2. NACHC UPDATE Dan Hawkins Sr. VP, Public Policy & Research National Association of Community Health Centers Mississippi Primary Health Care Association Annual Conference June, 2014

3. 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?

4. THE ENVIRONMENT The Environment in Washington – the BAD Political Polarization ACA is as divisive as ever “Must-pass” bills pass, but not much else Heightened scrutiny of federal programs Budget caps and future funding uncertainty

5. THE ENVIRONMENT The Environment in Washington – the GOOD Bipartisan support for Health Centers’ Program, Model and Mission Both sides looking for solutions in the health care arena Health Centers are at the center of the conversation

6. 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 and uninsured (MA experience) Federal support, through 330 grant and Medicaid payment, crucial to model of care We will have to advocate louder than ever

7. LEGISLATIVE UPDATE FY15 APPROPRIATIONS HEALTH CENTER FUNDING CLIFF MEDICAID/MEDICARE/CHIP WORKFORCE

8. FY15 APPROPRIATIONS Annual appropriations process determines funding for all of Section 330, other programs like NHSC New funding essential if we want base grant adjustments, expanded capacity, service expansion, new access points Since ACA, funding comes two ways:

9. HEALTH CENTER FUNDING STREAMS DISCRETIONARY Annual, up to Congress to determine amount Prior to ACA, the only funding for CHC program Cut in 2011, backfilled with mandatory funds Currently $1.5 billion (FY14) DISCRETIONARY Annual, up to Congress to determine amount Prior to ACA, the only funding for CHC program Cut in 2011, backfilled with mandatory funds Currently $1.5 billion (FY14) MANDATORY Required spending, unless Congress changes the law Special Fund created in ACA to boost Health Center Capacity Currently 2.2 billion (FY14) Expires in FY2016 (more on that in a moment) MANDATORY Required spending, unless Congress changes the law Special Fund created in ACA to boost Health Center Capacity Currently 2.2 billion (FY14) Expires in FY2016 (more on that in a moment)

10. OUR REQUEST FOR NEXT YEAR NACHC REQUEST $1.5 Billion Discretionary $3.6 Billion Mandatory $5.1 Billion total Invest in operations (Base Adj, EMC, Services, NAPs) NACHC REQUEST $1.5 Billion Discretionary $3.6 Billion Mandatory $5.1 Billion total Invest in operations (Base Adj, EMC, Services, NAPs) PRESIDENT’S BUDGET $1.0 Billion Discretionary $3.6 Billion Mandatory $4.6 Billion total Invest mostly in capital and construction PRESIDENT’S BUDGET $1.0 Billion Discretionary $3.6 Billion Mandatory $4.6 Billion total Invest mostly in capital and construction SIGN-ON SUPPORT LETTERS Stabenow-Wicker Letter (Senate): 54 signatures Pallone-Bilirakis Letter (House): 224 signatures

11. APPROPRIATIONS OUTLOOK $1.4 billion increase is a heavy lift, need to justify Senate wants to pass bill before August, House more uncertain Final resolution may be post-election, and tied to funding cliff issue

12. HEALTH CENTERS FUNDING CLIFF Mandatory funding expires at the end of FY15 Without action by Congress, up to 70% cut to Health Center grants NHSC, THCs in same position (though ALL mandatory)

13. FIXING THE CLIFF – OUR PLAN Extends, grows mandatory funding $20b over 5 years Grow from current 22m patients to 35m Continue funding for NHSC, Teaching Health Centers Message: Act Now!

14. THE CLIFF – KEY POINTS 1. This is real. Health Centers have had success in gaining new funding, but even our biggest champions can’t predict the outcome here. 2. Estimate the impact. What would a 70% cut to your grant mean in your community, to your patients? 3. Raise the drumbeat for a fix. We have a long fight ahead, but our best hope is the understanding that this is a “must-do”.

15. MEDICARE/MEDICAID/CHIP For the moment, not on the Congressional radar as much – fights are in the States and in the Administration Medicare “doc fix” bill passed in March Included 8 state demo on “Certified Community Behavioral Health Clinics” – NACHC neutral, but monitoring process Current CHIP funding expires in 2015

16. WORKFORCE POLICY National Health Service Corps and Teaching Health Centers GME programs currently 100% funded with ACA funds Funding for both expires in 2015 President proposed extending, expanding NHSC, and building on THCGME Working alongside coalition partners (AAFP, AAMC, ACU, AATHC) to extend

17. REGULATORY UPDATE

18. HRSA POLICY – FY14 FUNDING Congress increased Health Centers Funding by $700m in FY14. So far, they’ve announced there will be : $110m for Base Adjustments $58m to Outreach and Enrollment $50m to Behavioral Health Expansion $150m in New Access Points $300m for Expanded Services We hear the remainder will go for quality improvement

19. HRSA POLICY Also newly released or coming down the pike from HRSA: Governance PIN (released Jan 2014) Total Budget PIN (released Mar 2014) Sliding Fee Scale PIN (coming soon!) We are keeping a close eye on 340B “Mega-Reg” expected summer 2014 Increased scrutiny in Congress Important that health centers can speak to importance of the program

20. CMS POLICY Medicare PPS Rule in May 2014 Eliminates payment cap & screens New, bundled payment rate ($158.85) No 1-visit-per-day limit in certain cases PAY ATTENTION to “G” codes! Effective Oct. 1, 2014 CCIIO (Oversees the Exchange) Essential Community Provider Rules Navigator Guidance Ongoing State-by-State Medicaid Waiver/Expansions (incl. “Private Option ”)

21. Reasons people may STILL enroll in coverage after April 1: Marriage, having a baby, gaining citizenship Change in income or household status (divorce, etc.) Losing other health coverage (job loss, aging off parent’s plan AND Eligibility to enroll in Medicaid or CHIP is continuous (no limit on enrollment period) COVERAGE ENROLLMENT CONTINUES

22. GRASSROOTS ADVOCACY IMPORTANCE OF ADVOCACY ACCESS IS THE ANSWER CAMPAIGN NATIONAL HEALTH CENTER WEEK BECOME AN ADVOCATE TODAY!

23. 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

24. MAKE YOUR VOICE HEARD!

25. Campaign to organize EVERY HEALTH CENTER ADVOCATE to get Congress to fix the Health Center Funding Cliff. Goal is to demonstrate the support in local communities for health centers. We are asking every Health Center to take 3 Action Steps as part of the first phase of the Campaign. ACCESS IS THE ANSWER CAMPAIGN

26. # 1 - Petition Drive Goal: Every Health Center collects at least 500 Signatures Timeline: ONGOING Email tallies tograssroots@nachc.comgrassroots@nachc.com #2 - Local Support Letter Drive Goals: 5 Support Letters from Local Elected Officials 10 Support Letters from Community Partners & Supporters Collection Deadline: May 31 st /ONGOING Report Collection Totals & Names to NACHC: Email grassroots@nachc.com grassroots@nachc.com ACCESS IS THE ANSWER: ACTION STEPS

27. #3 - In Person Meetings With Your Members of Congress – Goal: Confirm Meetings with Each Member of Congress at your Health Center to Deliver All Collected Materials. –Timeline: Congressional Recess Weeks in June & July and/or National Health Center Week, August 10-16 –Report Confirmed Meetings to NACHC: grassroots@nachc.com grassroots@nachc.com ACCESS IS THE ANSWER: ACTION STEPS

28. Campaign Website : www.saveourchcs.org www.saveourchcs.org Petition Templates in English and Spanish Support Letter Templates for both Local Elected Officials and Community Partners Report Forms Bilingual Fliers, Handouts and Social Media Tools ACCESS IS THE ANSWER: RESOURCES

29. Invite Your Members of Congress to Visit During NHCW – August 10 th -16 th NATIONAL HEALTH CENTER WEEK More info updated regularly at www.healthcenterweek.org www.healthcenterweek.org

30. Join the Campaign for America’s Health Centers Weekly Washington Update Action Alerts Tele-townhall forums with national policymakers Send messages to your elected officials in support of Health Centers and the patients they serve. BECOME A HEALTH CENTER ADVOCATE TODAY!

31. 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

32. Dan Hawkins Sr. VP, Public Policy & Research National Association of Community Health Centers 1400 Eye St., N.W., Suite 910 Washington, DC 20005 p. 202-296-0131 e. dhawkins@nachc.orgdhawkins@nachc.org QUESTIONS? CONTACT INFO AND QUESTIONS