America s Voice for Community Health Care

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2 America s Voice for Community Health Care 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.

3 NACHC Update Dan Hawkins Senior VP, Public Policy & Research National Association of Community Health Centers Spring Primary Care Conference May, 2014

4 TODAY S AGENDA Federal Legislative Update Federal Regulatory Update

5 Congressional Outlook: Spring 2014 SGR Doc Fix FY2015 Approps Defund ACA Immigration Reform Sequester Debt Ceiling

6 FY Appropriations FY13 FY14 FY15 Program Actual Actual President s ($$ millions) ($$ millions) Request Health Centers, Total $2,995 $3,695 $4,600 - Appropriated $1,495 $1,495 $1,000 - ACA Trust Fund $1,500 $2,200 $3,600 - FTCA (Subset of CHC funds) ($95) ($95) ($95) National Health Service Corps $285 $283 $810 - Appropriated 0 0 $100 - ACA Trust Fund $285 $283 $710 Bureau of Health Professions $1,001 $1,045 $1,798 New GME Program (mandatory funding) Children s GME (set-aside) 0 $269 0 $265 $530 ($100) Nursing Workforce Development $140 $144 $144 Area Health Education Centers $30 $30 $30 Primary Care Training and Enhancement $39 $37 $37 Family Planning $278 $286 $286 Healthy Start $98 $101 $101 Rural Health Outreach Grants $56 $57 $57 Ryan White AIDS Program $2,249 $2,319 $2,323 Part C $194 $201 $280 ADAP $886 $900 $900

7 FY 2014 Health Center Funding Total Funding of $3.7 billion = increase of $700 million! How HRSA plans to use the new $700 Million: $150 million for NAPs (awarded) $58 million for expanded Outreach & Enrollment (awarded) $50 million for Mental Health Services Grants (decisions pending) $35 million for PCMH/facility improvement (decisions pending) $110 million in Base Grant Adjustments (coming) $~300 million for service expansions and expanded medical capacity grants for existing health centers (coming)

8 FY 2015 Funding: Two Different Visions Administration Budget: NACHC Examples: Total Funding = $4.6 billion Total funding = $5.1 billion $900 million increase - $1.4 billion increase $800 million 1-time capital - $200 million for 350 NAPs $60 million for 100 NAPs - $200 million base adjustments $40 million for QI - $500 million for ES/EMCs - $500 million 1-time capital Total Patients = 31 million Total Patients = 35 million

9 Health Center Funding Under Current Law 6 Community Health Center Funding: FY 2010 FY FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 Base Discretionary Sappropriation Mandatory Funding through ACA ARRA

10 And Under Obama and NACHC Proposals FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 Base Discretionary Funding Admin Request NACHC +

11 Fixing the Health Center Funding Cliff Senate Leadership and House Letters to President Sens. Harkin, Baucus, Sanders, Stabenow, Schumer, Milulski AND 149 House Democrats = SUCCESS! Petitions from Health Center Staff, Board Members, and Patients = VALUE! 45,000+ signatures to President, 80,000+ to Congress Letters from local elected officials and community stakeholders = VITAL! Universal Message: Please include a fix for the funding cliff in your FY 2015 budget FIXING THIS CLIFF WILL BE THE GREATEST CHALLENGE CHCs HAVE EVER FACED!

12 Workforce New Primary Care Workforce Initiative $14.6 billion in new 10-year funding to enhance & sustain a strong primary care workforce, including: National Health Service Corps President s budget proposes $810 million, mostly mandatory, for FY15, $3.95 billion thru 2020, to grow NHSC field strength to 15,000 & maintain that level Teaching Health Centers President s budget calls for $5.2 billion in HRSA-managed GME funding to produce 13,000 PC physicians by 2025, including 600+ residents at 60+ THCs, and more pediatric residents at Children s Hospitals

13 340B Drug Discount Program 340B Receives Increased Scrutiny & Attention On the Hill, Off the Hill Contract Pharmacy, Hospitals, Audits, Compliance Legislative Attention: NOT focused on health centers VAST MAJORITY OF FQHCs RELY ON 340B

14 FQBCHCs aka Behavioral Health Centers S. 264, Senators Debbie Stabenow & Roy Blunt H.R. 1263, Reps. Doris Matsui & Leonard Lance Would create Certified Community Behavioral Health Clinics, based on the health center model and with a similar Medicaid payment mechanism (PPS) Is NOT directly targeted at FQHCs Encourages linkages w/ FQHCs Focuses on severe & persistent mental illness Doc Fix bill (H.R.4302) instead calls for a 2-year, 8-state demo in Medicaid payment to FQBHCs for enhanced mental & behavioral health services signed into law April 1, 2014 (states not yet selected)

15 HRSA Policy Capital grants TBD (limited funding - <$30M) Governance and Total Budget PINs Total Budget PIN: maintains accountability but drops excessive restrictions on use of non-grant funds Governance PIN: comments submitted, HRSA response posted 340B Issues Audits, recertification, Mega-Reg coming 340B University for FQHCs, Tool Kit from Prime Vendor MUA/HPSA Designation Rule Rule coming shortly, result of Negotiated Rulemaking Committee recommendations; positive impact on MUAs

16 CMS Policy Medicare PPS Regulation Published as a proposed rule (NPRM) Sept. 23, 2013 New payment system: one national all-inclusive payment rate of $155 per visit (adjusted for geography) Higher payment rate for new Medicare patients and for Welcome to Medicare physical No payment caps or screens Analysis: payments will increase 30% on average Limit of one visit per day (comments invited on this, esp as concerns mental/behavioral health) To begin Oct. 1, 2014, with all FQHCs moving to calendaryear reporting on January 1, 2016 Final rule pending, expected shortly

17 CMS Policy (CCIIO) New Rules Navigators and non-navigator Assisters (CACs) Overrides non-federal laws/rules that restrict CACs from advising or comparing plan coverage terms (eg, cost-sharing), benefits, or provider networks, or require them to be agents/brokers or to carry errors/omissions insurance (CACs restricted from outreach NACHC commented opposing) Plan Provider Network Adequacy Requires that QHP provider networks must be sufficient to allow members access without unreasonable delay ( reasonable not defined) Essential Community Providers (ECPs) Requires QHPs to offer contract to 30% of all ECPs in service area, inc 1 of each type (eg, FQHC) in each county served (improvement over 2014 safe harbor at 20% of all ECPs), BUT QHPs could avoid 30% rule by explaining how their networks provide adequate service for low-income/underserved enrollees plus plans to increase ECP participation in future years (NOTE: This rule not required for closed panel/staff model HMOs) QHPs required to submit a list of all participating network providers for review against CMS reasonable access standard (BUT standard is undefined). Reminds QHPs they should pay FQHCs their PPS rate, BUT then requires ECP contract offers to be at same payment terms offered to non-ecp providers

18 New ACA Coverage Began January 1, 2014 Two new opportunities for health coverage: 1. Medicaid States still have the opportunity to expand Medicaid coverage to individuals up to 133% FPL no enrollment deadline. 2. Private insurance purchased through the Health Insurance Marketplace (also known as an Exchange) enrollment re-opens Nov. 15 Most individuals will be eligible for help paying for health insurance in the Marketplace.

19 Medicaid Expansion by State Expanding Medicaid Customized Expansion Under Discussion Not Expanding Source: The Commonwealth Fund, March Note: CMS has approved waivers for expansion with variation in Arkansas, Iowa, and Michigan. Pennsylvania s waiver is currently under review. Source for map: Avalere State Reform Insights; Center of Budget and Policy Priorities; Politico.com; Commonwealth Fund analysis

20 For Many, Enrollment Period Has Not Ended Reasons that individuals may STILL enroll in coverage after April 16: Marriage, having a baby, adopting a child or placing a child for adoption or foster care, moving outside your insurer s coverage area, gaining citizenship, leaving incarceration Change in income or household status (divorce, widowhood, etc.) that affects eligibility for premium tax credits or cost-sharing reductions Losing other health coverage (due to losing job-based coverage, divorce, COBRA expiration, aging off a parent s plan, losing eligibility for Medicaid or CHIP, and the like (NOTE: Voluntarily ending coverage doesn t qualify) Gaining status as member of an Indian tribe. AND Eligibility to enroll in Medicaid or CHIP is continuous (no limit on enrollment period)

21 UDS Mapper O&E SuperTool

22 We will continue to WIN & GROW Outlook Value in the quality care we deliver Value in expanding access and improving health Value in delivering cost savings PLUS some $20 billion dollars in jobs and economic activity for communities.

23 Resources NACHC My Learning Center ( Linkages with Health Center Controlled Networks Health Information Workforce Consortium Foundations & Agencies Supporting Best Practices RCHN Community Health Foundation ( Commonwealth Fund ( California Health Care Foundation ( CMS Innovation Center ( AHRQ Health Care Innovation Exchange ( HRSA & BPHC (

24 Our Website: NACHC.org > Policy Issues Blog: Health Centers on the Hill Where Can I Get More Information? Washington Update: Sign up to be a Health Center Advocate Join the Campaign for America s Health Centers today!

25 Thank You! Any Questions?