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Case 8:23-cv-00504 Document 1-4 Filed 03/20/23 Page 4 of 10 Page 1D #:146 Of the patients served by SOS, over 79% are of racial and/or ethnic minority backgrounds. 67% percent identify as Hispanic or Latino, 97% percent of SOS' patients are at or below 200% of the Federal Poverty Guideline, while 53% are at or below 100% of the Federal Poverty Guideline. Additionally, 57%of patients are covered by Medi-Cal and/or Medicare, and 24% of the patient population is uninsured. FQHCs are regulated by the Health Resources and Services Administration ("HRSA) of the United States Government. FQHCs receive an annual grant from HRSA for each approved site at which services are provided. In addition, FQHCs receive a higher reimbursement rate for seeing Medicaid (MediCal) patients than do hospitals, non-FQHCs, or practitioners. In exchange for the HRSA grant and higher reimbursement rate, FQHCs must provide cradle to grave primary care services and must accept all patients regardless of insurance status or ability to pay. F"QHC's are also required to establish "sliding scale" fees for uninsured patients based on an assessment of the patient's income relative to federally adjusted poverty line which takes into consideration the size of the individual's household among other factors. FQHCs are required to charge at least a"nominal fee" regardless of how low an individual's income may be_ The Public Health Service Act provides that eligible community health centers and their employees are employees of the federal Public Health Service ("PHS") for certain purposes. The Secretary of Health and Human Services deems a community health center to be a PH employee after the center has qualified for certain federal assistance. Once a community health center is deemed a PHS employee, it enjoys immunity from those acts that relate to its employment, and any actions against it are treated as actions against the United States. Furthermore, for an FQHC receiving funds under 42 U.S.C. § 254b, any officer, governing board member, or employee of such an entity . . . shall be deemed to be an employee of the Public Health Service for purposes such as immunity from liability for medical malpractice, etc. There is, therefore, a direct agency relationship between FQHCs, such as SOS, and the federal government. An Ordinance being considered for adoption by the Council would interfere and conflict with the accomplishment and execution of the full purposes and objectives of Congress, particularly with respect to providing health care to underserved populations. This fact alone presents serious issues concerning the Ordinance. Facts Regard in SOS's Proposed Expansion Proiect. Share Our Selves 3 1 P a g e