By Robert Kidney, Assistant Director of State Affairs, NACHC
$16.1 billion in extended FMAP funding was signed into law by President Obama last week, providing much needed fiscal relief to states. Approximately 30 states had already assumed the originally proposed $24 billion in extended FMAP funds in their SFY2011 budgets, and would have faced even larger budget gaps, if Congress failed to act. While the 6-month extension may not completely make up every last penny, it’s a relief for these states to have the federal dollars to help fill those gaps although some additional budget cutting measures may be necessary. The additional federal aid also provides a cushion to those 20 states that didn’t assume that FMAP would come through which could help them fill gaps or stave off cuts.
According to a recent update on state budget cuts by the Center on Budget and Policy Priorities (CBPP), 31 states have made cuts to health programs and services as a result of continuing state fiscal crises. These cuts could negatively impact access to health services for health center patients and health centers’ bottom lines. The FMAP extension should help states avoid further cuts, and possibly even restore cuts made.
Health centers are not immune from direct state funding cuts either. Preliminary findings of a recent NACHC survey of primary care associations indicate that 22 states have decreased funding to health centers for SFY2011 and in at least three states (MA, MI, PA), critical health center funding was contingent on the availability of the enhanced FMAP extension. Since the vast majority of state legislatures have adjourned for the year, restoring already-enacted budget cuts may require a special session of the legislature or separate legislation once lawmakers reconvene next year. This could leave health centers in many states in the lurch, unsure of the fate of critical state funding. Another challenge for advocates will be the fact that November’s election may result in the turnover of a large number of governors and state legislators who may be averse to re-opening the state’s budget to increase spending during tough economic times.
While there are still many unknowns, one thing is certain—the much-needed extension of enhanced FMAP will likely prevent even deeper cuts to Medicaid and other critical health programs and services than might otherwise have been made.
by Alexandra Sange, MPP
Yesterday, the House passed the $16.1 billion, 6-month FMAP extension the Senate sent over last week, and the President has now signed this critically important extension into law. This additional federal support for states will extend an enhanced Federal Medical Assistant Percentage (FMAP) Medicaid match rate to states through June of 2011. This will help states stabilize their budgets and prevent cuts to programs in economically challenging times and it will help ensure that many of the patients health centers serve will continue to have health coverage.
NACHC has been following this extension closely as proposals have moved through Congress in the last several months and we deeply appreciate Congress’ commitment to bringing this important aid to states and families nationwide. Read our statement in support of this extension becoming law here.
by Alexandra Sange, MPP
This week, with the House in recess and the Senate wrapping things up, we finally saw some big action on the FMAP extension we have all been watching closely for months. On Thursday the Senate voted to pass an amendment to HR 1586, a completely offset $26.1 billion bill which includes a $16.1 billion extension of an enhanced FMAP rate for states and $10 billion to avert teacher layoffs.
The $16.1 billion FMAP extension is not the full $24 billion originally proposed, although it is the last proposal the Senate considered back in June. This version of the enhanced FMAP extension would be phased out over six months, to end June 30, 2011, providing an enhanced rate of 3.2% for the first three months and 1.2% for the second three months. After weeks of policy negotiation and political wrangling, the bill passed in the Senate 61-38 with all Democrats and Senators Olympia Snowe and Susan Collins of Maine in support.
In response to the Senate action, Speaker Nancy Pelosi and Majority Leader Steny Hoyer unexpectedly announced yesterday that the House would reconvene next week, pulling members off their recess to pass the package sent over by the Senate. Although the House is rarely called back into session during a recess, Speaker Pelosi has indicated that the aid to states is too important not to pass immediately. The Majority Leader has said the House will convene at 10am on Tuesday to vote on the bill and send it to the President to sign.
Clearly, the importance of this extension and the critical aid it brings to states has reached the ears of our elected representatives and they are responding. Here at NACHC we will be watching the House eagerly next week and we’ll update the blog with information as it breaks.
by Kaitlin McColgan
Last week, the “FTCA for Volunteers” legislation (officially known as H.R. 1745- the Family Health Care Accessibility Act) took another important step forward in the legislative process. The House Energy and Commerce Committee voted unanimously to pass out the bill, setting it up for consideration by the full House of Representatives when the House returns to session this fall.
Before passing the bill, the Committee adopted an amendment offered by Rep. Gene Green (D-TX) the Democratic sponsor of the bill. NACHC had worked with Congressman Green and members of the committee staff to construct the amendment to broaden the scope of covered services in the bill beyond what was contained in the version of the bill passed by the Health subcommittee. The amendment was unanimously accepted.
In the fall, we expect the legislation to move to the floor of the House, and you can expect to hear from NACHC prior to that vote as we work to build support for passage. NACHC staff will also be working to garner support for the bill in the Senate, so stay tuned for more details.
Krystal E. Knight, MPH
More good news for the Health Centers program from the Senate!
On Tuesday the Senate Labor-HHS-Education Subcommittee on Appropriations marked-up the draft of its annual spending bill (comparable to the spending bill marked up in the House of Representatives two weeks ago). Yesterday at 2:30 PM, that Subcommittee bill was brought before the full Senate Committee on Appropriations. The Senate Labor-HHS Subcommittee proposed, and the full Committee approved, discretionary funding for the Health Centers program at last year’s comparable level. In combination with the $1 billion in dedicated funding from the Health Center Fund in the health reform law, the total Health Centers program funding for FY2011 would be $3.185 billion in FY 2011, a $1 billion increase!
Now that both the House and Senate are in agreement on maintaining our discretionary funding at the FY2010 funding level, we will have to work to keep this level throughout the rest of the appropriations process this year. As I mentioned in my last post, the $2.19 billion discretionary funding level, coupled with the $11 billion Community Health Center Fund passed as part of the Affordable Care Act (ACA), will serve to dramatically increase the capacity of the Health Centers program. Over the next five years, the Health Center Fund, along with insurance expansions and other provisions part of the ACA, will double the size of the Health Centers program from 20 million patients to 40 million patients, resulting in the largest expansion of the program to date. Health centers will be the primary care access point for millions of newly insured Americans and will continue to provide high quality, cost-effective health care to the medically underserved.
NACHC will continue to stay abreast of the appropriations process moving forward and work hard to maintain the funding we have secured up to this point. Again, thanks to all of the NACHC grassroots advocates who played a role in this effort.
by Kaitlin McColgan
Regular readers of Health Centers on the Hill (and other avid health reform-watchers) will recall that last year’s House-passed version of the health reform legislation contained a provision extending Federal Tort Claims Act (FTCA) coverage to volunteer practitioners in health centers. This expansion, long a priority for health centers, had also been included in the 2008 House-passed version of the Health Centers program reauthorization. Unfortunately, due to the unique health reform process through which only the Senate bill and a later reconciliation bill became law and there was no formal conference agreement, the FTCA for volunteers provision did not make it into law since it had not been in the Senate version of the reform legislation.
Providing health center volunteers with FTCA coverage, a policy change which has been championed on a bipartisan basis by Reps. Gene Green (D-TX) and Tim Murphy (R-PA), would allow health centers to take on volunteer practitioners without having to purchase costly malpractice gap insurance. These volunteer practitioners could significantly improve access to primary and some specialty care for health center patients. The Government Accountability Office (GAO) examined this issue in a report required by the 2008 Health Centers program reauthorization. GAO found that expanding FTCA coverage to health center volunteers would have a relatively low cost. Citing Congressional Budget Office (CBO) estimates, GAO reported that the cost of this policy change would be $6 million over a 5 year period, or about $1.5 million per year.
On Thursday, the House Energy and Commerce Committee Health Subcommittee unanimously passed H.R. 1745, the Family Health Care Accessibility Act, the FTCA for volunteers stand-alone bill sponsored by Reps. Murphy and Green. The Subcommittee first passed an “Amendment in the Nature of a Substitute” which made some changes to original bill, essentially altering the way through which the FTCA coverage for volunteers would work. NACHC worked with the subcommittee to make improvements to the amendment and we will continue to work with the Full Committee as it prepares to mark-up the bill to ensure the strongest possible bill. Stay tuned for more info on this important bill as we continue to work to see it through the House once again and turn our attention to building support in the Senate.
Krystal E. Knight, MPH
Great news from the House of Representatives!
Yesterday the House Labor-HHS Subcommittee on Appropriations released the mark-up of its annual spending bill. The proposal sets the FY 2011 spending levels for all discretionary health programs located within the Department of Health and Human Services (HHS), including the Health Centers program.
As you know, NACHC has been advocating that Congress fund the Health Centers program at least at last year’s level, which was $2.19 billion. This funding level, coupled together with the $11 billion Community Health Center Fund passed as part of the Affordable Care Act, will allow the full intent of the health reform bill to be realized. Recognizing this, the House Subcommittee has now officially proposed that the Health Centers program be funded at $2.19 billion in FY2011! Health Centers will now be on a path to serve an additional 20 million patients over the next five years, doubling the size of the program to 40 million patients.
While NACHC is pleased with the recent Subcommittee activity, our work on the appropriations front is not over yet! The Senate Labor-HHS Subcommittee on Appropriations will mark up its bill on July 22nd, and then the full Senate Appropriations Committee mark up will be held on July 27th. In the meantime, NACHC will continue to focus our attentions to key Senate Appropriations Committee members, especially those who are members of the Labor-HHS subcommittee.
It is great news that the House Subcommittee has now supported adequate funding of the Health Centers program, but our advocacy in the Senate will be critical during this extremely tight appropriations season. Therefore NACHC will continue to push for funding in the Senate that will enable the vision of the health reform bill to become a reality in FY2011.
NACHC would like to say thanks to those of you who contacted your Members of Congress in support of FY2011 funding, and we will continue to keep you all up-to-date on the appropriations process as we move into next week’s Senate mark ups!
by Alex Sange, MPP
This week, the House introduced and passed HR 5712, the Veterans’, Seniors’, and Children’s Health Technical Corrections Act. This bill, sponsored by Congressmen Levin, Waxman, Dingell, Pallone and Stark, included a technical correction of the Medicaid HIT incentive payments in the American Reinvestment and Recovery Act which will be helpful to health centers. HR 5712 now joins the number of other bills (their war supplemental spending bill, an unemployment benefit extension and five-year extension of the National Flood Insurance Program, to name a few) that the House has passed and sent to the Senate for consideration and final passage.
This House-passed provision would ensure that federal health center grants for health information technology (HIT) do not reduce Medicaid HIT Incentive Payments made to health center providers. As written in ARRA and passed into law, providers’ incentive payments will be reduced by any amount of other funds the provider is receiving from other sources for HIT… except state and local government sources. As we mentioned in our comments to CMS on their proposed rule, this could mean that federal grants awarded to a health center for HIT will result in lower Medicaid HIT Incentive Payments to providers at that health center. The bill (HR 5712) includes a provision that adds federal grants to the list of exclusions, ensuring that incentive payments will not be reduced if a health center is receiving Federal grant funding for Electronic Health Records or other HIT.
This technical fix is useful for health centers and we appreciate the ongoing efforts of the Chairmen and Committees of jurisdiction. Coincidentally, CMS issued their final rule on Electronic Health Records (EHR) Incentives (including the Medicaid HIT Incentive Payments) this week as well, which outlines all of the requirements that eligible professionals will have to meet to receive incentive payments for the adoption, implementation and upgrading of EHR. Read our alert on the final rule and stay tuned to our website and this blog for more information on the regulatory and legislative fronts on these critically important Medicaid HIT Incentive Payments.
The annual appropriations process picked up some steam in the House of Representatives last week. On Thursday night, the House passed its FY 2010 war supplemental spending bill, which also included new funds for teachers and federal student loans. The supplemental also included a budget enforcement resolution that set spending limits for FY 2011 discretionary appropriations.
The budget enforcement resolution differs from a traditional five-year budget resolution in that it only sets spending limits for one year, and it does not include future spending and revenue projections usually present in a traditional budget. The budget enforcement resolution passed as part of the supplemental bill caps FY 2011 discretionary spending at $1.121 trillion, which is $7 billion below the President’s FY 2011 budget request and $3 billion less than the Senate Budget Committee Resolution passed in April. Continue reading →
Alexandra Sange, MPP
After eight weeks of negotiation, the Senate was unable to collect the necessary 60 votes to clear the pared down Extenders Bill for a vote. After the Extenders third strikeout, Senate Majority Leader Reid (NV) pulled the bill from the floor. He indicated the Senate will move on to a small business credit and lending act before the Fourth of July Recess. The Extenders Bill is one we’ve all been following closely for its extension of the enhanced FMAP Medicaid rate in ARRA (which expires December 31, 2010), its Medicare preventive services clarification for health centers, and also for its extension of unemployment benefits, the National Flood Insurance Program, Build America Bonds and New Markets Tax Credits, among many other provisions.
The Future of Those Extensions (Especially FMAP) Continue reading →
