We have been receiving many inquiries about the 2017 Federal Poverty Guidelines. Here is the link from the HHS that was posted January 31st.
Needless to say, your Sliding Fee Scales should have been updated at that time. If you need Policies or Procedures relative to the Sliding Fee Scale, you can visit www.FQHCPolicies.com .
(This story previously appeared in The Hill Extra)
A little-discussed side effect of the ObamaCare repeal effort could be losing gains that community health centers — a lifeline for the nation’s most vulnerable — have made.
Republicans’ vow to gut President Obama’s signature domestic achievement has thrust all facets of the health system into uncertainty — and community health centers are no different. Nearly 25 million people receive care through the nonprofit groups, and in interviews, nearly a dozen state community health associations expressed concerns over whether advances under the law would be reversed.
“Talking points are wonderful, but we live in a reality here that talking points don't help,” Alan Pruhs, executive director of the Association for Utah Community Health, told The Hill Extra. “So we're really going to be vigilant and watching what the replacement strategies look like and how that's going to affect the populations that we’re focused on serving.”
As the nation’s largest source of comprehensive primary care for medically underserved populations, the centers are closely eyeing three major items: changes to Medicaid, a Sept. 30 fiscal cliff and the possibility of absorbing patients from Planned Parenthood
Providers at the nearly 1,400 clinics can’t, under federal law, turn patients away — even those who are uninsured — and they often provide a wide array of services, from mental health and substance use disorder treatment to dental care.
The Affordable Care Act helped these centers grow in brick-and-mortar locations and in their ability to provide services, according to the Kaiser Family Foundation, because more patients with Medicaid and private health insurance increased revenues. The health law also infused more federal funds into the programs, dollars which were extended in 2015.
Expansion of coverage and increased funding under the law helped the centers’ revenues grow from $15.9 billion in 2013 to $21 billion in 2015, according to Kaiser.
“The problem that we’re having right now, the 50,000-foot view, is the instability in the funding environment,” Jose Camacho, executive director of the Texas Association of Community Health Centers, told The Hill Extra. “You’ve got a lot of money that goes to health centers that’s on the table, and unless we're able to resolve those issues, then I think we’re going to have some problems.”
Medicaid changes are coming.
The health centers are in better fiscal shape in part because an increasing number of health center patients are insured largely due to the expansion of the federal-state program for the poor and disabled.
But it’s unclear how Medicaid expansion will fare when Republicans repeal and replace ObamaCare.
“For us, the biggest concern that we have is Medicaid,” Deb Polun, government affairs and media relations director for the Community Health Center Association of Connecticut, told The Hill Extra. “This is a huge part of how federally qualified health centers are funded and represent a huge chunk of our patients.”
At the very least, a GOP health law likely means changes to how Medicaid is financed. Republicans have been pushing two main proposals — locking states into a preset level of funds (known as a block grant) or reimbursing a state per beneficiary (called a per capita cap).
The Congressional Budget Office has estimated that recent Republican block grant proposals are likely to cut spending, according to Kaiser. Critics of the proposals say that’s sure to lead to cuts in benefits.
The proposals are hard to analyze because no legislative decisions have been made, Jonathan Watson, of the Minnesota Association of Community Health Centers, said. So he interprets the concept as less money for states, in either scenario.
“When states have less money to operate their medical assistance programs, to me, that only means cutting benefits, cutting eligibility, cutting payments to providers or asking patients for additional cost-sharing,” Watson, associate director and director of public policy, told The Hill Extra.
It might not be easy for states to make up for funding losses. Take Nebraska, for example: The state is facing a nearly $900 million shortfall over the next two years.
“So there isn’t room in our state budget right now to cover some of those needs in a Medicaid program were the federal dollars to be reduced — so it’s really kind of a double impact for us,” Amy Behnke, CEO of Health Center Association of Nebraska, told The Hill Extra.
A fiscal cliff looms.
Community health centers benefited from the Affordable Care Act in several ways, including a new trust fund for the program.
More than 70 percent of federal grant funding for health centers comes from this pot of money.
Congress extended the fund in 2015, authorizing $7.2 billion for two years, and it will hit a fiscal cliff on Sept. 30. State associations are hyper-focused on what will happen to these funds.
“That would cripple our health centers,” Jane Hayward, president and CEO of Rhode Island Health Center Association, told The Hill Extra.
And it would have a “devastating” effect on Utah, Pruhs said, adding it could lead to close to half of the state’s health centers shuttering their doors and potentially upwards of 35,000 patients losing access to care.
“I think if there's support for anything, there's probably support for continuing health centers,” Sara Rosenbaum, a George Washington University professor of law and policy, told The Hill Extra. “But there's no guarantee that they're going to have their funding continued.”
Federally qualified health centers “play a vital role” in the country’s health, the likely new head of the Department of Health and Human Services said.
“I think it’s imperative that we retain them or improve the delivery of care in that area,” Rep. Tom Price (R-Ga.) said at a Senate Finance Committee hearing on his nomination to head HHS.
The Planned Parenthood factor.
There’s another potential wrinkle — House Speaker Paul Ryan (R-Wis.) has said cuts to federal dollars for Planned Parenthood should go to community health centers instead.
“We think it's better to send these dollars to those clinics that do a very good job of giving women the services they need, the preventive services, without all the controversy surrounding Planned Parenthood,” he said recently.
But, at least in the short term, it’s not realistic that they would be able to care for the millions of patients that Planned Parenthood serves.
“There are a lot of services that are provided by Planned Parenthood that are not really that controversial,” Polun, of Connecticut, said, “and health centers do provide many of those same services, but it would be extremely difficult to take on all of those patients in one fell swoop.”
Some community health centers are no stranger to this debate.
Utah’s Republican governor, Gary Herbert, attempted to defund Planned Parenthood, raising a similar issue among centers.
At the time, the Association for Utah Community Health discussed the matter, and Pruhs said absorbing some of Planned Parenthood's patients would have taken time, Pruhs said. He added that Planned Parenthood is a referral partner and part of the healthcare safety net.
Ultimately, a federal appeals court halted the Utah governor’s effort.
Pause button on hiring, expansion.
When strategic planning came up at a recent Minnesota community health center board meeting, there were too many unknowns to make decisions.
The uncertain future is “putting, let’s say, a pause button on any significant strategic planning, capital expansions or really further integration of some services of the community health centers,” Watson said. “It’s creating a lot of angst amongst patients — patients are coming into providers saying, ‘Are you guys going to be here in a year?’”
In New York, there are about 28 job openings at Finger Lakes Community Health, which Mary Zelazny runs.
“I’m desperately trying to find people to take those jobs, and it’s hard,” Zelazny, who is also the board chair of the Community Health Care Association of New York State, told The Hill Extra. “Do I go ahead and fill those positions? Because I don’t really know if I’m going to have the funding that I have right now.”
Others echoed that sentiment.
“I think you're going to hear repetition from anybody in our world that there's a lot of concern,” Andrew Behrman, Florida Association of Community Health Centers president and CEO, told The Hill Extra, “and I think a lot of the concern is the unknown.”
Congratulations to our client Community Council Health Systems in Philadelphia. Pennsylvania was selected as one of the eight states to participate in the Certified Community Behavior Health Center (CCBHC) progam with HHS. After we successfully applied for the program, Community Council became one of only a handful of clinics in PA, and now in the country to meet the CCBHC requirements and become one of the only Certified Community Behavior Health Center's in the US.
This is a two year pilot program before it rolls out nationwide.
Jim Nixon, the CEO and his whole team were great to work with on this project and it is very exciting to be selected. Great job!
HHS selects eight states for new demonstration program to improve access to high quality behavioral health services
The U.S. Department of Health and Human Services today announced the selection of eight states for participation in a two-year Certified Community Behavioral Health Clinic (CCBHC) demonstration program designed to improve behavioral health services in their communities. This demonstration is part of a comprehensive effort to integrate behavioral health with physical health care, increase consistent use of evidence-based practices, and improve access to high quality care for people with mental and substance use disorders.
“These states and their community clinics have done an incredible job in paving the way for the demonstration program,” said Deputy Assistant Secretary for Mental Health and Substance Use Kana Enomoto. “We look forward to demonstrating that by balancing incentives and accountability, an enhanced level of accessible, comprehensive, and quality care can be provided to all Americans.”
The eight states HHS selected for this demonstration program include Minnesota, Missouri, New York, New Jersey, Nevada, Oklahoma, Oregon, and Pennsylvania. States have until July 1, 2017 to begin their two-year demonstration programs.
“The demonstration program will improve access to behavioral health services for Medicaid and CHIP beneficiaries, and will help individuals with mental and substance use disorders obtain the health care they need to maintain their health and well-being,” said Vikki Wachino, Deputy Administrator of the Centers for Medicare & Medicaid Services, and Director of the Center for Medicaid and the Children’s Health Insurance Program Services.
In 2015, HHS awarded planning grants to 24 states to support certification of community behavioral health clinics, solicit input from stakeholders, establish prospective payment systems for demonstration reimbursable services, and prepare an application to participate in the demonstration program. At the end of the planning grant year, 19 States submitted applications to participate in the demonstration program. The applications were reviewed by subject matter experts from the Substance Abuse and Mental Health Services Administration, CMS, and Office of the Assistant Secretary of Planning and Evaluation for strengths and weaknesses. A key consideration in their selection was that participating states represented a diverse selection of geographic areas, including rural and underserved areas.
Under the program, selected states will be reimbursed through Medicaid for behavioral health treatment, services, and supports to Medicaid-eligible beneficiaries using an approved prospective payment system. To qualify for certification, CCBHCs provide core services across the lifespan, utilize evidence-based practices and health information technology, report on quality measures, and coordinate care with primary care providers and hospitals in the community. Populations to be served are adults with serious mental illness, children with serious emotional disturbance, and those with long term and serious substance use disorders, as well as others with mental illness and substance use disorders. The demonstration program reflects a broader Administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people.
The selected states’ demonstration programs will be evaluated based on data from 21 quality measures collected through sources such as program records, Medicaid claims, managed care encounter data, and clinic cost reports. Qualitative data also will be obtained from interviews with state officials and clinic staff. HHS will report on the access, quality and financial performance of the demonstration programs annually beginning December 2017, using data from the evaluation.
Authorized under Section 223 of the Protecting Access to Medicare Act of 2014, this demonstration program is a combined effort by several HHS agencies including SAMHSA, CMS, and the Office of the Assistant Secretary of Planning and Evaluation.
For more information on the Section 223 Demonstration Program for
CCBHCs visit: http://www.samhsa.gov/section-223
Department of Health and Human Services awards over $50 Million for new health center sitesToday, Health and Human Services (HHS) Secretary Sylvia M. Burwell announced over $50 million in funding for 75 health centers in 23 states, Puerto Rico and the Federated State of Micronesia.
“We expect this competitive New Access Point funding to provide health care to more than 240,000 additional patients, ” said Dr. Mary Wakefield, Acting Deputy Secretary at HHS. “These new health center sites will contribute significantly to the health of families and communities across the nation.”
Health centers are community-based and patient-directed organizations that deliver comprehensive, culturally competent, high-quality primary health care services. Health centers also often integrate access to pharmacy, mental health, substance abuse and oral health services in areas where economic, geographic or cultural barriers limit access to affordable health care services.
“For millions of Americans, including some of the most vulnerable individuals and families, health centers are the essential medical home where they find services that promote health and diagnose and treat disease and disability,” said Health Resources and Services Administration (HRSA) Acting Administrator Jim Macrae. “One in 13 people nationwide rely on a HRSA-funded health center for their preventive and primary health care needs.”
Nearly 1,400 health centers operating over 9,800 sites provide care to more than 24 million people across the nation, in every U.S. state, the District of Columbia, Puerto Rico, the U.S. Virgin Islands and the Pacific Basin. Today, health centers employ nearly 190,000 people.
For more information on these awards, visit https://bphc.hrsa.gov/programopportunities/fundingopportunities/newaccesspoints/fy2017awards/index.html
Congratulations to CEO Laurie Asbury and the entire team at the Northeast Florida Health Services in Pierson, FL for being awarded an New Access Point grant for FY 2017. Great job!
To view all award winners click here
Congratulations to our client the Great Salt Plains Health Center in Cherokee, Oklahoma for being awarded a New Access Point grant. FQHCmd is very happy for the CEO, Tim Starkey and the entire Great Salt Plains staff.
To view all award winners click here
The Bureau of Primary Health care has improved the CIS process that FQHC/LAL have to go through. Here are the main changes:
The BPHC has released new, streamlined instructions for applicants applying for Look-Alike Initial Designation.
The purpose of the look-alike initial designation application is to establish new look-alike service delivery sites under the Health Center Program to provide comprehensive primary health care services to underserved and vulnerable populations. Look-alikes were established to maximize access to care for medically underserved populations and communities by allowing entities that do not receive Health Center Program funding to apply to become part of the Health Center Program and, once designated, become eligible for Medicaid and Medicare Federally Qualified Health Center (FQHC) Prospective Payment System (PPS) reimbursement and other related programs.
Here is a link to the instructions on the HRSA website.
The Bureau of Primary Health Care (BPHC) has released a draft Health Center Program Compliance Manual (the Compliance Manual) for public comment.
The Bureau of Primary Health Care (BPHC) has released a draft Health Center Program Compliance Manual (the Compliance Manual) for public comment. The Health Center Compliance Manual serves as a web-based policy resource to assist in understanding and demonstrating compliance with Health Center Program requirements.
Here is a link to the guide on the HRSA website.
About the FQHCmd Consulting Group
FQHCmd Consulting Group is a nationwide consulting group for FQHC, FQHC Look Alikes, Rural and Community Health Centers.