2. NACHC UPDATE Indiana Primary Care Association Elizabeth Kwasnik Manager of Grassroots Advocacy National Association of Community Health Centers May 5, 2015

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 in Washington Bipartisan support for Health Centers’ mission as we celebrate 50 years Both sides are looking for solutions in the health care arena Health Centers are at the center of the conversation There are Health Centers in 98% of Congressional Districts (425/435) THE ENVIRONMENT FOR HEALTH CENTERS

5. 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, remaining uninsured and underinsured Federal support, through 330 grant and Medicaid payment, crucial to model of care We will have to advocate louder than ever

6. LEGISLATIVE UPDATE FUNDING CLIFF FIX NEXT STEPS – APPROPRIATIONS MEDICAID, 340B

7. HEALTH CENTER FUNDING STREAMS Annual Annual, up to Congress to determine amount Prior to ACA, the only funding for CHC program Cut several times, backfilled with mandatory funds Currently $1.5 billion (FY15) “Discretionary” Annual Annual, up to Congress to determine amount Prior to ACA, the only funding for CHC program Cut several times, backfilled with mandatory funds Currently $1.5 billion (FY15) “Discretionary” Health Center Trust Fund Required spending, unless Congress changes the law Special 5-year Trust Fund created in ACA to boost Health Center Capacity Currently $3.6 billion (FY15) “Mandatory” Health Center Trust Fund Required spending, unless Congress changes the law Special 5-year Trust Fund created in ACA to boost Health Center Capacity Currently $3.6 billion (FY15) “Mandatory”

8. RAISING THE NOISE ON THE HILL Sign-on Letters Bipartisan letters circulated in both Chambers Addressed Appropriations Support and Cliff Issue House: 271 Signers (173 D, 98 R) Senate: 60 Signers (39 D, 19 R, 2 I) Member Contacts Target fly-in with Leadership, Key Committees Hundreds of visits during P&I Hill Day Thousands of calls to Congressional Offices

9. RAISING THE NOISE IN INDIANA Sign-on Letters Cliff sign-on letter (October 2014) – Reps. Carson, Visclosky, and Walorski and Sen. Donnelly FY16 Approps letter (March 2015) – Rep. Carson and Sen. Donnelly

10. Primary Care Cliff Averted! Congress passed, and the President signed into law, H.R. 2, the Medicare and CHIP Reauthorization Act of 2015 Overwhelming support – passed House by a vote of 392-37, and Senate by 92-8! Permanent Medicare SGR “Doc Fix” 2-year extension of CHIP What’s in it for us? Two years of additional mandatory funding for Community Health Centers, National Health Service Corps, and THC Program (Extended through Sept. 2017)

11. Primary Care Cliff Averted! Health Center Funding Chart

12. Note About H.R. 2 Funds Senate Human Trafficking Legislation ―Use of Health Center funds set aside in H.R. 2 to cover health care-related services for victims ―Cost could range from $5mil to $30mil per year (for two years) ―Press release/statement available on NACHC website

13. Where Do We Go From Here? FY16 Appropriations Funding at Risk After big investments in mandatory funding, Congress may cut back on discretionary funding – need to advocate louder than ever to maintain $1.5 billion Medicaid changes included in ACA alternative proposals, budget negotiations and entitlement program discussions, including block grants, per-capita caps, and increased state waiver flexibility

14. Where Do We Go From Here? King v. Burwell Supreme Court Decision Expected in June Potential to severely undermine insurance exchanges 340B Drug Discount Program Recent Congressional Hearing “Mega Guidance” expected this summer

15. REGULATORY UPDATE

16. HRSA POLICY – FY15 FUNDING $5.1 billion in FY15 - $1.4 billion more than FY14, largest amount ever. HRSA has/will spend this on: $350M - New Access Points and Expanded Services $165 - Base Adjustments $150M – Construction & Capital Improvements $150M - Outreach and Enrollment $51M - Behavioral Health Integration $36M - Quality awards

17. HRSA POLICY – 340B We are keeping a close eye on 340B “Mega-Reg” never published; “Mega- Guidance” expected this summer Increased scrutiny from Congress and beyond – concerns re: rapid growth, contract pharmacies Important that health centers ensure and document compliance can speak to importance of the program

18. CMS POLICY Medicare PPS Started in October Phased in Oct 2014 – Sept. 2015 Your G-code charge and coding matter Ongoing State-by-State Medicaid Waiver/Expansions (incl. “Private Option”) Health Center O&E staff becoming even more important as other funding streams dry up.

19. GRASSROOTS ADVOCACY Access is the Answer Update Advocacy in Indiana Key Contact Program National Health Center Week Become an advocate today!

20. MAKE YOUR VOICE HEARD!

21. We did it! H.R. 2 signed into law on April 16 th Don’t forget to thank your MOCs! –Direct email/call –Media templates available Health Center advocates made a HUGE difference BUT, our job isn’t done… ACCESS IS THE ANSWER CAMPAIGN

22. Appropriations process– need to protect our discretionary funding! Federal discussion around Medicaid King v. Burwell* Workforce issues Funding past FY17 We need to be able to adequately respond when issues come up, and be on the offensive moving forward! We cannot afford to lose any ground we’ve gained! ONGOING ADVOCACY NEEDS

23. ADVOCACY IN INDIANA Member Contact 38 emails (total) to Reps. and 56 emails per Senator on H.R. 2 Cliff Call in Day (March 19): 365 calls Senate/H.R. 2 Call in Day (April 13): 202 calls Access is the Answer Activity 3,247 petition signatures 1,573 local support letters 850 staff letters 300 advocate cards H.R. 2 Vote House: All voted yes except Visclosky Senate: Both Sens. voted yes

24. ADVOCACY IN INDIANA Outstanding Performers: HealthLinc ―Access is the Answer activities Open Door Health Services ―Access is the Answer activities Heart City Health Center ―House email campaign (Walorski) ―House & Senate call in days

25. Does your Health Center have a Key Contact? We rely on Key Contacts to leverage their relationships with Members of Congress and their staff Key Contacts are our advocacy leaders/grasstops! Can be anyone at a CHC with a relationship with Member or staff- CEO, O&E, clinician, etc. KEY CONTACT PROGRAM

26. Why do we need Key Contacts? Key Contacts are go-to folks in the field who can get Members/staff on the phone, because of an existing personal or working relationship and urge support of CHC issues Their work complements grassroots efforts, makes a huge difference Work in coordination with NACHC and PCA to ensure consistent messaging Are asked to respond to targeted requests for outreach KEY CONTACT PROGRAM

27. 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

28. August 9 th -15 th, 2015 America’s Health Centers: Celebrating Our Legacy, Shaping Our Future It’s never too early to start planning! –Think about incorporating a bit of history into your events this year in celebration of the 50 th anniversary of the Health Centers Program. Kick-off webinar May 12 at 2PM ET! NATIONAL HEALTH CENTER WEEK 2015

29. Join the Campaign for America’s Health Centers Weekly Washington Update Action Alerts Spanish-language Advocacy updates TeleForums with NACHC leadership and national policymakers Send messages to your elected officials in support of Health Centers & the patients they serve. BECOME A HEALTH CENTER ADVOCATE TODAY!

30. 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

31. Elizabeth Kwasnik Manager of Grassroots Advocacy 202-331-4614 ekwasnik@nachc.org QUESTIONS? CONTACT INFO AND QUESTIONS