2. NACHC UPDATE Jana Eubank Associate Vice President, Public Policy and Research National Association of Community Health Centers Federal Policy Update TACHC Annual Conference October 17, 2014

3. TODAY’S AGENDA THE ENVIRONMENT FOR HEALTH CENTERS FEDERAL POLICY UPDATE: LEGISLATIVE AND REGULATORY GRASSROOTS ADVOCACY: MAKE YOUR VOICE HEARD! RESOURCES 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 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

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 5-year Trust Fund created in ACA to boost Health Center Capacity Currently 2.2 billion (FY14) Set to expire in FY2016 (more on that in a moment) MANDATORY Required spending, unless Congress changes the law Special 5-year Trust Fund created in ACA to boost Health Center Capacity Currently 2.2 billion (FY14) Set to expire 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 REQUEST $1.0 Billion Discretionary $3.6 Billion Mandatory $4.6 Billion total Invest mostly in capital and construction PRESIDENT’S REQUEST $1.0 Billion Discretionary $3.6 Billion Mandatory $4.6 Billion total Invest mostly in capital and construction APPROPRIATIONS SIGN-ON LETTERS SENT THIS SPRING Stabenow-Wicker Letter (Senate): 54 signatures Pallone-Bilirakis Letter (House): 226 signatures

11. 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)

12. APPROPRIATIONS OUTLOOK Senate Subcommittee passed full NACHC request - $5.1 billion total Process stalled until after November elections, possibly into next year Final resolution of this year’s funding may be tied to funding cliff issue

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 broad support, but Congress has to act in order to fix this problem. 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. RAISING THE DRUMBEAT ON THE HILL Sign-on Letters: Did Your Member Sign On? Bipartisan letters circulating in House and Senate Addressed to Leadership, and emphasize need to address the cliff No dollar figures, timelines, specific prescriptions Record Numbers: 250 House, 66 Senate

16. ACTION THIS FALL Congress returns after the November elections for a “lame-duck” session. There is a lot of unfinished business and several “must-do” items may be moving. Details depend on the election…BUT Expect a major grassroots push focused on fixing the cliff in the lame duck session.

17. 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

18. REGULATORY UPDATE

19. HRSA POLICY – FY14 FUNDING Congress increased Health Centers Funding by $700m in FY14. HRSA has/will spend this on: $110m in Base Adjustments $58m in Outreach and Enrollment $50m in Behavioral Health Integration $150m in New Access Points $300m in Expanded Service $34m PCMH Incentives

20. HRSA POLICY Also newly released or coming down the pike from HRSA: Total Budget PIN Sliding Fee Scale PIN We are keeping a close eye on 340B “Mega-Reg” was expected summer 2014, now potentially stalled Increased scrutiny in Congress Important that health centers can speak to importance of the program

21. CMS POLICY Medicare PPS Rule Issued in May 2014 Eliminates Medicare Cap New, bundled payment rate Transition will take place through 2015 Trainings upcoming in Oct, Nov, Dec – listed on T&TA page on nachc.com Ongoing State-by-State Medicaid Waiver/Expansions (incl. “Private Option”) PA approved, IN & others expected

22. ACCESS IS THE ANSWER CAMPAIGN 1.Continue collecting Local Support Letters 2.Submit a letter to the editor/Op- Ed to a local media outlet 3.Setup in-person meetings with your Members of Congress Email grassroots@nachc.com to report your numbersgrassroots@nachc.com www.saveourchcs.org/ab out.cfm We are asking every Health Center to take 3 Action Steps as part of the second phase of the Campaign.

23. Petition templates in English, Spanish, Vietnamese, and Chinese Local Support Letter templates Coming soon: media templates Fliers and notecards Sample social media posts and images www.saveourchcs.org/about.cfm www.nachc.com/cliff Cliff estimator Cliff graphs Talking points and FAQs State-by-state fact sheets on economic impact HELPFUL RESOURCES TO FIX THE CLIFF

24. 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

25. Jana Eubank Associate Vice President, Public Policy and Research National Association of Community Health Centers 1400 Eye Street, NW, Ste. 915 Washington, DC 202.834.4391 jblasi@nachc.org jblasi@nachc.org QUESTIONS? CONTACT INFO AND QUESTIONS