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TRANSCRIPT
10/17/2016
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NACHC Federal
Policy Update
Jana Eubank
Associate Vice President
Public Policy and Research Division
National Association of Community Health CentersTennessee Primary Care Association
October 17, 2016
CONGRESSIONAL UPDATE
REGULATORY UPDATE
STATE UPDATE
ADVOCACY UPDATE
CONTACT INFO & QUESTIONS
Today’s Agenda
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HEALTH CENTERS ON THE HILL :
CONGRESSIONAL UPDATE
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BACK TO BASICS:
The Health Center Funding Cliff
Community Health Center Operational Funding: FY 2010 – FY 2018
$$ in Billions
2.21.6 1.6 1.5 1.5 1.5 1.5 1.5 1.5
1 1.2 1.52.2
3.6
0.25
3.6 3.6
0
1
2
3
4
5
6
FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18Base Discretionary Appropriation ACA Health Centers Fund ARRA H.R. 2/MACRA
?
• No action = 70% cut to 330
• Would affect every HC, not
just newly funded/expanded
• NHSC, THCGME in same
situation: only NO base
• Impact analysis (from 2015):
• 2,200 sites closed
• 7+ million patients lost
• 57,000 jobs lost
• Would quickly reverse more
than 2 decades of growth
2015 vs. 2017: What’s Different This Time?
MACRA Created Bipartisan Vote
484/535 have now voted in favor
of CHC mandatory funding.
Strength in Numbers
More than 20 other programs
expire at the same time.
The Dollars Are Being Used
In 2015, not all funds had been
spent. Now, any cut has impact.
ACA Connection is Diminished
CHCs are less associated directly
with divisive ACA politics.
Potential Presidential Priority
At least one Presidential candidate
has embraced CHC growth.
ADVANTAGES
Cost of any Extension
Minimum needed to stay whole is
$3.6 billion/year. Plus NHSC, THC.
No Clear Legislative Vehicle
In 2015 everything health-related
“rode” on the SGR/“Doc Fix.”
Hyde Amendment Challenges
Parts of both parties are
unsatisfied with status quo.
Changing CHC Insurance Mix
Harder to explain need for grant
investment with fewer uninsured.
Competing Priorities on the Table
Same bill could contain Medicaid
cuts, 340B reforms, etc?
DISADVANTAGES
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A Possible “Safety Net Package?”
SOME OF OUR PARTNERS• Most likely scenario is
“everything goes together”
• CHIP seen as “anchor” –
CHCs not far behind
• NACHC working
collaboratively on joint
efforts – letters, visits, etc.
• Challenge of package
approach – musical chairs
• Coordination is key
What will the Election Mean?
PRESIDENTIAL SENATE HOUSE
• Sec. Clinton has large
CHC/NHSC growth plan
• Election will determine future
of ACA, Medicaid expansion
• Personnel is policy: possible
change at HHS, CMS, HRSA
• Senate control is currently
too close to call.
• Majority will control agenda
and key committees.
• Still, no party likely to top
60 vote threshold.
• House Republicans likely
to retain the majority.
• Narrower margins means
each individual member
has more influence.
• Bipartisanship is critical.
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Additional Front Burner Issues in 2017
340 B• As expected, little activity
this year as Congress and
340B stakeholders await a
final decision regarding
last year’s HRSA Proposed
Omnibus Guidance
• Continued scrutiny by
outside oversight groups
including HHS OIG &
MedPAC
• Unlikely legislative action
this year, however
possibility of potential
activity in 2017
Medicaid• Not a LOT of legislative
activity at federal level –
fights are in the states
and at CMS
• Small tweaks have been
proposed
• House E&C Republican
workgroup/House GOP
Proposal “A Better Way”
calls for block grants and
per-capita caps
• In discussion but not
2016 threats
Behavioral Health• S. 524, Comprehensive
Addiction Treatment and
Recovery Act (CARA):
Signed into law by
President Obama on
July 22, 2016
• H.R. 2646, Helping
Families in Mental Health
Crisis Act:
Passed House only
• HRSA Funding:
$94 million for MAT
to 271 health centers
in 45 states, DC, and
Puerto RicoFor the latest, reach out to
Funding Cliff Fix 2.0: Timeline for Action
WINTER ‘16FALL ‘16 SPRING ‘17 SUMMER ‘17
• Congress in Session
in Sept. (short)
• In-district meetings
with Members of
Congress
• Election November 8
• Transition Team
engagement
• New Member outreach
• National Teleforum
• Targeted Fly-in for
Leadership, Cmte
Chair KCs (January)
• NACHC Winter
Strategy Meeting
• Finalize ask, possible
legislation introduced
• Connect w/ key Cmte
staff and members
• Pre-P&I briefings,
calls and webinars
• President’s Budget
• NACHC P&I – end of
March: we need
RECORD TURNOUT
• Capitol Hill Briefing
• 2017 Policy Papers
• Sign-on letter or
legislative push
• All-out grassroots
push on funding cliff
• If legislation not done,
increase pressure
• Use July 4 recess and
August recess as “drop
dead” markers
• Targeted fly-ins as
necessary
• Aggressive grassroots
& media campaign
• Re-assess most effective
tools, redouble effort
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BPHC: Updates
Award Type Amount # of Awards
Substance Abuse
Expansion
$94 m 271
Oral Health
Expansion
$150 m 420
Additional Capital $265 m 290
Health Information
Investment
$90 m 1300
Health Center
Controlled
Networks
$33 m 45-50
Quality
Improvement
$100 m 1300
NAP funding depends on final FY17 #s
FTCA
NACHC has asked BPHC to clarify
whether FTCA applies to certain
services provided for non-FQHC
patients, e.g., Prescribing Naloxone to
FQHC patients for them to administer
to friends or family members
BPHC is still considering these issues.
FY16 New Spending
Compliance Guide
• Consolidates most PINS and PALs
into a single document.
• Public comments due Nov. 22 –
NACHC is doing a deep dive.
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340B Developments
Scrutiny continues
• From Congress, HRSA, drug
manufacturers, press, & beyond
• Important that health centers
ensure and document compliance
− NACHC’s new 340B Manual
can help
Medicaid 340B savings at risk:
• Savings for Rx to fee-for-service
patients will be eliminated next
spring
• Getting harder to keep 340B
savings for managed care patients
Waiting on the 340B Mega-Guidance
• HRSA is expected to publish a final
version of its “mega-guidance” this fall
• Big issue will be whether it will prohibit
FQHC patients from getting 340B Rx
for prescriptions written by non-
FQHC doctors (e.g., specialists, upon
hospital discharge)
• Is expected to require annual audits &
quarterly reviews of all contract
pharmacies.
For the latest, visit
http://nachc.org/policy-
matters/regulatory-issues/
Proposed Changes to HPSA Scores
For auto-facility HPSAs, HRSA has
proposed to:
–Establish separate scores for each
site
–Measure poverty using Census
data for all persons within a 30-
minute travel radius of the site
HRSA is considering advancing major changes to how HPSA scores are
calculated.
NACHC has serious
concerns about these
proposals, and has had
extensive discussions with
HRSA about them.
To read NACHC’s summary of the proposed changes,
visit http://nachc.org/policy-matters/regulatory-
issues/
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Medicaid and Medicare
Developments
Medicaid
Final Rule and State Health Official letter on
managed care changes released April 2016.
Clarified that:
• “Delegated wrap” is only permissible if:
− total payment is at least equal to what
would be paid under PPS, and
− each health center agrees individually to
the arrangement
• Every MCO must contract with at least one
FQHC
• Value-based payments must be in
addition to PPS payments
Medicare
• CMS is finalizing MACRA
implementation
• While there’s no direct impact on
FQHC Medicare payment, FQHCs
can choose to report on some of
the new measures
• New format for Cost Report finalized
• CMS proposed new FQHC specific
market basket
• Expected to result in higher
annual inflation updates than
the MEI
For the latest, reach out to [email protected].
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Medicaid Expansion:
A National Landscape
• Medicaid Expansion
– 32 states have expanded
Medicaid
– 6 states have used 1115
Waivers for expansion: AR, IA,
MI, IN, NH, MT
- A couple of expansion states
are currently considering
changes via waiver (AZ, KY)
-CMS recently denied Ohio’s
waiver proposal
State activity in:
• Alternative payment models for
health centers (e.g. CA, OR)
• Accountable Care Organizations
(e.g. MN)
Payment Reform:
A National Landscape
For lessons learned, best practices, challenges,
and opportunities, visit
http://nachc.org/policy-matters/states/
National trend toward payment reform, e.g. State
Innovation Models Initiative, Section 2703 Health Homes
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State Related Resources
Available at
http://nachc.org/policy-
matters/states/
Research: NACHC Resources
Visit www.nachc.org for a number of research and
data-driven resources on health centers such as:
State Fact Sheets
District Health Center Maps
Sketch of Community Health
Center Chartbook
Fact sheets on topics like
Medicaid, Medicare, Preventing
Emergency Department Use,
and Cost Effectiveness
Summaries of health center
research
Questions? Contact [email protected]
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ADVOCACY
By Joining the Health
Center Advocacy Network…
Are you a Health Center Advocate?
Para recibir
comunicaciones en español
• You’ll have more ways to
contact Congress
• You can easily share alerts &
calls to action with your social
media networks
• You can opt in with your mobile
phone to receive updates and
alerts via text message.
How To Sign Up:
Visit www.saveourchcs.org and
click “Join the Campaign”
OR
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Why the Emphasis on Social
Media for Advocacy?Anyone can start a policy conversation with almost every Member of Congress,
simply by going to their Facebook or Twitter page and asking a question.
84%
16%
Members of Congress Utilizing Social Media
Yes
No76%
24%
Staffers Who Think Social Media Improves Relationship
Yes
No
Social media posts can be influential, but they don’t take the place of
building relationships with and being a local resource for Congressional staff!
We Did It!
100K Advocates in 100 Days!
Health Center Advocates across the nation stepped up to bring new
advocates into our community—helping to achieve this ambitious goal and
ensure a bright future for Health Centers and those we serve.
The Health Center Advocacy Network now totals
more than 101,000 Advocates. THANK YOU!
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More Good News:
NHCW16 was a HUGE Success!
1,650 Events Organized by
650 HCs
30,000,000 #NHCW16
Social Media Impressions
88+ Events with Members of Congress
7th Consecutive Presidential
Proclamation
Visit www.healthcenterweek.com for more info.
Get Ready for NHCW 2017: August 13th – 19th
The Hispanic Advocacy Program (HAP)
Spread the word
www.saveourchcs.org/se-un-defensor.cfm
Discover resources
to help you engage
more advocates in
your community
and spread the
Word about Health
centers including:
- A brief video
“¿Que es un
defensor?”
- Infographic
about Health
centers
- Fliers
- Signup forms
- Social media
tools
Stay connected
in Spanish
Send DEFENSOR
to 52886 for text
message updates
in Spanish
Sign up for Spanish
email updates on
www.saveourchcs.org
Learn more
about advocacyAttend quarterly
Spanish-language
webinars to learn
more about
advocacy topics
including:
- Engaging with
elected officials
- Storytelling
- National Health
Center Week
- Using social
media for
advocacy
- And more!
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Health Center Key Contact Program
If you
answered
‘YES’ –
YOU could
be a Health
Center Key
Contact.
Do you have a direct relationship with your Member(s) of Congress or their staff?
Do you consistently respond to calls to action with a phone call or personal email to these contacts?
Are you committed to delivering the Health Center message on behalf of your Health Center and the Program as a whole?
Are you a Key Contact?
Email [email protected]
Key Contacts: TN
Key Contacts: Both Senators
All 9 Representatives
Email [email protected]
Don’t forget to reach out to other
candidates/elected officials!
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What Can You Do Right Now?
Recruit Staff and Board Members to
Grow Your Grassroots
Network – keep the momentum going, sign up 100% of
staff and board as Health Center
Advocates.
Check In with Your Members of Congress -
remind them of what’s going well
& what’s at stake.
Get to Know Your Candidates & Invite Them to Visit Your
Health Center –host them to establish a
relationship and show them the
critical role your HC in the
community.
Do Your Homework –reacquaint
yourself with the possible
implications of the next Primary
Care Funding Cliff on your
Health Center and the patients
you serve.
Stay Connected with
NACHC’s Advocacy Efforts
facebook.com/CFAHC @CFAHC
Email [email protected]
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Questions?
Jana EubankAssociate Vice President
NACHC
Public Policy and Research Division
1400 Eye St., NW, Suite 910
Washington DC, 20005
202-296-3800
www.nachc.org