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10/2/2015
1
NACHC FEDERAL
POLICY UPDATE
Jana EubankAssociate Vice President
National Association of Community
Health CentersTennessee Primary Care Association
October 2, 2015
10/2/2015
2
TODAY’S AGENDA
• LEGISLATIVE UPDATES
• REGULATORY UPDATES
• STATE UPDATES
• ADVOCACY UPDATES
• CONTACT INFO & QUESTIONS
Dan HawkinsSenior Vice President
Jana EubankAssociate Vice President
Federal Affairs
John SawyerDirector,
Federal Affairs
Abigail PinkeleDeputy
Director,Federal Affairs
Jennifer TaylorDeputy
Director, Federal Affairs
State Affairs
Dawn McKinneyDirector,
State Affairs
Heidi EmersonDeputy Director,
State Affairs
Luke ErtleProgramAssociate
Research
Michelle ProserDirector,Research
Caitlin CrowleyPolicy
Associate, Research
Michelle JesterManager, Research
Kersten Burns Lausch
Manager,State Affairs
Advocacy
Amanda Pears Kelly
Director,National Advocacy
Elizabeth Kwasnik
Manager, Grassroots Advocacy
Dorian WanzerManager, Advocacy
Communications
Alex HarrisManager, Advocacy
Special Populations
Regulatory
Colleen MeimanDirector,
Regulatory Affairs
Susan SumrellDeputy
Director,Regulatory
Carla DevoeOffice
Manager
National Association of Community Health CentersPublic Policy and Research Division
Alyssa ShintoProgram
Associate, Federal Affairs
VacantManager,
Federal Affairs
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THE ENVIRONMENT
FOR HEALTH CENTERS
The Environment in Washington – the BAD
• Congress not productive - “must-pass” bills
pass, but not much else
• Limiting budget caps and future funding
uncertainty
• Crowded agenda – breaking through the
noise is harder than ever
• ACA and health care remain politically
polarizing
• New members to educate
The Environment in Washington – the GOOD
•Bipartisan support for Health Centers’
mission as we celebrate 50 years
• Both sides are looking for solutions
in the health care arena
• Health Centers are at the
center of the conversation
• Health Centers in 98% of
Congressional Districts
(425/435)
• New members to educate
THE ENVIRONMENT
FOR HEALTH CENTERS
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HEALTH CENTER FUNDING STREAMS
Annual• Annual, up to Congress to
determine amount
• Prior to ACA, the only
funding for CHC program
• Cut several times, backfilled
with mandatory funds
• Currently $1.5 billion (FY14)
• “Discretionary”
Health Ctrs Fund• Required spending, unless
Congress changes the law
• Special 5-year Trust Fund
created in ACA to boost
Health Center Capacity
• Currently $3.6 billion (FY15)
• “Mandatory”
HEALTH CENTERS FUNDING CLIFF
• Health Centers
“mandatory” Fund
was set to expire
at the end of FY15
• Without action by
Congress, would
have meant up to
70% cut to Health
Center grants
• NHSC, THCs were
in same position
(though ALL
mandatory)
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PRIMARY CARE CLIFF AVERTED!
H.R. 2, the Medicare and CHIP
Reauthorization Act of 2015 (MACRA)• CHCs: 2 add’l years at $3.6 billion/year.
• NHSC: 2 add’l years at $310 million/year.
• THCGME: 2 add’l years at$60m/year
• House vote of 392-37, and Senate by 92-8!• Permanent Medicare SGR “Doc Fix”
• 2-year extension of CHIP funding
CURRENT FUNDING SITUATION
• Mandatory
funding
through H.R.
2/MACRA
• Solved
problem for 2
years, however
need to
continue to
fight for
sustainable
funding
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HOW DID THIS HAPPEN?
Advocacy
• Access is the Answer Campaign
• Key Contacts Program
• Broad smart grassroots
Bipartisanship
• Only way to get things done in
current environment
• Breadth led to depth
Connections
• Members know/see what you do
• We remind them often
THANK YOU!!!
As past of the Access is the Answer Campaign, Tennessee made:
•Over 325 calls (out of 25,000 nationally)
•Over 3,100 petitions signatures (out of
202,000 nationally)
•Over 10 local support letters (out of 4,300
nationally)
Thank you for your hard work and
dedication to the health centers!!
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ARE WE DONE YET?
FY16 Appropriations Funding at Risk
• After big investments in mandatory funding,
Congress may cut back on discretionary
funding – need to advocate louder than
ever to maintain $1.5 billion
• In September, Congress averted a
shutdown and extended all gov’t funding
until December 11th. Very unclear after
that.
OTHER LEGISLATIVE ACTIVITY?
• Medicaid changes being discussed:- As part of ACA alternative proposals,
budget negotiations and entitlement
program discussions
- Options include block grants and per-
capita caps
- Unlikely to pass this fall
• 340B Drug Discount Program- First-ever hearing held in March
- Flurry of potential activity in May
10/2/2015
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OUTLOOK FOR THE FALL
• Congress has a long list of to-do’s- Appropriations – possible omnibus or CR
need by October 1, or shutdown
- Other Deadlines – highway trust fund,
debt limit, FAA, expiring budget deal,
export-import bank
- Mental Health Legislation – House E&C
- 21st Century Cures – passed House
- Medical Innovation – Senate HELP
- Chronic Care Legislation – Senate
Finance
HRSA POLICY – FY15 FUNDING
$5.1 billion in FY15 - $1.4 billion more than FY14. HRSA has spent or is committed to spend the following:
Award Type Date (expected) # Awards Amount
Behavioral Health Integration November 2014 210 $51m
Quality Improvement December 2014 1,113 $ 99m
New Access Points (Round 1) May 2015 164 $101m
New Access Points (Round 2) August 2015 266 $169m
National Cooperative Agreement June 2015 4 $ 3m
Expanded Services September 2015 1,184 $350m
Health Infrastructure Improvement September 2015 160 $150m
Base Adjustments September 2015 1,280 $165m
Substance Abuse Service Exp. September 2015 310 $100m
Sequestration (across-the-board) N/A N/A $90m
Total $1.278b
10/2/2015
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POLICY DEVELOPMENTS- 340B
• Close scrutiny from Congress, HRSA, & beyond- Important that health centers ensure and
document compliance - NACHC is developing tools to assist FQHCs
in ensuring compliance.
• HRSA recently issued a “mega-guidance”; now seeking comments- Says FQHC patients can’t get 340B Rx for
prescriptions written by non-FQHC doctors- Requires annual audits & quarterly reviews
of all contract pharmacies.
POLICY DEVELOPMENTS – CMS
• Medicare
- New format for Cost Report expected soon
- Likely to start billing for Chronic Care
Management in January
• Medicaid
- Final reg on managed care changes not
expected till 2016
- Getting harder to use 340B Rx for managed care
patients
• Meaningful Use - Reg expected any day, will
hopefully loosen rules & timelines
• Marketplace – CMS will ask you to confirm your
interest in being listed as an Essential Community
Provider.
10/2/2015
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POLICY DEVELOPMENTS – BPHC
COMPLIANCE GUIDE
• BPHC expected to publish a draft
“Compliance Guide” any day
– Will consolidate all PINs &PALs in a
single document
– Will explain how to demonstrate
compliance
– NACHC is prepared to do an in-depth
analysis and comment
New and Improved Reg Affairs website
www.nachc.com/regulatory
MEDICAID EXPANSION:
A NATIONAL LANDSCAPE
• Medicaid expansion
– 31 states have expanded Medicaid
– 6 states have 1115 Waivers for
expansion: AR, IA, MI, IN, NH, PA
– A number of states are actively working
on Medicaid expansion (UT, SD, TN, WY)
– A number of expansion states are
currently considering changes (NH, MI,
AZ, OH)
10/2/2015
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MEDICAID EXPANSION:
A NATIONAL LANDSCAPE
• Alternative payment models for health centers (e.g. CA, OR)
• Accountable Care Organizations (e.g. MN)
• National trend toward payment reform
– e.g. State Innovation Models
Initiative, Section 2703 Health
Homes
PAYMENT REFORM:
A NATIONAL LANDSCAPE
10/2/2015
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MAKE YOUR VOICE HEARD!
WHY “ACCESS IS THE ANSWER”?
High-Quality
• Where will everyone go to receive care?
• Health Centers already serve as the health care home to more than 24 million patients and prepared to serve millions more with adequate resources.
Cost-effective
• Where will the savings come from to reduce health care spending?
• Health Centers already save the health care system billions of dollars – many times the money invested in the program – and can save much more by expanding the model of care.
LOCAL
• How can we maintain local control over our health care and create jobs?
• As locally owned and operated small businesses, Health Centers have a record of being real local economic engines and creating tens of thousands of jobs leveraging a relatively small investment.
10/2/2015
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Access is the Answer Action Steps:
What can YOU do right NOW?!1. Present a Letter of Appreciation from Your Health
Center BoardDraft & Present to Your MOC - IN PERSON
Submit similar Letter to other supporters
2. Host Your MOC at Come Visit your Health CenterInvite Your MOC to visit
Present Board Appreciation Letter & Make the Case for Continued
Funding
3. Submit an OpEd or LTE to Local MediaExpress your appreciation publicly & continue making the case for
continued investment
4. Take the Advocacy PledgeRecommit to Health Center Advocacy & Taking Action EVERY TIME
ACCESS IS THE ANSWER: RESOURCES
• Campaign Website:
www.saveourchcs.org/about.cfm
• Templates:
– English
– Spanish
• Letter & Media Templates:
– Local Elected Officials
– Community Partners
• Report Forms
• Tools to Spread the Word
– Bilingual Fliers
– Bilingual Handouts
– Social Media Tools
10/2/2015
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GET READY!
• NACHC will launch a new set of action steps as part of the Access is the Answer Campaign in early October!
– Look for Advocacy Webinar Launch
Notice coming soon
– Access new Advocacy Tools &
Resources on the website
– Make sure to report all your
advocacy activities thus far to
• August 9th-15th, 2015
• Great success!
• Over 1,700 events and
70 Member of
Congress visits
• 6th Consecutive
Presidential
Proclamation
NATIONAL HEALTH CENTER WEEK 2015
Visit the NHCW website at www.healthcenterweek.org for
more info & get ready for NHCW 2016, August 7th-13th
10/2/2015
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Does your Health Center
have a Key Contact?• Leverage your relationship with
Members of Congress and their
staff
• Be an advocacy leader; Key
Contacts are our grasstops and go-
to folks in the field!
• Can be anyone at a CHC with a
relationship with Member or staff-
CEO, O&E, clinician, etc.
• Will be called to action on time-
sensitive, critical issues
KEY CONTACT PROGRAM
TENNESSEE MEMBERS
WITHOUT A KEY CONTACT
Each Senator (2) and
Representative (9) has a Key
Contact!
10/2/2015
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HEALTH CENTERS’ SUCCESS & OUR COLLECTIVE
FUTURE DEPEND ON THE STRENGH OF OUR ADVOCACY.
• Local connection is the key to policy change –build relationships and demonstrate impact over time
• Advocacy requires ACTION - the key is to develop a sustained culture of advocacy in your center
• The challenges ahead are huge, as are the
opportunities. We have to take them on TOGETHER.
LEGISLATIVE & ADVOCACY:
THE BOTTOM LINE
WHAT YOU CAN DO?
• Become a Key Contact
• Watch for Washington Update, Advocacy Alerts
• Support our comments on proposed legislation
• Plan health center events or visits for Members of Congress
• Establish advocacy programming at your health center
• Put us to work, share intelligence
10/2/2015
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Campaign for America’s Health Centers:
www.saveourchcs.org
NACHC Website:
www.nachc.org
NACHC Blogs (Health Centers on the Hill, the Policy Shop,
Health Center News and Happenings, etc.):
blogs.nachc.com
NACHC MyLearning Center (webinars, conference
archives, resources, online communities):
mylearning.nachc.com
RESOURCES
Jana Eubank
Associate Vice President
National Association of Community Health Centers
Public Policy and Research Division
1400 Eye St, NW, Suite 910
Washington DC, 20005
202-331-4615
QUESTIONS?
CONTACT INFO AND QUESTIONS
