America

1
(No Transcript)
2
Americas 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
A Tale of Two Years
Presentation to Bi-state Primary Care
Association 25th Anniversary Primary Care
Conference
Dan Hawkins National Association of Community
Health Centers May 16, 2011
4
Last Year Health Reform!

5
Health Reform What Was it About?

• Expanded coverage for the very people
  communities served by CHCs, AND
• Guaranteed funding to expand CHCs the NHSC to
  reach 40 million by 2015
• PLUS
• Changes designed to revitalize Primary Care
  (THCs, Training, Payment Improvements) and
  Promote Integrated Care for Better Quality
  Lower Costs

6
Health Center Funding in ACA

• The Affordable Care Act (ACA) provides 11
  billion in dedicated funding for health center
  operations and capital for FY2011-FY2015.
• 9.5 billion to support health center operations.
• 1.5 billion for capital needs.
• Approximately half (727 million) of the funding
  for capital has already been granted to 143
  health centers across the country (FIP
  have-nots).
• HRSA will make awards for previously-announced
  FY2011 funding opportunities contingent upon this
  years final CHC program funding level.

7
NHSC and THC Provisions in ACA

• HRSA has publicly stated that NHSC field strength
  is over 10,000 and will reach 11,000 this year.
• HRSA has streamlined the site application
  process if all health centers seeking NHSC
  placements apply, the proportion of NHSC
  assignees at CHCs could reach 50
• HRSA recently announced designation of 11 THCs
  that will receive funding in the final months of
  this fiscal year to conduct community-based
  training of primary care residents.
• 9 of 11 grantees are health centers or
  CHC-involved

8
This Year Armageddon!

• 112TH CONGRESS
• 1ST SESSION
• H. R. 1
• Making appropriations for the Department of
  Defense and the other departments and agencies of
  the Government for the fiscal year ending
  September 30, 2011, and for other purposes.
• IN THE HOUSE OF REPRESENTATIVES

9
Armageddon What Does it Mean?

• 600 million in CHC spending cuts halfway through
  Fiscal Year 2011, AND
• 125 million in cuts to NHSC funding, AND
• An ACO rule that effectively banishes CHCs to
  second-class status in reform
• PLUS
• A House-passed 2012 budget that would dismantle
  Medicaid and force savage cuts in health human
  service programs

10
House Budgets Impact on Programs for Low- and
Moderate Income People
Source The Path to Prosperity FY2012 Budget
Resolution
11
Medicaid Costs 27 Less for Children, 20 Less
for Adults Than Private Insurance
Source Center for Budget and Policy Priorities.
12
The Outlook for Medicaid

• House-Approved Budget (Ryan) Plan for FY 2012
• Cap on all entitlement spending, including
  Medicaid
• Block grant Medicaid (ends all guarantees)
• Cut Medicaid by at least 1.4 trillion over next
  10 years
• Obama/Senate Proposals
• Deficit reduction proposals limit total federal
  spending w/ automatic cuts proportional to growth
  in spending from previous year
• Other Medicaid issues/areas of concern
• Maintenance of Effort (MOE) provisions
• State flexibility GOP Govs seeking freedom from
  limits

13
NACHC Medicaid Priorities

• Preserve Medicaid
• Health Centers payer mix 37 Medicaid and CHIP
• 46 50 Medicaid and CHIP expected in 2015
• Prospective Payment System (PPS)
• Preserve the PPS and health reforms Menendez
  Amendment, ensuring that private insurance plans
  pay at least Medicaid PPS
• Partnership for Medicaid
• Work with Congress to protect and strengthen
  Medicaid

14
Other NACHC Medicaid Priorities

• Medicaid Health Information Technology Incentive
  Payments The FIX-HIT Act (H.R. 1187, S. 643)
• Automatic reassignment of ARRA Medicaid HIT
  Incentive Payments directly to health centers
  rather than providers
• Prompt Pay
• Current statute requires health centers be
  reimbursed within 12 months
• Proposed statutory change 90 of claims within
  30 days, 99 within 90 days (current law for many
  other providers

15
Most Health Centers Meet Key Medical Homes
Criteria
Source Health center data from 2009 UDS, HRSA
and the 2010 HIT survey conducted by George
Washington University, and the National
Association of Community Health Centers. Note
All health centers are required to be governed by
patient majority board to ensure quality care
meets the needs of the community, and to provide
quality of care data to HRSA in their annual UDS
report.
16
Health Centers and Payment Reform

• FQHC Payment Systems ARE reform
• Bundled payment per visit, NOT open-ended
  fee-for-service
• Rate unique to each centers costs/scope, NOT
  single universal rate
• Prospective Payment, with limited growth, NOT
  unrestricted
• Effectively risk-based if patients need more,
  furnished at NO additional cost
• Original intent is still vital
• Ensure appropriate payment for covered
  individuals
• Not force Medicare/aid subsidy by uninsured grant
  funds

17
Health Center Participation in New Payment Systems

• 45 health centers have been certified as medical
  homes by NCQA
• 250 health centers plan to seek certification by
  2012
• At least 50 health centers are participating in
  medical home demos, and CMS Medicare demo will
  involve 500 CHC sites
• Most current demos (eg, Adirondacks NY) build off
  of current FQHC payment systems
• In CO, health centers are participating in state
  Medicaid ACO demo in 6 of 7 regions, leading in 3
• HOWEVER, CMS proposed ACO rule prohibits FQHCs
  from forming ACOs, and prohibits assignment of
  Medicare FQHC patients to ACOs for shared savings
  purposes

18
What Does This Mean for Us?

• No CHC will experience service cuts
• All ARRA-funded services will continue
• The NHSC still has TWICE its 2008 level
• ACA expansion may be delayed, BUT there is still
  6.5 billion (2/3 of original) expansion funding
  over next 4 years
• Medicaid is still intact, even if under siege
• ACO rule is not final yet
• In other words
• THE SKY HAS NOT FALLEN YET!!

19
The Takeaway

• The View from Capitol Hill is turbulent, with the
  parties taking dramatically different approaches
  on many big issues, especially the budget
• Yet, we are still here, 23 million strong, with
  great bipartisan support a great record on
  quality and cost-effectiveness
• Our message remains the same health centers
  offer a real solution that can appeal to all
  Members and contribute to improving fiscal health
  through SIGNIFICANT system-wide and
  Medicare/Medicaid savings.
• Deep partisan divide will NOT last forever
  already some are pulling back from most harmful
  changes

20
Where Can You Get 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 www.nachc.org

21
Thank You!

• Any
• Questions?