1. Texas Association of Community Health Centers Annual Conference HRSA Guidance on Outreach and Enrollment Funding Presented by Lori McCain, CPA, CGMA Chief Financial Officer, AccessHealth October 6, 2014

2.  History of Outreach and Enrollment Funding  Current Outreach and Enrollment Funding  Expectations for Use of Outreach and Enrollment Funding  Outreach and Enrollment Budget Requirements  Accounting for Outreach and Enrollment Funds  Tracking and Reporting Outreach and Enrollment Activities and Funds  Resources 2

3.  Initial HRSA Outreach and Enrollment Funding July 2013 $150 million in supplemental Outreach and Enrollment (O&E) assistance to be used July 1, 2013 – June 30, 2014 (included one-time award of $5,000) December 2013 $58 million in one-time supplemental O&E funds awarded to health centers 3

4. 66 Texas health centers received a total of $15,339,108 in O&E supplemental funding ($9,907,738 initial funds in July and $5,431,370 one-time funds in December) 4

5.  Continued HRSA Outreach and Enrollment Funding O&E assistance funds were provided as part of HRSA’s ongoing commitment to support health centers in their efforts to help uninsured patients and others in their approved service areas to gain access to affordable health insurance coverage. 5

6. HRSA included O&E supplemental funding in FY 2014 health center base awards. Notice of Award (NoA) stated, “FY 2014 O&E funding has been provided to support continued O&E assistance activities funded initially in FY 2013.” 6

7. FY 2014 funds pro-rated from July 1, 2014 to start date of next budget period less one-time funds awarded in July and December 2013 In FY 2014 and beyond, O&E funds will be annualized to the amount originally awarded in July 2013 (excluding one-time $5,000 funding) Future support reflected as part of Recommended Future Support commitment on most recent NoA 7

8.  HRSA’s Expectations Communicated to Health Centers August 2014 email reminding grantees of HRSA’s commitment to O&E as ongoing health center activity and explanation of incorporation of O&E funding into base awards 8

9. Email stated, “HRSA expects health centers that receive O&E funds will continue to conduct in- reach, outreach and enrollment assistance throughout the year, with the understanding that during open enrollment periods, health centers will likely have to adjust resources in order to meet the increased health center patient and service area needs.” 9

10. Level of effort of O&E activities should be consisted with amount of effort supported by initial O&E funding in FY 2013. 10

11. Reasonable staffing levels maintained that will: 1. Allow the organization to do proactive outreach and to meet the demand for enrollment assistance and related activities throughout the year; and 2. Ensure that the organization is reasonably prepared and has sufficient numbers of trained assisters to conduct O&E activities to meet health center patient and service area needs during open enrollment periods. 11

12.  HRSA Budget Requirements O&E-specific budget or work plan for ongoing O&E activities not required Annual overall budget must account for how federal dollars are spent Health centers should use their discretion in budgeting additional O&E funding in support of O&E activities HRSA expects O&E funds to be spent in accordance with health center’s approved budget and work plan 12

13. FY 2014 funding applications required submission of a total budget that included separation of section 330 grant funding (including funding for O&E activities) and non-grant funding Budget should reflect project costs supported by section 330 grant funds and project costs supported by other sources of funding (non- grant) 13

14.  Policy Information Notice (PIN) 2013-01 PIN 2013-01, Health Center Budgeting and Accounting Requirements, updated March 18, 2014 PIN 2013-01 provides health centers with discretion in how their budget is allocated between section 330 grant funds and non-grant funds Projected budgeting must comply with all applicable HHS policies and other federal requirements 14

15. Health centers must track 330 grant expenditures Have the ability to prove grant expenditures are consistent with HRSA approved budget Follow all applicable requirements for accounting for federal grant funds (45 CFR 74 and/or 45 CFR 92) Keep 330 grant revenue and expenditures separate from non-grant revenue and expenditures 15

16.  AccessHealth Example Develop mechanisms for tracking 330 grant funds within the accounting system Accounting system allows account segregation by location, department and program 330 grant funds and O&E supplemental funds both set up as different programs Initial O&E supplemental funding covered two separate 330 grant budget periods 16

17.  AccessHealth Example (continued) FY 2013 supplemental O&E funding provided four O&E positions for AccessHealth Positions incorporated into 330 grant portion of FY 2014 project budget Tracking of funds in accounting system provides documentation for draw down of 330 grant funds in support of O&E activities 17

18. Spreadsheet utilized to separate 330 grant draws between regular draws and draws that support O&E activities AccessHealth always tracks supplemental funding from HRSA separate from base funding 18

19.  Tracking of Outreach and Enrollment Activities System for tracking O&E activities is necessary to compile information for quarterly progress reports (QPRs) required by HRSA AccessHealth utilized a combination of practice management system and Excel spreadsheets for tracking and reporting through September 30, 2014 19

20. TACHC online reporting tool should be used to compile O&E activities to facilitate QPR preparation Health centers should consider tracking qualified health plans (QHPs) in their practice management systems 20

21.  AccessHealth Example During initial funding year July 2013 – June 2014, AccessHealth reported:  13 certified application counselors (CACs)  15,156 individuals assisted with Marketplace information  2,707 applications submitted  1,339 individuals enrolled in QHP, Medicaid or CHIP Possible that actual assists were higher due to confusion over HRSA reporting requirements 21

22.  AccessHealth Experience O&E workers estimated 72% of individuals assisted were not eligible for Marketplace because household income was below 100% FPL 22

23. ‣ AccessHealth Experience (continued) Growth in uninsured population experience over last year is a combination of:  O&E activities  Marketing and branding efforts  1115(b) Medicaid waiver project participation Isolated payer mix shift from 75.7% to 57.9% uninsured 23

24.  Summary Requirement to collect and report information pertaining to O&E and Health Insurance Marketplace will continue for foreseeable future 24

25. Take action now:  Use TACHC’s online reporting tool for O&E activities  Track grant expenditures separately in accounting systems  Track new health center patients resulting from O&E activities  Track Marketplace QHPs in practice management systems 25

26.  Please Visit HRSA Website For information on Outreach and Enrollment: http://bphc.hrsa.gov/outreachandenrollment/inde x.html For a copy of PIN 2013-01: http://bphc.hrsa.gov/policiesregulations/ policies/index.html 26

27. 27 Please feel free to contact Lori McCain Lmccain@myaccesshealth.org 281.633.3165 Please visit our website http://myaccesshealth.org