Are You Ready? NACHC Offering Trainings on Medicare FQHC PPS

As you all know, CMS published a final rule on the Medicare Prospective Payment System for Federally Qualified Health Centers (FQHCs) as mandated by the Affordable Care Act. The final rule is estimated to increase the ability and capacity of FQHCs to provide essential and affordable services by increasing Medicare payments.

The new payment system will be implemented beginning on October 1, 2014. FQHCs will be transitioned to the new payment system throughout 2015.

Are you ready for these changes? It is essential that you implement these changes correctly the first time as the stakes are extremely high!

Have you considered these factors for the implementation process?

  1. If you implement the new Medicare PPS rule correctly, your health center stands to increase its revenue substantially.
  2. If you implement incorrectly, you risk not only leaving money on the table, but also scrutiny from CMS for setting your rates too high (or too low).
  3. This rule has significant impact on your grant – particularly as to how your sliding fee scale is applied to patients. All Health Centers must understand and prepare for these changes.

It is important to implement the new Medicare PPS rule correctly the FIRST time!

To assist you with this process, NACHC has developed a one-day hands-on training that will assist you with this process with the first training scheduled for September 3 and 4 in Chicago, IL.

It is not too late to register for the September 3 or 4 session in Chicago, IL and implement correctly on October 1!


HRSA Issues Revised and Updated FTCA Manual

On July 21, 2014, HRSA issued a new Federal Tort Claims Act: Health Center Policy Manual – which updates and supersedes the prior manual (PIN 2011-01), as well as a Program Assistance Letter (PAL) explaining the updates and modifications (PAL 2014-09). The new updated manual reflects an expansion in Federal Tort Claims Act (FTCA) coverage for certain services provided to non-health center patients, which was published as a final rule in the Federal Register on September 23, 2013.

Specifically, Sub-section I.C.4 of the manual expands FTCA coverage to include services provided to non-health center patients experiencing certain individual emergencies, provided that the health center provider is furnishing (or is about to furnish) FTCA covered services within the center’s scope of project and is asked to temporarily assist in an individual emergency situation at or near the provider’s location. This could include, for example, situations under which a health center provider is rounding a hospitalized health center patient and asked to assist with an emergency occurring with another inpatient who is not a health center patient. To be eligible for coverage, HRSA requires the health center to have documentation verifying that the provision of such individual emergency treatment is a condition of the provider’s employment at the health center. According to the manual, documentation could include “employee manual provisions, health center bylaws, or an employee contract.”

Sub-section I.C.4 also clarifies that: (1) FTCA coverage is available when, on behalf of the health center, a health center provider conducts or participates in health fairs and immunization campaigns (previously, coverage was available when the health center conducted those activities directly but it was unclear whether FTCA extended to participation in a health fair or immunization campaign conducted by another organization); and (2) the covered immunization campaigns include immunizations provided to both children / adolescents and adults. Both of these clarifications were published in the September 2013 final rule and update prior policy published in the Federal Register in 1995.

Finally, the new manual updates certain links and contact information. Specific updates include the following:

Sub-section I.G. The Deeming Application Process: provides an updated link to information on deeming applications.
Sub-section II.J. Overview of Claims Filings & Section III Appendix: provides updated contact information for the General Law Division within the Office of the General Counsel of the Department of Health and Human Services.
Endnotes 6 and 9: provide updated links to the Bureau of Primary Health Care Policy Website

Court of Appeals Rulings Don’t “Blow Up” the ACA

By Dashawn Groves

On June 22, 2014, two U.S. courts of appeals issued conflicting rulings on whether the health insurance subsidies are available to ONLY people in states that have created their own exchanges or to all residents regardless if the exchange was created by the state or federal government. The cases center on a brief description in the Affordable Care Act (ACA) that says subsidies will be available “through an exchange established by the State.”  The Internal Revenue Service (IRS) interpreted the law to allow individuals to receive subsidies to help purchase insurance, regardless of whether they are in an exchange run by their state or by the federal government. Opponents are questioning the interpretation of the law, saying that subsidies are only available to individuals residing in the 14 states with state-based exchanges.
What does it mean for health centers and their patients?
Neither case will have an immediate impact on the ACA as it could take years for the courts to decide. Individuals across the country will continue to receive the ACA’s tax credits and subsidies, ensuring they can afford the health care they need. Health center O&E staff should continue to do business as usual, reaching out to individuals and enrolling them in Medicaid, CHIP and the Marketplace. Current subsidies would likely remain in place until there is a final legal decision on the matter.
What did the Courts decide?
The U.S. Court of Appeals for the District of Columbia was the first ruling (Halbig v. Burwell) out last week. In a 2-1 decision, the three-judge panel ruled that the health insurance subsidies were only available to the individuals in the 14 states and the District of Columbia operating their own health insurance exchanges. The majority opinion concluded “that the ACA unambiguously restricts” the subsidies to “exchanges ‘established by the state.’ “ The dissenting opinion argues, “it was well understood that without the subsidies, the individual mandate was not viable as a mechanism for creating a stable insurance market.”

Shortly following the Halbig v. Burwell ruling, a three-judge panel on the Fourth Circuit Court of Appeals in Richmond, VA unanimously ruled in King v. Burwell that the subsidies were available to residents in all states.  Similar to the dissenting opinion in Halbig v. Burwell, the Fourth Circuit concluded that “established by the State” is ambiguous, when read in combination with another section of the ACA, and could include federal exchanges.  The “broad policy goals of the Act,” described above, primarily persuaded the court that the IRS’s interpretation of the statute was permissible.
What happens next?
The two decisions are not the final word.  All 11 judges on the D.C. Circuit Court could be asked to decide the Halbig v. Burwell case, a process called “en banc” review.  The Obama administration has said it will ask the court for such a review.  A majority of the judges would have to agree to rehear the case for it to be reconsidered in this way.  The challengers in King v. Burwell could ask the Fourth Circuit to reconsider as well.  Two trial court cases raise similar issues, one in Oklahoma and one in Indiana.  Those cases could also go to appellate courts. Oklahoma is in the 10th Circuit; Indiana is in the 7th.  Depending on the outcomes of the various rulings, all the courts could end up agreeing, or there could remain a disagreement between different circuits.  Either side could appeal the rulings to the Supreme Court for consideration. It is unclear when a final decision will be made.

HRSA Funding Opportunities Announced

Last week, the Health Resources and Services Administration (HRSA) announced two important funding opportunities, the new FY2015 Service Area Competition (SAC) and Supplemental Ryan White Funding. See below for more information on both announcements.


FY 2015 Service Area Competition Has Been Released

On June 19, 2014, HRSA issued the FY 2015 Service Area Competition (SAC) application.  In total, there will be eight rounds throughout FY 2015 for project periods beginning November 1, 2014 through June 1, 2015.  HRSA anticipates awarding approximately $591,000,000.00 in funding to 242 applicants.  Similar to prior years, each round will have a distinct Funding Opportunity Announcement (FOA) with its own application package.  Although the applications generally are the same with the exception of the submission deadlines and the service areas available for competition, it is vital that each applicant use the application package that matches its FOA – failure to do so will result in an ineligible application that will not be reviewed and could result in awarding the funds to another applicant or a re-competition of the service area.

Presently, the first four (4) rounds have been announced for project periods beginning:

  •  November 1, 2014 – submission of July 23; EHB submission of August 6
  • December 1, 2014 – submission of July 30; EHB submission of August 13
  • January 1, 2015 – submission of August 13; EHB submission of August 27
  • February 1, 2015 – submission of August 27; EHB submission of September 10

HRSA anticipates announcing the next two rounds (with 2015 start dates of March 1 and April 1) on September 10, 2014 and the final two rounds (with 2015 start dates of May 1 and June 1) on October 8, 2014.

Eligible applicants must be organizations that propose to serve an existing service area and its population as specified in the Service Area Announcement Table.  The Table identifies which service areas are available for competition in FY 2015 and pertinent information for each area (such as project period start date, city and state, available funding, respective target population, patient origin and service area zip codes, percentage of patients from each zip code, total patient projection).  Similar to prior years, the applicant must propose a project that: (1) serves all existing target populations (including any special populations); (2) reflects zip codes from where at least 75% of the current patients reside; and (3) requests annual funding that does not exceed the amount specified in the Table.

In a change from prior years, the applicant can propose to serve less than 100% of the patient projection specified in the Table, provided that the proposal will serve at least 75% of the projection by December 31, 2016 and the funding requested is reduced consistent with the SAC instructions.  HRSA indicated that it will hold all grantees accountable for their stated patient projections – if a grantee is unable to demonstrate compliance within 5% of its projection by December 31, 2016, HRSA may proportionately reduce the funding for the service area.  Other changes from prior years include:

  • Availability of 5 priority points for current grantees renewing their existing projects if the grantee has no unresolved grant conditions in the 60-day, 30-day or default phases of the Progressive Action process at the time of submission.
  • Availability of an additional 5 priority points for current grantees renewing their existing projects if they meet the aforementioned and can demonstrate a positive or neutral 3-year patient growth trend (must meet both of these requirements to receive the additional 5 points).
  • Modifications to the standard forms based on HRSA policies issued this past year regarding governance, budgeting and scope of project.

The new SAC also revises the criteria for awarding a one-year project period (as opposed to the standard 3-year period).  Applicants who meet one or more of the following will be awarded a one-year project period:

  •  Current grantee or new applicant has 10 or more grant conditions based on non-compliance with Program Requirements including existing unresolved conditions as well as those that would be placed on the grant based on the SAC application.
  • Current grantee has 3 or more unresolved grant conditions based on non-compliance with Program Requirements that are in the 60-day phase of the Progressive Action process.
  • Current grantee has 1 or more unresolved grant condition(s) based on non-compliance with Program Requirements that are in the 30-day phase of the Progressive Action process.

It is crucial that applicants submit proposals that do not exceed the available funding and that meet all of the other eligibility criteria.  An application that fails to comply with all eligibility requirements will be considered ineligible for funding, which could result in awarding the funds to another applicant or a re-competition of the service area. The FY 2015 SAC Technical Assistance page can be accessed at .  From that page, applicants can access, among other things: (1) the specific FOAs; (2) the Service Area Announcement Table; (3) the chart listing all submission dates; (4) Frequently Asked Questions; (5) eligibility criteria; and (6) links to technical assistance resources, program specific forms that are part of the application, and applicable performance measures.


HRSA Announces Availability of Supplemental Ryan White Part D Funding

On June 25, 2104, HRSA published a notice in the Federal Register announcing the availability of a one-time only non-competitive program expansion supplement under the Ryan White HIV/AIDs Part D program.  These supplemental awards will be provided to Part D grantees for the purpose of supporting interventions that will positively impact the HIV health outcomes of women, infants, children, and youth in the grantees’ communities.  All 115 existing grantees are eligible for the funds, which will be awarded in amount not to exceed the lesser of $150,000.00 or 25% of each FY 2014 grant award with a maximum cumulative amount not to exceed $12,177,374.00. The project period for these supplemental funds will be 11 months, starting August 1, 2014 through June 30, 2105.

Recording of NACHC Medicare PPS Webinar

Recording of NACHC Medicare PPS Webinar

Last week, NACHC held a webinar “Dawn of a New Day: the Medicare FQHC PPS” which provided an overview of the new Medicare FQHC PPS final rule.   We had overwhelming participation in the webinar, but wanted to make sure you had an opportunity to listen to the recording in case you missed it last week.  Below are the instructions on how to access the recording.   Please do not hesitate to let us know if you have any questions on this or the Medicare PPS.

You can now access the webinar recording and all supporting materials on the MyNACHC Learning Center, by clicking here.   If you have technical difficulties logging in to MyNACHC or accessing the materials please contact Neha Desai at

To access MyNACHC and the recorded webinar, follow these easy steps:

  1. Click on the link above which direct you to the My NACHC Learning Center login screen.
  2. Your username and password is the same one you used to register for this webinar and all NACHC events
  3. If this is your first time visiting MyNACHC, you will be prompted to choose a role.  The role you select will determine the type of continuing education credits you receive when credits are available.
    • Currently, NACHC only offers continuing education credits (CPE, CME, CEU & Gov ) for some of our live and recorded conference sessions, not webinars or webinar recordings.
    • After choosing your role, click on “update”
  1. If this is not your first time logging in to MyNACHC or after selecting your role, you will be directed to the recorded webinar.  Click “Launch” to view the recording or view handouts.