing well pumps are not capable of pumping water to the elevation of Site No. 3
without an intermediate booster station. The booster station would be constructed near
the Forest Acres PRV (Hemlock Street at Afognak Avenue) at elevation 180 feet.
North Seward Water Storage Tank
Tank Sites Summary Memo
March 22, 2011
Page 6 of 7
A set of pumps and an additional 300 feet of transmission main piping would be
constructed to convey water from Site No. 3 to the Gateway water tank (Pressure Zone
343). Operation of these pumps would be controlled by the surface elevation of the water
in the Gateway tank. These pumps and piping would eliminate the Swetmann Booster
Station.
The advantages of Site No. 3 are:
• Lowell Canyon tanks can be filled by gravity from the new tank
• Both Lowell Canyon tanks can be taken out of service at the same time for
maintenance
The disadvantages of Site No. 3 are:
• Property must be acquired from private ownership
• Requires 3,300 feet of dual transmission mains to connect to well manifold piping
and Pressure Zone 204 distribution system piping
• Requires a booster station to get water from wells to site
• Requires a PRV station to connect to Pressure Zone 204 distribution system piping
• Higher operating cost because all City water would be pumped above Pressure
Zone 204
• Potential for new well unknown
Project Cost Estimates
Rough order of magnitude project costs were prepared for each alternative tank site (see
Appendix C). Construction costs include a 25% construction contingency. Total project
costs include administration, engineering, permitting, and construction administration
which are calculated based on a percentage of the construction cost:
• City of Seward Administration — 5% of Construction Cost
• Engineering & Permitting — 10% of Construction Cost
• Construction Administration — 15% of Construction
These project cost estimates do not include the cost of obtaining site control for the tank
sites.
Construction Total Project
Cost Cost
Site No. 1: KPB Property Near Well House No. 6 $3,840,000.00 $4,990,000.00
Site No. 2: Northeast Corner of Gateway Subdivision $3,330,000.00 $4,330,000.00
Site No. 3: Gateway Subdivision- North of Unimak Circle $3,940,000.00 $5,120,000.00
North Seward Water Storage Tank
Tank Sites Summary Memo
March 22, 2011
Page 7 of 7
O&M Cost Estimates
Operation and maintenance (O&M) cost estimates were prepared for two of the
alternative tank sites — Site No. 1 and Site No. 2 (see Appendix D). The O&M costs
include labor, materials for routine O&M and repairs, electricity, chemicals, heating fuel,
and equipment replacement costs (pumps, piping, tank, building, generator). Equipment
replacement costs are based on an 80-year life for buried piping, 50-year life for the tank
and building, and 20-year life for pumps and generator.
Even assuming smaller well pumps (75 hp) versus the existing 125 hp well pumps, Site
No. 1 uses about $43,000/year more in electricity due to the operation of the Booster
Pumps (60 hp) that would be needed to fill the Lowell Canyon tanks.
Labor/
Materials/ Equipment
Chemicals/ Replacement Total Annual
Fuel Electricity Cost O&M Cost
Site No. 1: KPB Property Near Well House No. 6 $19,043 $101,107 $292,876 $413,026
Site No.2: Northeast Corner of Gateway Subdivision $18,390 $58,129 $270,494 $347,013
End of Memorandum
( Ithi
July 08, 2011
North Seward Water Storage Tank
A
In the Mid 90's,the need for additional water storage capacity was identified. This "need" was
based on the City's continual battle with maintaining adequate water levels in the two water
storage tanks during high water demands during the summer months. Discussions with various
administrations culminated in the desire for an engineering study to be funded by the ADEC
Municipal Loans and Grants program. Reasoning for this avenue of funding was: The Water
Enterprise Fund had no money. After failing to qualify for an ADEC funded grant, it was
determined that the priority should be to get the Water Enterprise Fund on a sound financial
foot. This resulted in a cooperative effort between Public Works staff and the Finance
Department to look at fiscal solutions (studying the R.W. Beck water rate study and
implementing their recommendations). Through the 2000's the Public Works Department and
the Finance Department lobbied and slowly gained administration support to raise rates.
Concurrently,the Public Works staff, applied for, and were denied funding on several occasions
from ADEC's Municipal Loans and Grants. The theme for the denial's were consistently the
financial condition of the Water Enterprise Fund.
In 2004,the Department of Environmental Conservation Municipal Loans and Grants,
contracted with Boise State to assist with Financial Audits and make recommendations to
communities regarding rate setting and administrative changes to better leverage their
financial affairs in a manner that would increase the likelihood of a successful grant and or loan
application.Two of the major changes were,the separation of the Water and Sewer Enterprise
Funds and a substantial rate increase. Implementing of these changes was done in 2005, and in
the course of two years, the Water Enterprise Fund had gained the financial stability that was
needed. As a result,the City was successful in garnering a grant for$3,600,000 (that was vetoed
by the Governor)for the Third Avenue Water Line upgrade. The ADEC Municipal Loans and
Grants personnel offered the City of Seward a low interest loan (1.5 %) as an alternative source
of funding to complete this important project. We began payments on this loan in 2011.
In 2009,the Water Department administrative staff, completed their preliminary research of
the Site selection of the new North Forest Acres Water Storage Tank. During this process, it was
identified that the Seward Water Distribution System was unique and required a closer look at
"true" costs associated with the new water storage location. ARRA funding indicated the
potential for partial funding of the new tank, and CRW was instrumental in providing final
engineered drawings for Phase I of the North Forest Acres Water Storage Tank Project in time
for receipt of ARRA funds. Phase I was completed in 2010 (last year), and CRW has continued to
assist in the engineering and cost estimates associated with the various site selection options.
The first Technical Memorandum for this project was completed in January of 2011. Public
Works staff reviewed the memorandum, made recommendations, and the final Tech. Memo
was completed March 22, 2011.
Upon receipt of the March 22, 2011 Technical Memorandum,the Public Works staff entered
into discussions with the owners of the preferred tank site. Those discussions have moved
forward, and currently we have a "Summary Appraisal Report" conducted by MacSwain
Associates LLC, in hand. It is anticipated that by the end of July,the staff and the property
owner will have reached a tentative agreement. Issues associated with the acquisition of the
preferred property will begin at that time (platting, subdivision agreement, purchase
agreement, etc.), with the package coming to the Council for approval in September/October,
if all goes as expected.
I/I Ill Mil
Johanna Kinney
From: Phillip Oates
Sent: Friday, July 08, 2011 2:42 PM
To: Johanna Kinney
Cc: Kris Erchinger; christopher.bolton@providence.org; cbrooking@akatty.com; Michelle
Weston
Subject: Background Information
Attachments: 750K_appropriation,justification_071111_council_meeting_V2.doc
Johanna,
Please provide the attachment to the Council. It is a document that provides additional background information
to the Council about Resolution 2011-057 (Appropriating $750,000 to Providence Seward Medical and Care
Center...). Thanks.
Phillip
Phillip E. Oates. DBA
Major General(U.S. Army, Retired)
City Manager.City of Seward
Direct: 907-224-4012
Cell: 907-362-1468
poates@cityofseward.net
Make a difference for our community and shop Seward first!
1
Seward City Council Meeting
Discussion of Appropriation to Providence Seward Medical & Care Center
July 11, 2011
Primary Take-Away: These losses of $750,000 may be entirely reimbursable if
Providence Seward is deemed to have met "meaningful use" requirements for its new
electronic health records implementation (under a reimbursable grant program), and if
we succeed in challenging the State's arbitrary reductions in cost-based reimbursement
and receive the cost reimbursements that we have anticipated under the previous
reimbursement methodology.
Reimbursement Rate Reduction by the State of Alaska
Changes in Medicaid reimbursement methodology are resulting in lower reimbursement
rates from the State of Alaska to health facilities throughout the state. You will recall
that Seward's rates were rebased utilizing 2009 actual costs, and under a cost-based-
reimbursement scenario, we expect to recover our costs. However, the State is refusing
to reimburse us for some of the costs which we legitimately incurred in 2009, and which
they have previously reimbursed us for. Since we live with the rebased rates for a four-
year period, cost-reimbursement decisions at the State have a four-year impact. If we
received reimbursements from the State based on their past practice of reimbursement,
the current level of reimbursement would have resulted in us actually "making money"
for the next four years, based on higher census in the current facility. However, the
State's decision to exclude costs from reimbursement is resulting in lower
reimbursements than expected for Seward Mountain Haven, causing financial losses on
the order of $350K year-to-date, versus the budgeted financial gain of $234K year-to-
date. The State's action is adversely impacting health facilities throughout Alaska and is
not unique to Seward. For example, Valdez reports that this will result in a $400,000
annual loss in reimbursements to them. It appears that the change in methodology is not
driven by any change in State law or regulation. Rather, it is based on a change in
interpretation by staff at DHSS. This change however, is inconsistent with past State
reimbursement practice, and is contrary to federal reimbursement guidelines. For that
reason, Providence Seward — and other healthcare providers in Alaska — have appealed
this change in reimbursement methodology and if we do not prevail on administrative
appeal, we can expect that Providence will join with other healthcare providers to seek
legal remedy to the rate issue. Ultimately, if we prevail on the appeal at either the
administrative or legal level, we could expect to reverse these losses and retroactively
receive reimbursement to fully cover these losses.
Seward Mountain Haven (census)
The number of residents at Seward Mountain Haven also has a material impact on the
cost-based reimbursement of the health system. The pro forma projections show us
ramping up occupancy to 34.8 in 2010 with the goal of reaching 90% occupancy by 2014
(36 elders). We have had some challenges implementing the Green House Model, as
evidenced by recent federal survey results. However, those challenges are being
addressed in large part by providing a stronger integration of nursing oversight into the
homes. During this initial transition to Green House, we have been cautious to increase
the census slowly in order to avoid issues that arise when elders become more mobile in
the new living environment (e.g. slips and falls), and to avoid overwhelming the staff
Seward City Council Meeting
Discussion of Appropriation to Providence Seward Medical & Care Center
July 11, 2011
who are learning to provide the best quality of care under a new delivery model.
Currently the census is 32, but it has been as high as 38 since opening the doors in
October 2009, and we expect to be able to ramp up occupancy to pro forma levels as we
strengthen the implementation of this new model of care.
Seward Mountain Haven (FTEs)
The number of employees at Seward Mountain Haven also drives costs at the facility,
although cost-based-reimbursement is intended to recover those costs once the facility is
rebased. Seward was rebased in 2009, before the new model of care was fully
implemented at Seward Mountain Haven (doors opened October 2009). Therefore, the
additional costs associated with staffing-up the facility will not be recovered until the
rebasing of rates which will take place in 2013. After that time, the full costs associated
with the new model of care will be included in the reimbursement rates beginning in
2014. We initially anticipated that the Green House model of care would not be more
expensive from a staffing perspective, because we would replace some of the `middle
management' positions with a higher number of direct care providers (at lower cost).
However, in order to ensure the highest possible patient safety, and to address the
transition to a new model of care, the number of FTEs in the facility has been increased.
Currently, staffing at Seward Mountain Haven is at 69.3 FTEs versus the staffing in 2009
of 56, or an increase of approximately 13.3. These staffing increases are important to
ensuring patient safety, and once the model is fully implemented, we will have a better
idea of whether the staffing increase will continue or can be reduced. Ultimately, under
the cost-based reimbursement scenario, these costs will work into reimbursements to the
facility, but there is a four-year lag before the costs are fully recovered.
Electronic Health Record Implementation
In 2010, the Centers for Medicare and Medicaid Services announced an American
Recovery and Reinvestment Act incentive grant program to encourage critical access
hospitals to implement certified electronic health record ("EHR") technology aimed at
enhancing the ability of health providers to improve health care quality, efficiency, and
patient safety. Providence Seward participated in that program by implementing a new
EHR system which is compatible with all Providence facilities in Alaska, at a cost of
approximately $300,000 in 2011 ($500K total over three years). Much of this investment
in software and hardware may be eligible for reimbursement depending on whether
PSMC is confirmed to have met the "meaningful use" requirements as established by the
Centers for Medicare and Medicaid ARRA grant. The best case scenario shows that
PSMC may be eligible for reimbursement of up to $1 million over a period of four years
(in excess of direct hardware and software costs).
Another significant benefit to implementing the electronic health records system in
Seward is that patient billing has returned to Seward and is being done at Providence
Seward rather than as it was previously done outside of Alaska. The billing system was
the largest patient dis-satisfier in the past few years, so addressing that concern by
purchasing a system which allowed for billing to return to Seward, was a very positive
Seward City Council Meeting.
Discussion of Appropriation to Providence Seward Medical & Care Center
July 11, 2011
outcome for residents of Seward. Seward residents can now deal with local hospital staff
to address billing questions, which should represent a significant improvement in
customer service.
Federally Qualified Health Center
The Community Health Center ("CHC") board continues to await the outcome of the
application for approval as a federally qualified health center. We understand that the
federal program has been significantly pared back in the current year, based on a
reduction in funding of the program aimed at new CHCs. We are now told that the
announcement of grant awards will be made around August 1st. If Seward is not awarded
a FQHC designation, it is still possible that the CHC board may decide to ask the City to
consider establishing an FQHC "look-alike" facility. Such a facility could potentially
achieve many benefits of a federally qualified health center (loan reimbursement for
healthcare providers, tort insurance, clinical efficiencies), but would not be eligible for
the annual $600K federal grant. However, establishing an FQHC look-alike could still
result in significant cost-savings over the current clinic's employed physicians model,
and it could strengthen the future application for full FQHC status. More work is
required to assess this potential option.