In This Issue­ 340B Drug Pricing Program

­ Advocacy Campaigns

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­ Dept. of Health Care Services

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­ Human Resources

­ Immigration Policy Update

­ Medi­Cal Update

­ Medicaid Update

­ State Legislative Update

2015 Annual Sponsors

340B Drug Pricing Program

HRSA Releases 340B Mega­Guidance: 18 Key Points

The U.S. Department of Health and Human Services HealthResources and Services Administration (HRSA) has released thelong­awaited "mega­guidance" on the 340B Drug Pricing Program.The 90­page guidance on the 340B program was formally publishedin the Federal Register on August 28. There will be a 60­daycomment period, with comments due on or before October 27.Becker's Hospital Review has provided 18 takeaways on theguidance, including that “the guidance addresses a broad range oftopics within the 340B Program, including the definition of patient,contract pharmacy compliance requirements, hospital eligibilitycriteria and eligibility of off­site outpatient locations.”

340B Peer­to­Peer Webinars

The Health Resources and Services Administration’s 340B Peer­to­Peer Program is hosting a webinar on September 9, 2015 from 2pm­3pm ET. They will discuss “Operationalizing 340B Policies andProcedures for Auditable Records” Register here.

Advocacy Campaigns

CPCA Bills Head to Governor’s Desk – Letters of SupportNeeded

Our sponsored legislation is near the finish line and it’s time to ask

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Grant Opportunities | Training & Events | CPCA Employment

September 3, 2015

the Governor for his support! We need to send the Governor NEWletters for AB 858, AB 1130, SB 147, and SB 610 to show him thatwe stand together on these issues. We truly appreciate the 80+health centers who sent letters to the legislature in the past andhelped us get this far, but unfortunately, the Governor will onlyconsider NEW letters addressed directly to him. Submissioninstructions are included in each letter template. Please contact BethMalinowski at bmalinowski@cpca.org with questions. Letters aredue by noon on Tuesday, September 8.

NEW CALL IN NUMBER ­ CPCA’s Government Affairs ­ AllMember Weekly Update Call

CPCA’s Government Affairs ­ All Member Weekly Update CallHosted by Sean South, Associate Director of Policy and LegislationEvery Wednesday / 11– 11:30 a.m. (may end earlier if subjectmatter is covered before 11:30 a.m.) Call­in number: 1 888 585 9008/ Conference Room: 616 822 842#. If you would like an update on aspecific issue covered by any of our Government Affairs staff,please send your request to Sean South at ssouth@cpca.org theMonday preceding our Wednesday call. We will be providing afederal update and an update on each of our sponsored bills.

National Health Center Week 2015

CPCA would like to congratulate all of community clinics and healthcenters that hosted over 160 events statewide for this year’sNational Health Center Week (NHCW). CPCA launched the “What’sYour Plus?” social media campaign, encouraging health centers topromote what their plus is. We would like to congratulate San YsidroHealth Center for winning the Grand Prize GoPro Camera! We wouldalso like to recognize Cares Community Health, LifeLong MedicalCare, Northeast Valley Health Corporation, Petaluma Health Center,and Santa Cruz Community Health Centers for sharing your healthcenter's plus and receiving the Runner­Up prizes. All of your photoswere wonderful and demonstrated what made your health centersunique.

In addition, CPCA would like to recognize those who participated inNACHC’s 2015 National Health Center Week Picture & VideoContest. Peach Tree Health (Marysville) was a runner­up for thevideo contest and South Central Family Health Center (Los Angeles)and Omni Family Health (Bakersfield) were runner­ups for the picturecontest. Thank you all for sharing with the country what makesCalifornia’s health centers great!

Join the CaliforniaHealth+ Movement Today!

CaliforniaHealth+ is an innovative new vision and brand to educatepatients about the benefits of California’s community clinics andhealth centers (CCHCs). CaliforniaHealth+ represents the “plus” thatCCHCs offer their patients by going beyond primary care toencompass a whole health approach. Have your clinic or healthcenter representative go through the online Rapid Recognitionprocess by clicking here.

For more information about CaliforniaHealth+, contact Val Sheehan,Director of Development & External Relations, vsheehan@cpca.orgor (916) 440­8170.

CPCA News

New Grant Opportunities

Two new listings have been added to CPCA’s Grant Opportunitiesweb page: HRSA – Service Area Competition HRSA­16­006 andCDPH – California Reducing Disparities Project Phase II –Capacity­Building & Implementation Pilot Projects.

Did you know you can earn up to 10.5 CME credits at this year’sAnnual Conference?!

For more information on educational sessions, general sessionspeakers and registration information, please click here. You won’twant to miss out on all of this year’s activities taking place at thisyear’s Annual Conference, including the Managed Care Summit &Reception, CPCA’s first­ever Silent Auction, mobile app, Health &Wellness Expo, and more! Hope to see you there!

ICD­10 Clinician Mission: Coding Primer­Diabetes/Depression

Please join us next Wednesday, September 9th for this 60­minutesession that builds on lessons learned during the webinar training onAugust 6th of this year, Clinician Mission: Prepare Your Transition toICD­10, with an advanced level of detail regarding clinical diagnosiscoding with a focus on diabetes and depression. This training willalso include discussion on improved diagnosis coding in ICD­9 toease impact of ICD­10 changes. Common clinical scenarios will beused to point to anticipated issues. Key­point examples involvingoften­requested documentation improvement will be shared. Forregistration information, please click here.

Adding Dental Hygienists as Billable Providers

This 60­minute webinar being held next Thursday, September 10thwill provide an overview of the California Department of Health CareService's process regarding the election of dental hygienists as abillable provider. This training will include a discussion of financialissues that should be considered before embarking on thismodification. For more information and to register, please click here.

Department of Health Care Services

DHCS Releases RFA for Geographic Managed Care Counties

The California Department of Health Care Services (DHCS),Managed Care Operations Division (MCOD), is solicitingapplications from managed care plans to provide Medi­Cal managedhealth care services and behavioral health services in theGeographic Managed Care (GMC) model counties of Sacramentoand San Diego. This is a non­competitive process and may result inone or more additional Medi­Cal managed care plans being offered inthose counties. Click here to view the RFA.

Health Center Operations

Long­awaited “340B mega­guidance” published

Last Thursday, HRSA published the long­awaited Mega­Guidance onthe 340B drug discount program. This document addresses a widerange of issues, including the definition of a patient, contractpharmacy arrangements, and audit requirements. CPCA will beworking closely with our 340B Peer Network on formal comments forsubmission to HRSA. The next 340B Peer Network meeting isscheduled for Sept. 9 at 3 p.m. Comments are due on TuesdayOctober 27. Please contact Ben Avey at bavey@cpca.org withquestions.

Healthcare Symposium

California Quality Collaborative (CQC) is pleased to present a half­day discussion and interactive event convening care managementand medically complex­focused clinicians and healthcareprofessionals to learn about best practices in complex caremanagement programs on September 24th, 2015 at the RadissonHotel Ontario Airport from 8:30am – 2:30pm. The event will feature akeynote by Clemens Hong, MD, MPH of LA County Department ofHealth Services. The Symposium also includes a panel discussionsof California medical groups and managed service organizations(MSOs) as well as facilitated exercises between medical grouppeers & interactive collaboration. Click here for more details.

Regional Opioid Safety Coalitions

The epidemic of prescription opioid overuse and overdose has led tothe deaths of over 7,400 Californians in five years, and has alsoresulted in high medical and societal costs. The CaliforniaHealthcare Foundation (CHCF) is working with partners across thestate to decrease opioid­related deaths by 30% in three years. Insupport of this goal, CHCF is issuing a request for applications(RFA) for organizations to create or strengthen regional opioid safetycoalitions, aiming to drive down prescription painkiller overuse andoverdose in their communities. Applications are due Sunday,October 11, 2015. Click here for complete details and an application.

Webinar: Integrating Hepatitis C Treatment into Primary Care

CCI hosted in partnership with the UCSF Center for Excellence inPrimary Care (CEPC), with support from Blue Shield of CaliforniaFoundation, the webinar will cover strategies for integrating hepatitisC treatment into primary care. This webinar is the latest in a seriessupplementing the Facilitating Care Integration resource center,which offers strategies, tools and best practices for integratingprimary care with various domains of the medical neighborhood. Youcan join this webinar on Wednesday, September 16, 12pm PST byregistering here.

Save The Date! Adolescent Sexual Health Conference in Fresno,CA

Please see here for the flyer regarding the Adolescent Sexual HealthConference in Fresno, CA on Tuesday, November 17th from 8:00AM – 1:30 PM.

Free STD Expert Hour Webinar Series

CAPTC’s STD Expert Hour is a recurring webinar series thathighlights current topics in the prevention and management of STDto further advance your practice and offer access to their network ofSTD Experts. In this edition CAPTC’s Medical Director, Dr. InaPark, will present 'What's New in the CDC's 2015 STD TreatmentGuidelines'. This webinar will occur on 09/15/2015 from 12:00­1:00PM PST and will be recorded and distributed to registrants. Pleaseregister here.

Human Resources

California Equal Pay Bill May be Toughest in Nation

California's new Fair Pay Act, which awaits Gov. Jerry Brown'ssignature, may be the nation's most aggressive attempt yet to closethe salary gap between men and women. Supporters said thelegislation, passed unanimously by the California Senate onMonday, closes loopholes that prevented enforcement of existinganti­discrimination law. The bill ensures that male and femaleemployees who perform "substantially similar" work receive equalpay, even if their job titles aren't the same or if they work in differentoffices for the same employer. To read more, click here.

Immigration Policy Update

Request for Nominations FY 2016 ­ National Advisory Councilon Migrant Health

The HRSA\BPHC is soliciting nominations for membership on theNational Advisory Council on Migrant Health (NACMH) for 4­yearterms starting November 26, 2015. For details on eligibilityrequirements, number of vacancies, selection criteria, applicationprocess, and other information, please click here for theannouncement and click here for the fact sheet on the AdvisoryCouncil.

Medi­Cal Update

Medi­Cal NewsFlash: CA­MMIS Health Enterprise: StatusUpdate

The article titled “CA­MMIS Health Enterprise: Status Update” wasposted to the NewsFlash area of the Medi­Cal website on August25, 2015.

Medi­Cal NewsFlash: Family PACT Updates: Benefits for IUCsand Subdermal Contraceptive Implants

The article titled “Family PACT Updates: Benefits for IUCs andSubdermal Contraceptive Implants” was posted to the NewsFlasharea of the Medi­Cal website on August 27, 2015.

Medi­Cal NewsFlash: CA­MMIS Health Enterprise: BCCTP,CHDP and Hospital PE Provider Training

The article titled “CA­MMIS Health Enterprise: BCCTP, CHDP andHospital PE Provider Training” was posted to the NewsFlash area ofthe Medi­Cal website on September 1, 2015.

Presumptive Eligibility Enrollment Period Policy Updates &Limitations

On August 28, 2015, the Department of Health Care Services(DHCS) released a Medi­Cal Eligibility Division Information Letterinforming counties that effective July 31st the Medi­Cal PresumptiveEligibility (PE) programs implemented limitations on PE enrollmentperiods for various coverage groups based on guidance receivedfrom the Centers for Medicare and Medicaid Services (CMS). PEsare date specific, beginning on the date that PE eligibilitydetermination is made and ending when the individual is determinednot eligible for Medi­Cal or at the end of the following month if anapplication is not submitted. To read more, click here.

Medicaid Update

Guidance for Issuers on the 2016 Reenrollment Process

On August 25, 2015, CMS published a bulletin with operationalguidance for issuers on the 2016 reenrollment process in theFederally­facilitated Marketplaces (FFMs), as well as in State­basedMarketplaces that use the federal eligibility and enrollment platform.Important changes from last year’s guidance include:

1. The FFM will calculate eligibility for 2016 advance payments ofthe premium tax credit (APTC) and cost­sharing reductions (CSRs)using the most recent family income data available and updated2016 qualified health plan (QHP) prices 2. The FFM will discontinue APTC/CSRs for enrollees who do notcomply with the requirement to file a tax return and reconcile APTCfor tax year 2014

2016 Assister Training Now Available for Certified ApplicationCounselors (CACs)

The Centers for Medicare and Medicaid Services (CMS) announcedthat as of August 26, 2015, the new 2016 Assister Training isavailable to Certified Application Counselors. It will be availablethrough Open Enrollment; however, CMS recommends completing itbefore the upcoming Open Enrollment Period and stronglyencourages CACs to print their training completion certificates bySeptember 4, 2015. Navigator training will also be available in earlySeptember following announcement of the Navigator grant awards.The CAC training can be accessed on the Marketplace LearningManagement System through the CMS Enterprise Portal. Assisterscan access training presentations and additional resource here.

Navigator & CAC Recertification Update: CMS EnrollmentAssister Bulletin

On August 24, 2015 CMS released the Enrollment Assister Bulletin:2015­01, which provides guidance on training, certification, andrecertification requirements and procedures for Navigators, CACs,

and CAC designated organizations in the in Federally­facilitatedMarketplaces (FFMs), including State­partnership Marketplaces(SPMs). CMS regulations require all Navigators in FFMs, includingSPMs, to complete HHS­approved training and achieve a passingscore on all approved certification examinations before beingcertified and carrying out any Navigator duties. CMS regulations alsorequire Navigators to obtain continuing education and be certifiedand/or recertified on at least an annual basis.

Navigator & CAC Recertification Update: CMS EnrollmentAssister Bulletin

This summer the Marketplace started sending reminder notices tothose determined eligible to enroll in a Qualified Health Plan withfinancial help and potentially have access to other minimumessential coverage (MEC); and those who have indicated anAmerican Indian and Alaska Native (AI/AN) status on theirMarketplace application, but who have not yet provideddocumentation. Notices reminded consumers to resolve such MECand AI/AN status Data Matching Issues (DMIs) as soon aspossible. Otherwise, financial assistance could end as early asSeptember 1st. Assisters can help consumers review eligibility andreminder notices to determine DMIs, when documents are due, andhelp submit documents.

APIAHF Releases DACA Outreach Best Practices Report

The Asian & Pacific Islander Health Forum released a new report–Immigrant Outreach: Applying Health Care Enrollment BestPractices to Deferred Action– examining how successful strategiesused in health insurance outreach can be applied to the DeferredAction for Childhood Arrival program (DACA) enrollment efforts. Itdescribes successful practices used to provide education andoutreach about health insurance enrollment to Asian Americans,Native Hawaiians and Pacific Islanders (AA and NHPI). Thesestrategies can be applied to DACA enrollment efforts as the healthcare enrollment process can be similarly confusing, challenging andin contrast with deeply held beliefs in some communities.

Senate Considering Bill that Could Increase Health CarePremiums

With a little over a week left in the legislative session, a bill thatcould increase health care premiums, deductibles, and out­of­pocketcosts for millions of enrollees and purchasers in order to reduce theirout­of­pocket costs for prescription drugs is awaiting a vote on theSenate Floor. AB 339 (Gordon; D­Menlo Park) could drive up healthcare premiums by severely restricting the ability of health plans andpharmacy benefit managers to control health care costs on behalf ofpurchasers through their prescription drug benefit designs, and alsoplaces strict caps on prescription drug copayments. To read more,click here.

State Legislative Update

SB 4 (Lara) ­ Health for AllThe recently passed state budget included funding to expand full­

scope Medi­Cal to children, regardless of their immigration status.Senator Lara’s signature bill, SB 4, continues as a vehicle toimplement that budget action, and allow undocumented immigrantsthe right to enter into Covered California without subsidy. A secondprovision of the bill which addressed health coverage for adults wasremoved from SB 4 and added to SB 10. SB 10 is a two year bill andwill not be considered until next year. Bill Status: The bill is currently being considered by the StateAssembly.

SB 147 (Hernandez) ­ Payment Reform Pilot Program forFederally Qualified Health Centers Senate Bill 147 by Senator Ed Hernandez (D­West Covina) requiresthe Department of Healthcare Services (DHCS) to authorize avoluntary three­year alternative payment methodology pilot forFederally Qualified Health Centers (FQHC) in California. Under thepilot, participating FQHCs would receive capitated monthlypayments from their health plan rather than the traditional fee­for­service per­visit reimbursement s from DHCS. The capitatedpayment will provide the FQHC with greater flexibility to deliverhealth care to the patient in a manner that best meets the patient’sneeds. Bill Status: The bill has been passed by the legislature and has beensent to the Governor for consideration.

SB 610 (Pan) ­ Timely Reimbursement of Health Centers SB 610Senate Bill 610 by Senator Richard Pan (D­Sacramento) establishesreasonable timelines for the Department of Healthcare Services(DHCS) to finalize Medi­Cal reimbursement rates and complete theannual reconciliation process for federally qualified health centers(FQHCs). The author has amended the bill, and it now requireDHCS to finalize a health center rate within 1 year after receivingthe requisite information and complete the annual reconciliationwithin 18 months of the last date of the fiscal year for which thedepartment is conducting the review. Bill Status: The bill is currently being considered by the StateAssembly.

AB 858 (Wood) ­ Improving Access to Behavioral HealthServicesAssembly Bill 858 by Assembly member Jim Wood (D­Healdsburg)will increase Californians’ access to mental health services bypermitting Marriage and Family Therapists (MFT) services at anFQHC or RHC to be reimbursed on a per­visit basis, just asservices provided by other mental health professionals arereimbursed. FQHC’s and RHCs will be required to complete a rateadjustment or submit for a new rate prior to initiating MFT’s as abillable provider. AB 858 was amended on July 1 to eliminate aprovision that allowed patients to access mental health and medicalservices on the same day, and be reimbursed for each. For a fulldescription of this bill, and its history, click here. Bill Status: This bill is currently being considered by the StateSenate.

AB 1130 (Gray) ­ Improving Access to Primary Health CareAB 1130 allows part­time primary care clinics operating on anintermittent basis the option to provide 30 hours of care per week,rather than 20 hours, as currently allowed by law. The additional 10hours per week will allow primary care clinics to better meet theneeds of their communities. Bill Status: The bill has been passed by the legislature and has been

sent to the Governor for consideration.

California Primary Care Association1231 I Street, Suite 400Sacramento, CA 95814

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