NACHC UPDATE Indiana Primary Care Association Elizabeth Kwasnik Manager of Grassroots Advocacy National Association of Community Health Centers May 5,

NACHC UPDATEIndiana Primary Care Association

Elizabeth KwasnikManager of Grassroots Advocacy

National Association of Community Health Centers

May 5, 2015

TODAY’S AGENDA

• THE ENVIRONMENT FOR HEALTH CENTERS

• FEDERAL POLICY UPDATE: LEGISLATIVE AND REGULATORY

• GRASSROOTS ADVOCACY: MAKE YOUR VOICE HEARD!

• RESOURCES AND FOLLOW-UP

• QUESTIONS?

The Environment in Washington

• Bipartisan support for Health Centers’mission as we celebrate 50 years

• Both sides are looking for solutionsin the health care arena

•Health Centers are at the center of the conversation

• There are Health Centers in 98% of Congressional Districts

(425/435)

THE ENVIRONMENT FOR HEALTH CENTERS

HEALTH CENTERS IN A POST-ACA WORLD

Where do we fit? Where do we stand?• Access to primary care is vital for cost savings

and improved outcomes

• Unmet need for our services remains enormous – 62 million without primary care

• We expect increased demand, among newly insured, remaining uninsured and underinsured

• Federal support, through 330 grant and Medicaid payment, crucial to model of care

• We will have to advocate louder than ever

LEGISLATIVE UPDATE

•FUNDING CLIFF FIX

•NEXT STEPS –

APPROPRIATIONS MEDICAID,

340B

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

(FY15)• “Discretionary”

Health Center Trust 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”

RAISING THE NOISE ON THE HILL

Sign-on Letters Bipartisan letters circulated in both Chambers• Addressed Appropriations

Support and Cliff Issue• House: 271 Signers (173 D, 98 R)• Senate: 60 Signers (39 D, 19 R, 2 I)Member Contacts• Target fly-in with Leadership, Key Committees• Hundreds of visits during P&I Hill Day• Thousands of calls to Congressional Offices

RAISING THE NOISE IN INDIANA

Sign-on Letters • Cliff sign-on letter (October 2014)

– Reps. Carson, Visclosky, and Walorski and Sen. Donnelly

• FY16 Approps letter (March 2015)– Rep. Carson and Sen. Donnelly

Primary Care Cliff Averted!

• Congress passed, and the President signed into law, H.R. 2, the Medicare and CHIP Reauthorization Act of 2015• Overwhelming support – passed House by

a vote of 392-37, and Senate by 92-8!• Permanent Medicare SGR “Doc Fix”• 2-year extension of CHIP

What’s in it for us? Two years of additional mandatory funding for Community Health Centers, National Health Service Corps, and THC Program (Extended through Sept. 2017)

2010 2011 2012 2013 2014 2015 2016 2017

2.19

1.58 1.58 1.495 1.495 1.495 1.495 1.495

1 1.2 1.5

2.2

3.6 3.6 3.6

Discretionary ACA HR 2

Primary Care Cliff Averted!

Health Center Funding Chart

Note About H.R. 2 Funds

• Senate Human Trafficking Legislation― Use of Health Center funds set aside in

H.R. 2 to cover health care-related services for victims

― Cost could range from $5mil to $30mil per year (for two years)

― Press release/statement available on NACHC website

Where Do We Go From Here?

• 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

• Medicaid changes included in ACA alternative proposals, budget negotiations and entitlement program discussions, including block grants, per-capita caps, and increased state waiver flexibility

Where Do We Go From Here?

• King v. Burwell Supreme Court Decision• Expected in June• Potential to severely undermine

insurance exchanges

• 340B Drug Discount Program• Recent Congressional Hearing• “Mega Guidance” expected this summer

REGULATORY UPDATE

HRSA POLICY – FY15 FUNDING

• $5.1 billion in FY15 - $1.4 billion more than FY14, largest amount ever.

• HRSA has/will spend this on:• $350M - New Access Points and Expanded

Services• $165 - Base Adjustments • $150M – Construction & Capital

Improvements• $150M - Outreach and Enrollment• $51M - Behavioral Health Integration• $36M - Quality awards

HRSA POLICY – 340B

We are keeping a close eye on 340B• “Mega-Reg” never published; “Mega-

Guidance” expected this summer

• Increased scrutiny from Congress and beyond – concerns re: rapid growth, contract pharmacies

• Important that health centers • ensure and document compliance• can speak to importance of the

program

CMS POLICY

• Medicare PPS Started in October• Phased in Oct 2014 – Sept. 2015• Your G-code charge and coding matter

• Ongoing State-by-State Medicaid Waiver/Expansions (incl. “Private Option”)

• Health Center O&E staff becoming even more important as other funding streams dry up.

GRASSROOTS ADVOCACY

•Access is the Answer Update

•Advocacy in Indiana

•Key Contact Program

•National Health Center Week

•Become an advocate today!

MAKE YOUR VOICE HEARD!

•We did it! H.R. 2 signed into law on April 16th

•Don’t forget to thank your MOCs!–Direct email/call–Media templates available

•Health Center advocates made a HUGE difference• BUT, our job isn’t done…

ACCESS IS THE ANSWER CAMPAIGN

• Appropriations process– need to protect our discretionary funding!• Federal discussion around Medicaid• King v. Burwell*•Workforce issues• Funding past FY17

We need to be able to adequately respond when issues come up, and be on the offensive moving forward! We cannot

afford to lose any ground we’ve gained!

ONGOING ADVOCACY NEEDS

ADVOCACY IN INDIANA

Member Contact• 38 emails (total) to Reps. and 56 emails per

Senator on H.R. 2• Cliff Call in Day (March 19): 365 calls• Senate/H.R. 2 Call in Day (April 13): 202 calls

Access is the Answer Activity• 3,247 petition signatures• 1,573 local support letters• 850 staff letters• 300 advocate cards

H.R. 2 VoteHouse: All voted yes except ViscloskySenate: Both Sens. voted yes

ADVOCACY IN INDIANA

Outstanding Performers:• HealthLinc

―Access is the Answer activities• Open Door Health Services

―Access is the Answer activities• Heart City Health Center

―House email campaign (Walorski)

―House & Senate call in days

Does your Health Center have a Key

Contact?• We rely on Key Contacts to leverage their relationships with Members of Congress and their staff

• Key Contacts are our advocacy leaders/grasstops!

• Can be anyone at a CHC with a relationship with Member or staff- CEO, O&E, clinician, etc.

KEY CONTACT PROGRAM

Why do we need Key Contacts?• Key Contacts are go-to folks in the field who can get Members/staff on the phone, because of an existing personal or working relationship and urge support of CHC issues

• Their work complements grassroots efforts, makes a huge difference

• Work in coordination with NACHC and PCA to ensure consistent messaging

• Are asked to respond to targeted requests for outreach

KEY CONTACT PROGRAM

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.

ADVOCACY: THE BOTTOM LINE

• August 9th-15th, 2015• America’s Health Centers:

Celebrating Our Legacy, Shaping Our Future

• It’s never too early to start planning!

–Think about incorporating a bit of history into your events this year in celebration of the 50th anniversary of the Health Centers Program.

• Kick-off webinar May 12 at 2PM ET!

NATIONAL HEALTH CENTER WEEK 2015

Join the Campaign for America’s

Health Centers• Weekly Washington Update

• Action Alerts

• Spanish-language Advocacy updates

• TeleForums with NACHC leadership and national policymakers

• Send messages to your elected officials in support of Health Centers & the patients they serve.

BECOME A HEALTH CENTER ADVOCATE TODAY!

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

Elizabeth KwasnikManager of Grassroots Advocacy

[email protected]

QUESTIONS?

CONTACT INFO AND QUESTIONS