Please join us on May 29, 2013 at 2 PM ET for a free one hour webinar to discuss important 340B Drug Discount policy issues. Specifically, we will provide an overview and discussion on 340B contract pharmacy rules and policies and related issues, including health center use and charges for 340B drugs for Medicaid Managed Care enrollees. This webinar will be lead by Roger Schwartz at NACHC and Mike Glomb, NACHC Legal Counsel. All those interested should join us for this free webinar, including health centers and PCA staff that are involved with the 340B Drug Discount Program or are interested in learning more about the policies on this program.

To register for the webinar, please click here.

The National Health Law Program (NHeLP) has put out a couple of helpful resourceson Exchanges that we wanted to make you aware of. First, a checklist Ensuring Accessibility for Individuals with Disabilities in the ACA’s Marketplaces, which provides recommendations advocates can use to encourage their states to address the needs of consumers with disabilities. Next, a checklist Language Access Checklist For Marketplace Implementation, which address the needs of limited English proficient individuals in marketplaces.  We hope that you find these helpful and as always, please let us know if you have any questions on the Exchanges or any other policy issue that comes up.

We wanted to let you know that earlier this month CMS and HRSA released a joint information bulletin on Medicaid and Ryan White HIV/AIDS Programs.  This bulletin is a good resource for those who work with both the Medicaid and Ryan White programs,  as it discusses new changes from the Affordable Care Act and coordination between the two programs.   For more information on either Medicaid or Ryan White, please visit the CMS and HRSA websites or contact us.

By: Rob Kidney

As Health Insurance Exchanges begin open enrollment in October, a key feature and a critical element to getting eligible consumers enrolled in coverage are their consumer assistance functions. By law, these include a Navigator Program, a Certified Application Counselor Program and an optional in-person assister program. NACHC’s latest State Policy Report, Navigating the Health Insurance Marketplace: Community Health Centers and Consumer Assistance Programs, describes their roles and functions, outlining the relevant federal regulations and discusses how community health centers can participate.

 
On April 5, 2013, CMS issued a funding opportunity announcement for the Navigator Program in Federally-Facilitated and State Partnership Exchanges. It is clear in the guidance that health centers are eligible to apply for Navigator grants in these types of Exchanges, however, State-Based Exchanges will be free to determine eligibility on their own and it is critical that health centers make the case in their state as to why they should be considered eligible entities.

 
The report also includes a discussion of recently proposed conflict of interest, training, certification and recertification standards that apply to Navigators and in-person assisters in Federally-Facilitated and State Partnership Exchanges and federally funded in-person assisters in State-Based Exchanges. In developing their own standards, State-Based Exchanges may wish to use these as a model, but are not required to do so. Therefore, as States move forward with regulating consumer assistance programs, health centers should seek to provide input, as appropriate.
It is important to note that CMS is seeking public comments on the proposed conflict of interest, training, certification and recertification standards. NACHC is currently reviewing them to determine whether or not to provide comments. Please contact Roger Schwartz or Susan Sumrell with any questions.

 
As work on Exchanges and consumer assistance programs moved ahead in your state, it might be helpful for health centers to consider the following:

 
• If your state is operating a State-Based Exchange, will community health centers be eligible to apply for Navigator grants? If not, why not?
• Will your State-Based or Partnership Exchange establish an In-Person assister program? Will health centers be eligible for this role?
• As your State-Based Exchange develops training, certification and conflict of interest standards, do they unnecessarily restrict your ability to participate in consumer assistance programs? For example, do they automatically assume that a conflict of interest exists for health care providers?
• Is your State considering requiring Navigators to hold a license? If so, are the requirements overly-burdensome? Do they unnecessarily prevent certain entities from participating?
• Are policymakers aware of the consumer assistance functions your health center already performs?
• What opportunities exist for stakeholder input? Is there an opportunity for a representative from your health center or state primary care association to participate in your state’s Navigator or consumer advisory committee?
• Is your health center or staff certified by your State’s Medicaid agency as an application counselor?
• What other organizations or individuals in your community might apply to become Navigators or in-person assisters? Are there identifiable gaps in the number of eligible entities? Are there opportunities for partnering?

For more information on Health Insurance Exchanges, click here.

On April 9, the Centers for Consumer Information and Insurance Oversight (CCIIO) announced a funding opportunity for the Navigators in the Federally Facilitated Exchange and State Partnership Marketplace. Navigators are individuals or entities who will provide consumers with unbiased information about health insurance, the new Health Insurance Marketplace, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program.

Those individuals and entities interested in applying for the grants should submit a Letter of Intent to CCIIO by May 1, 2013 and applications are due June 7, 2013. Grants awards are expected to be announced in August.

To view the announcement, visit grants.gov and search CFDA number 93.750.  CCIIO will hold two technical assistance calls for interested parties on April 11, 2013 and April 19, 2013.  Call in information for these calls is as follows:

First call: Thursday, April 11, 2013 from 3:30 to 5:00 p.m. EDT

Toll-free teleconference phone number: 877-267-1577; ID: 5119

 Second call: Friday, April 19, 2013 from 3:30 to 5:00 p.m. EDT

Toll-free teleconference phone number: 877-267-1577; ID: 2917

In addition to this funding announcement, CCIIO also released a proposed rule on a number of outstanding issues in the Navigator Program. We are currently reviewing this proposed rule and will be sharing any comments we will be submitting with health centers and PCAs.

Please don’t hesitate to let us know if you have any questions on this new funding opportunity, the proposed rule, or any other issues surrounding navigators.