NACHC FEDERAL POLICY UPDATE. Jana Eubank Associate VP of Policy and Research National Association of Community Health Centers

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2 NACHC FEDERAL POLICY UPDATE Jana Eubank Associate VP of Policy and Research National Association of Community Health Centers Kentucky Primary Care Association February 22, 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 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 , and Senate by 92-8! Permanent Medicare SGR Doc Fix 2-year extension of CHIP funding

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 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

10 THANK YOU!!! As part of the Access is the Answer Campaign, Kentucky made: - Over 360 calls (out of 25,000 nationally) - Over 550 petitions signatures (out of 202,000 nationally) - 12 local support letters (out of 4,300 nationally) Thank you for your hard work and dedication to the health centers!!

11 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

12 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 More at:

13 REGULATORY UPDATE

14 What s expected this year? Substance Abuse Expansion Awards Oral Health Expansion Awards Additional Capital Awards Health Center Controlled Networks HRSA Finalizing Final FY16 Spend Plan Now HRSA POLICY FY15 & FY16 FUNDING $5.1 billion in FY15 - $1.4 billion more than FY14 largest increase in program history. Funds went to New Access Points, Capital awards, Expanded Services, Base Adjustments, Quality Awards, etc.

15 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 issued a proposed mega-guidance and is currently reviewing the1200 comments received. - Says FQHC patients can t get 340B Rx for prescriptions written by non-fqhc doctor - Requires annual audits & quarterly reviews of all contract pharmacies. - See NACHC summary and comments

16 POLICY DEVELOPMENTS CMS Medicare - Chronic Care Management fee: FQHCs can now bill for this service - New format for Cost Report expected soon Medicaid - Waiting on final rule on managed care changes Getting harder to use 340B Rx for managed care patients Marketplace New process for confirming your interest in being listed as an Essential Community Provider.

17 POLICY DEVELOPMENTS BPHC COMPLIANCE GUIDE BPHC expected to publish a draft Compliance Guide soon - 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 More at:

18 STATE AFFAIRS UPDATE

19 Medicaid expansion MEDICAID EXPANSION: A NATIONAL LANDSCAPE 32 states have expanded Medicaid 6 states have 1115 Waivers for expansion: AR, IA, MI, IN, NH, PA, MT -A number of states are actively working on Medicaid expansion (SD, WY, UT, TN) A number of expansion states are currently considering changes (KY, NH, AZ, IA, OH)

20 MEDICAID EXPANSION: A NATIONAL LANDSCAPE

21 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:

22 RESEARCH UPDATE

23 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 millions more patients Much more to come; new brief for P&I

24 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:

25 MAKE YOUR VOICE HEARD! ADVOCACY UPDATE

26 NEW ADVOCACY PLATFORM! Have you checked out our new advocacy platform yet? More ways to contact Congress Easily share the alert with your social media networks Opt in on your mobile phone to update your advocate profile and receive information via text Para recibir comunicaciones en español

27 OUR S WILL HAVE A SIMILAR LOOK Make sure you add grassroots@nachc.org to your safe-senders list.

28 ONLINE SIGNUP FORM STILL ON

29 NOW IT S EASIER TO INVITE: Friends Family Colleagues to the Health Center Advocacy Network

30 INFLUENCING LEGISLATORS: CHEAP & EASY Anyone can start a policy conversation with almost every Member of Congress right now, simply by going to their Facebook or Twitter page and asking a question. 84% Senators and Representatives are more inclined to use social media than they were in the past. 76% of Staff generally feel social media have improved relationships between constituents and Congress. Fewer posts are required on social media for an office to take notice than traditional methods of communication like and phone calls Social media posts can be influential, but don t take the place of building relationships with and being a local resource for Congressional staff!

31 WHAT CAN YOU DO RIGHT NOW? 1. Use Social Media to Express Appreciation and Tell Your Investment Story Tweet & Facebook Your MOC 2. Hold a Local Meeting to Celebrate CHCs 50 th Anniversary and Tell Your Investment 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 MOCs publicly & tell your investment story

32 ADVOCACY CENTER OF EXCELLENCE (ACE) PROGRAM Is your Health Center an ACE? Coming soon: PROGAM TO LAUNCH IN EARLY MARCH! ACEs are CHCs that have achieved certain measures of advocacy success and demonstrate ongoing commitment to advocacy ACEs receive national recognition and other benefits for their advocacy efforts NACHC partners with PCAs to support ACEs in each state Three achievement levels: bronze, silver, and gold complete the ACE checklist to apply!

33 NATIONAL HEALTH CENTER WEEK Get ready for NHCW 2016! When: August 7-13 Theme: Celebrating America s Health Centers: Innovators in Community Health Stay tuned for the annual kick-off webinar coming in May! Visit for more info

34 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

35 KENTUCKY: KEY CONTACTS PROGRAM Each Senator (2) and Representative (6) has a Key Contact!

36 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.

37 Jana Eubank Associate Vice President National Association of Community Health Centers Public Policy and Research Division 1400 Eye St, NW, Suite 910 Washington DC, QUESTIONS?