NACHC Spring Update 2012: Trough of the Wave?

Transcription

1 NACHC Spring Update 2012: Trough of the Wave? Kaitlin M. McColgan, MPH Director of Federal Affairs National Association of Community Health Centers Annual Community Health Institute May 9-11, 2012 Resort & Conference Center of Hyannis Hyannis, MA

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3 NACHC Spring Update 2012: Trough of the Wave? Presentation to: Massachusetts League of Community Health Centers 2012 Community Health Institute Presented by: Kaitlin M. McColgan Director of Federal Affairs National Association of Community Health Centers May 15, 2012

4 Federal discretionary health budget landscape Today s Agenda FY2012 Health Center funding outcome and FY2013 budget and appropriations status Regulatory Snapshot Supreme Court Crystal ball

5 The NACHC Mission To promote the provision of high quality, comprehensive and affordable health care that is coordinated, culturally and linguistically competent, and community directed for all medically underserved people.

6 THE DISCRETIONARY HEALTH BUDGET LANDSCAPE

7 Discretionary Funding Environment Deficit reduction is a major focus Congress is under increasing pressure to reduce discretionary spending Discretionary budgets are getting smaller discretionary spending caps have been written into law

8 Health Discretionary Funding Trends President s initial 2012 Budget request for Labor-HHS totaled $180 billion Total Labor-HHS discretionary spending level for 2012 was $156.3 billion (compared to $157.4 billion for 2011) However, Labor-HHS Subcommittee s Program Level was $163.8 billion, as result of $6.7 billion Change in Mandatory Program funding

9 Two-phase debt ceiling increase: The Budget Control Act of 2011 Phase 1: $900 billion through end of 2011 Phase 2: $1.2-$1.5 trillion through November 2012 Increases contingent upon offsets: Phase 1 offset: discretionary caps over next decade FY 2012 capped at $1.043 trillion FY 2013 total is $1.047 trillion Phase 2 offset: sequester takes effect January 2013 Across the board spending cuts of 8 percent, $984 billion cut over 10 years, or $109 billion annually Cuts equally divided between defense and non-defense Applied proportionately to discretionary/direct spending Health Center discretionary cuts under sequestration are capped at 2% in FY2013, with no special protections after FY2013

10 The President s FY2013 HHS Budget Proposal Total HHS Outlays (overall increase) FY2013: $941B Change from FY2012: +$69B Mandatory Funding (overall increase) FY2013: $860B Change from FY2012: +$73B Discretionary Funding (overall decrease) FY2013: $77B Change from FY2012: -$218M Adheres to the discretionary spending caps adopted in the BCA

11 Congressman Ryan s Proposed 2013 Budget Plan Total federal spending would fall to 16 percent of GDP by 2050 (currently about 23 percent; historically around 20 percent). Ryan s budget path would shrink federal expenditures below current levels for everything other than Social Security, Medicare, Medicaid, and CHIP Reductions in these entitlement programs would also be significant as compared to current projected levels Includes immediate, severe cuts in non-defense discretionary programs over the next ten years: Cuts funding for these programs by nearly $1.2 trillion below the BCA funding caps Funding would be $800 billion below non-defense sequestration levels

12 HEALTH CENTER FUNDING

13 Health Reform Refresher The Affordable Care Act (ACA) provided $11 billion in dedicated funding for health center operations and capital for FY 2011 FY $9.5 billion to support health center operations. $1.5 billion for capital needs. Mandatory funding provided through the Health Center Fund ends after FY2015.

14 Health Center Funding Under Current Law 4.00 Community Health Center Funding: FY 2010 FY $3.6B $250M ARRA $1.0B $1.2B $1.5B $2.2B $2.19B $1.58B $1.58B $1.58B $1.58B $1.58B $1.58B Base Discretionary Appropriation Mandatory Funding through the Affordable Care Act

15 FY2012 Appropriations Result The outcome of the FY2012 budget (a ~$200M increase from FY2011): $1.58B in discretionary funding $1.2B available through the mandatory Health Center Fund FY2012 budget funds 220 new Health Centers (to be announced) $150M for these new access points Additionally, it funds: ~$15-20M in expansion of services ~$5M to support the President s HIV/AIDS strategy ~$20M to support Health IT through Health Center controlled networks

16 The President s FY2013 CHC Budget Proposal The Administration s proposed budget for FY2013 includes $3.1B for Health Centers (a $300M increase from FY2012): $1.58B in discretionary funding $1.5B available through the mandatory Health Center Fund The Administration s proposed policy approach reflects an unnecessary slow-down of needed Health Center expansion: Utilize $20M to fund 25 new Health Centers in FY2013 Reserve remaining $280M to prevent future year shortfalls in funding

17 NACHC FY2013 Funding Ask NACHC s federal appropriations approach prioritizes stability and growth Health Centers requested $3.1B in total programmatic funding for FY2013 (a $300M increase)- same total as the President, but: Establish a base discretionary Health Centers funding level of $2.8B (equal to current program operations) from $1.58B in discretionary funding plus $1.2B transferred from the Health Center Fund Direct the remaining $300M increase to expand care to 2.5 million new patients who lack access to a health center today

18 Where s Congress? House Labor-HHS may put out draft bill- May, June?? - could wait until after Supreme Court - interest in protecting existing operations, but given allocation (decrease of $7B), unlikely growth Senate- expect to see Labor-HHS bill first week in June - priority: growth now - concerns over hold back AND transfer

19 Estimated Number of Total Health Center Patients Under Health Reform* (pre- FY2011 Reduction) Patients in Millions Health Reform Implementation Begins Sources: Data for federally-funded health centers only. FY00-09 are from HRSA s Uniform Data System. FY10-15 are NACHC projected estimates based on new federal funding. NACHC estimates future health center patients as a function of new federal funding. Note: Other factors are difficult to predict and include payer mix, growth in non-federal grant sources, and the costs of care, which may be related to new patients having unmet health needs.

20 Regulatory Snapshot

21 Just a little bit going on... Exchange and Medicaid expansion rules ACOs and Medicare Shared Savings Program 1115 waiver transparency Medicaid outpatient drugs New Medicare/Medicaid and CHIP requirements from the ACA new application fees 340B administrative dispute resolution process CO-OPs Aligning Medicare and Medicaid (duals issues) Assuring access to Medicaid Section 1332 innovation waivers Medicare PPS development

22 Development of Medicare PPS Created in Section of the Affordable Care Act The Secretary shall develop a prospective payment system for payment for Federally qualified health center services furnished by Federally qualified health centers under this title. Such system shall include a process for appropriately describing the services furnished by Federally qualified health centers and shall establish payment rates for specific payment codes based on such appropriate descriptions of services. Such system shall be established to take into account the type, intensity, and duration of services furnished by Federally qualified health centers. Such system may include adjustments, including geographic adjustments, determined appropriate by the Secretary.

23 Health Centers are not coding services- could seriously imperil success of the new system. Development of Medicare PPS FQHCs began reporting Healthcare Common Procedure Codes (HCPCS) January 2011 NACHC met with CMS Contractor has been hired. Of critical importance: - Leg. Language does not call for caps or screens- meaning new system could accurately reflect costs; IF -We code appropriately NOW during data collection phase.

24 Exchanges- Key Issues Governance Will consumers and providers be adequately represented? What will provider networks look like? Will QHPs contract with FQHCs? Fair payment for FQHC services Essential Health Benefits Will package include FQHC services? Eligibility determination and enrollment assistance Will health centers fill the role of Navigators? Preventing churn between exchange and other affordability programs How will the exchange interact with the state Medicaid agency and other programs; plan benefit design; netw

25 Payments to FQHCs in the Exchanges- aka Menendez amdt- Final Rule QHPs must pay FQHCs no less than what they would be paid under Medicaid FQHC law 1902(bb) but a QHP issuer and an FQHC can mutually agree upon payment rates other than required under Medicaid PPS law as long as these rates are at least equal to the generally applicable payment rates of the QHP issuer. No contracting requirement. Silent on payment to FQHCs when a QHP enrollee receives services from an FQHC that has not contracted with the QHP.

26 Navigator Provisions in Final Rule Require expertise in the needs of underserved and vulnerable populations and eligibility and enrollment rules and procedures, and must meet any licensing certification or other standards established by the State or Exchange. Exchange must include entities from at least one of the following caregivers for a navigator grant: includes community and consumer-focused non-profit group; trade, industry, and professional associations; licensed agents and brokers, etc (c).

27 And everything else...

28 The Supremes

29 Four Main Issues, Lots of Tea-Leaf Reading Timing Mandate Severability Medicaid What if??

30 Looking ahead... Senate approps- early June Supreme Court- June TBD House Approps- June/July if at all Election Lame Duck-ageddon: debt limit increase; sequester undo-ing?; Bush tax-cuts; host of expiring provisions; omnibus, etc. The reckoning- deficit reduction is coming.

31 NACHC Membership We need YOU Turbulent times, need everyone rowing the boat! Health Care not going away as national issue, we need to keep holding our own.

32 Where You Can Find More Information Visit our improved, expanded web site for more information on all issues, for the latest on federal & state policy developments, including health reform, for the schedule of webcasts and trainings on key health center management topics Latest research & data on health centers Read the Washington Update each week All Are available at

33 Thank You! Any Questions?