NACHC FEDERAL POLICY UPDATE. Dan Hawkins Sr. VP, Public Policy & Research National Association of Community Health Centers

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2 NACHC FEDERAL POLICY UPDATE Dan Hawkins Sr. VP, Public Policy & Research National Association of Community Health Centers May, 2016

3 TODAY S AGENDA CONGRESSIONAL UPDATES REGULATORY UPDATES STATE UPDATES RESEARCH UPDATES ADVOCACY UPDATES CONTACT INFO & QUESTIONS

4 National Association of Community Health Centers Public Policy and Research Division Dan Hawkins Senior Vice President Luke Ertle Program Associate Jana Eubank Associate Vice President Carla Devoe Office Manager John Sawyer Director, Federal Affairs Dawn McKinney Director, State Affairs Michelle Proser Director, Research Amanda Pears Kelly Director, National Advocacy Colleen Meiman Director, Regulatory Affairs Abigail Pinkele Deputy Director, Federal Affairs Michaela Keller, Manager, Federal Affairs Alyssa Shinto Program Associate, Federal Affairs Jennifer Taylor Deputy Director, Federal Affairs Heidi Emerson Deputy Director, State Affairs Kersten Burns Lausch Manager, State Affairs Michelle Jester Manager, Research Caitlin Crowley Policy Analyst, Research Elizabeth Kwasnik Manager, Grassroots Advocacy Alex Harris Manager, Advocacy Special Populations Dorian Wanzer Manager, Advocacy Communications Susan Sumrell Deputy Director, Regulatory Federal Affairs State Affairs Research Advocacy Regulatory

5 CONGRESSIONAL UPDATE

6 THE ENVIRONMENT FOR HEALTH CENTERS IN WASHINGTON Bipartisan support for Health Centers Low expectations for major action in Congress Administration finalizing regulations Presidential politics overshadowing Congressional agenda CHCs in 98% of Congressional Districts (425/435) New leadership in the House Still educating new members

7 2016 NACHC LEGISLATIVE AGENDA 2016 POLICY PAPERS Health Center Funding: Investing in Community Health Workforce: Staffing the Safety Net CHC Innovation: Innovating for Healthy Communities

8 CURRENT FUNDING SITUATION Mandatory funding through H.R. 2/MACRA Solved problem for 2 years, however need to continue to fight for sustainable funding

9 OUR ASK- HEALTH CENTER FUNDING Support health center funding in the FY17 annual Appropriations process: sign the Bilirakis-Green letter in the House and the Wicker-Stabenow letter in the Senate. House letter: 307 House Members signed the Bilirakis-Green letter 70% of all House Members (a new record!) Senate letter: 62 Senators signed the Wicker-Stabenow letter 62% of all Senators (another record!) Request level discretionary funding ($1.5 billion) in individual request letters. Commit to taking action well before the September 2017 deadline to make the Health Centers Fund permanent

10 THANK YOU!!! As part of the Access is the Answer Campaign for 2016, Massachusetts Congressional Members: Achieved a perfect 100% of the delegation as signatories on the FY 2017 Dear Colleague letters Nationally, 69% of all Members signed onto the Dear Colleague letters Thank you for your hard work and dedication to the health centers!!

11 OUR ASK- WORKFORCE Platform/menu of policy solutions to the workforce crisis, including: Fully funding the National Health Service Corps at the President s Budget Request of $380 million Investing in Teaching Health Centers short term and long Passing the Family Health Care Accessibility Act (S. 2151, Thune/Casey) to include volunteer providers under FTCA Passing the CONNECT For Health Act (S. 2484, Schatz/Wicker and H.R. 4442, Black/Welch) to improve CHCs access to telehealth technology. Reauthorizing and funding Nurse Practitioner Training.

12 OUR ASK(S)- CHC INNOVATION Demonstrate support for the community health center model! Join the Bipartisan Caucus on Community Health Centers. Senate: Contact co-chairs Senators Blunt, Carper, Cornyn or Cardin House: Contact co-chairs Representatives Grange (TX), Davis (IL), Zinke (MT), or Capuano (MA) to join. Come see innovation firsthand! Visit a community health center during an upcoming district work period, or during National Health Center Week (August 7 th -13 th ).

13 340B Drug Discount Program - First-ever hearing held in Flurry of activity last May, but no changes - Continued scrutiny, unlikely legislative action this year OTHER LEGISLATIVE ACTIVITY? Medicaid changes - 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 created Republican workgroup - Block grants and per-capita caps, have been discussed but aren t 2016 threats

14 OTHER LEGISLATIVE ACTIVITY? Also under consideration: - Substance Abuse legislation Senate HELP, Judiciary (possibly part of Criminal Justice Reforms) - Mental Health Legislation House E&C - 21 st Century Cures passed House, slower path in Senate - Chronic Care Legislation Senate Finance Committee Working Group

15 REGULATORY UPDATE

16 HRSA POLICY FY15 & FY16 FUNDING $5.1 billion in FY15 most of $1.4 billion new funding went to New Access Points, Capital awards, Expanded Services, Base Adjustments, Quality Awards, etc. FY 16 Funding Plan same level ($5.1 billon) Substance Abuse Expansion Awards ($94M) Oral Health Expansion Awards ($150M) Additional Capital Awards ($265M) Health Center Controlled Networks ($33M) Quality Improvement ($100M) Continuation of current CHC funding levels

17 HRSA recently issued a proposed megaguidance ; now seeking comments - Says FQHC patients can t get 340B Rx for prescriptions written by non-fqhc doctor - Requires annual audits & quarterly reviews of all contract pharmacies. - NACHC response opposed any restrictions 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.

18 POLICY DEVELOPMENTS CMS Medicare - New format for Cost Report expected soon - Likely to start allowing billing for Chronic Care Management in January Medicaid - Final reg on managed care expected shortly - Getting harder to use 340B Rx for managed care patients Meaningful Use Final rules just released, loosened timelines for attesting to Stage 2 Marketplace Hopefully you confirmed your interest in being listed as an Essential Community Provider.

19 POLICY DEVELOPMENTS BPHC COMPLIANCE GUIDE BPHC expected to publish a draft Compliance Guide any day Will consolidate all PINs &PALs in a single document no new policy Will explain how to demonstrate compliance NACHC is prepared to do an in-depth analysis and comment New and Improved Reg Affairs website More at:

20 STATE AFFAIRS UPDATE

21 Medicaid expansion MEDICAID EXPANSION: A NATIONAL LANDSCAPE 31 states & DC 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)

22 MEDICAID EXPANSION: A NATIONAL LANDSCAPE

23 PAYMENT REFORM: 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 More at:

24 RESEARCH UPDATE

25 NATIONAL CHC WORKFORCE NEEDS ASSESSMENT First national CHC workforce survey since 2004 Goal: better understand current vacancies, recruitment/retention challenges, training activities, barriers, opportunities 40%+ response rate THANK YOU!! Top Line Findings: 95% of all CHCs have a current vacancy 70% have family doc vacancy if fully staffed, CHCs could serve 2 million more patients Policy Brief available online at NACHC website

26 PRAPARE Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences Overall Project Goal To create, implement/pilot test, and promote a national standardized patient risk assessment protocol to assess and address patients social determinants of health (SDH). In other words, position health centers to: Document the extent to which each patient and their total patient populations are complex Use that data to: improve patient health, affect change at the community/population level, and sustain resources and create community partnerships necessary to improve health. More at:

27 WE ARE SEEN AS A SOLUTION

28 MAKE YOUR VOICE HEARD! ADVOCACY UPDATE

29 Access is the Answer Action Steps: What can YOU do right NOW?! 1. Use Social Media to Express Appreciation and Tell Your Investment Story Tweet & Facebook Your Member of Congress (98% have accounts) 2. Hold a Local Meeting to Celebrate CHCs Anniversary and Tell That Story Share what recent investments in your Health Center have meant for staff, patients, and the community 3. Recruit Staff and Board Members to Grow Your Grassroots Network Sign up 100% of staff and board as Health Center Advocates 4. Submit an OpEd or Letter to the Editor to Local Media Express your appreciation to Members publicly & tell your investment story

30 : NATIONAL HEALTH CENTER WEEK Last year: Great success! 6 th Consecutive Presidential Proclamation This Year s Theme: Celebrating America s Health Centers: Innovators in Community Health Over 1,700 events and 70 Member of Congress visits Get ready for NHCW 2016, August 7 th -13 th Visit for more info

31 KEY CONTACT PROGRAM Are you a Key Contact? Be an advocacy leader Key Contacts are our go-to advocates in the field our grasstops Can be anyone at a CHC with a relationship with Member or staff- CEO, O&E, clinician, board member, etc. Will be called to action on time-sensitive, critical issues

32 MASSACHUSETTS MEMBERS WITHOUT A KEY CONTACT Sen. Markey Rep. Capuano Rep. Keating Rep. McGovern Rep. Moulton Rep. Tsongas Want to sign up? grassroots@nachc.com

33 ADVOCACY: THE BOTTOM LINE HEALTH CENTERS SUCCESS DEPENDS ON THE STRENGH OF OUR COLLECTIVE ADVOCACY. Local connection is the key to policy change build relationships and demonstrate impact 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.

34 Dan Hawkins Senior VP, Public Policy & Research National Association of Community Health Centers 1400 Eye St, NW, Suite 910 Washington DC, Phone # QUESTIONS?