Our Analysis: What 2017 Could Hold for Health Centers

With the 114th Congress scheduled to wrap up by the end of this week (with a few key victories for health centers along the way), we here on the NACHC Policy and Advocacy team are nearly 100% focused on preparing for 2017, which will be a pivotal year for health centers unlike any we’ve seen in some time. Every health center advocate heard directly this morning from NACHC President and CEO Tom Van Coverden about the 4 steps advocates can take NOW to engage and be ready for many of the state and federal legislative debates to come.

In addition to those steps, many of you have asked us for a more detailed analysis of the elections, the new faces in key areas of influence, and of what’s “on the table” and what’s off in Congress next year. That memo is linked below:

NACHC 2016 Election and 2017 Legislative Outlook Memo

One thing that you’ll see noted in the memo is that our staff will be hosting monthly Policy and Advocacy Webinar Briefings between now and the 2017 Policy and Issues Forum in late March. The goal of these briefings is to keep all health center advocates up to date on the latest developments, our “asks” and arguments, and resources to help make the case in the year ahead. The first webinar briefing will take place next Wednesday, December 14th, at 3:30 PM Eastern Time. Click here to register.

The environment is changing rapidly here in DC, and our goal is to keep you up to speed. As always, don’t hesitate reach out to our staff at federalaffairs@nachc.org with any questions, ideas, or report-backs from recent conversations with Members of Congress.

 

Key Wins for Health Centers in Year-End Health Package

On Wednesday, November 30, the House plans to vote on a newly released, more robust version of the 21st Century Cures Act, a comprehensive bill that packages together a wide variety of health policy provisions related to medical research, drug development, mental health, opioid addiction, foster care and Medicare, among others. A comprehensive summary is available to help walk through each section of the legislation.

There are at least three major changes include in the bill that will be of great benefit to community health centers.

  • FTCA for Volunteers: Included in the mental health title of the bill is a provision which health center advocates and NACHC have fought for over nearly a decade – known as the Family Health Care Accessibility Act. That provision extends Federal Tort Claims Act (FTCA) coverage to licensed medical practitioners who wish to volunteer at health centers. Health center employees have long been covered by FTCA for medical malpractice purposes, yet health center volunteers have never been eligible for this coverage. While increasing the number of volunteer practitioners at health centers certainly doesn’t resolve all of the workforce challenges health centers face, it is an important step forward.
  • Medicare ACO Legislation: Section 17007 of the bill is a provision that would make it easier for health centers to participate in Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program (MSSP), by allowing FQHCs and rural health clinics to directly assign their patients to ACOs. Currently, in order for a Medicare beneficiary to be assigned to an ACO he or she must receive at least one primary care service from a physician participating in an ACO. As a result, while individual physicians at an FQHC may assign patients to an ACO, these assignments cannot be made when a patient’s primary caregiver is not a physician, and the FQHC cannot make these assignments at the organizational level. The original Senate version of this legislative language was introduced in 2015 as the Rural ACO Provider Equity Act (S.2261) by Senators Thune (R-SD), Cantwell (D-WA), and Murray (D-WA) and passed the Senate unanimously last December. More recently, an identical House version, H.R. 5667, was introduced by Reps. Lynn Jenkins (R-KS) and Linda Sanchez (D-CA).
  • Opioid Funding: the bill provides $1 billion over 2 years for grants to states to supplement opioid abuse prevention and treatment activities, such as improving prescription drug monitoring programs, implementing prevention activities, training for health care providers, and expanding access to opioid treatment programs. Several of these grant programs were newly authorized earlier this year in the Comprehensive Addiction and Recovery Act (CARA), including programs which will help expand health center access to the opioid overdose reversal drug, naloxone.

While the bill is expected to pass by a wide margin on the House floor it is likely to encounter some resistance in the Senate, where several Senators have expressed serious concerns over the bill’s funding mechanisms and/or content, including Senators Elizabeth Warren (D-MA) and Charles Grassley (R-IA), both of whom have publically stated that they cannot support the bill in its current form.  Those issues are still being resolved and a vote on the legislation is expected this week.

 

If you have any questions about the bill, please contact federalaffairs@nachc.org.

Congress Passes Short-Term Funding Extension and Avoids Government Shutdown

Last week, Congress was able to pass a continuing resolution (CR) to extend federal funding until December 9th. After weeks of negotiating and one failed attempt to bring the measure up for a vote in the Senate, the legislation was finally signed into law by President Obama after Republicans broke the logjam by agreeing to address the Democrats request to provide funding assistance to Flint, MI when Congress comes back for the lame duck session after the election.

The CR provides continued funding for federal operations until December 9th at existing levels, but there is a 0.5% across the board cut to all programs to comply with the Fiscal Year 2017 budget caps as funding levels need to adhere to the spending caps from the agreement signed in 2015. For health centers, when applied to the $1.5 billion in discretionary funding for the program, that equates to a $7.5 million funding reduction.

In addition to extending federal funding, the CR also includes several other funding provisions including $37 million in funding for the implementation of grant programs in the recently passed opioid addition legislation known as CARA or the Comprehensive Addiction and Recovery Act, $500 million in emergency supplemental funding for disaster response efforts to flooding in Louisiana and other states, and $1.1 billion in supplemental funding for activities related to the Zika virus.

The Zika funding debate was resolved 233 days after President Obama first requested funding to address the Zika virus. Of the $1.1 billion in funding provided by Congress, $40 million will be directed to health centers in Puerto Rico and the territories, $6 million for National Health Service Corps (NHSC) in Puerto Rico and the territories and $20 million for Maternal and Child Health special projects of regional and national significance (SPRANS) in Puerto Rico and the territories.  The remaining funding is allocated to Zika-related efforts at the Centers for Disease Control and Prevention (CDC), vaccine development and research at the National Institutes of Health (NIH), vaccine development and diagnostics at the Biomedical Advanced Research and Development Authority (BARDA) and for Zika-related activities globally at the State Department and USAID. Overall, a positive end result for health centers and other health care providers on the front lines of caring for individuals infected by the Zika virus and for those at risk of infection. That being said, given what we continue to learn about the virus and its potential effect on unborn children of Zika-infected mothers, it is likely that we will continue to follow this issue closely over the coming weeks, months and years.

Congress will return after the election and they will quickly need to work to either pass another CR or a longer term funding bill by December 9th. At that time, the landscape will be changed due to the elections and it is unclear how they will choose to proceed. For health centers, a long term funding bill such as an omnibus as opposed to short term CRs is the best outcome in terms of stability in a year when we will be facing another funding cliff. Once the election is settled and Congress returns, we will be working on the Hill to ensure health center funding in FY2017 remains a priority.

Congress Comes Home Part III- To Utah, North Carolina, and Texas

Over the past six months, we’ve heard from you about thirteen Members of Congress visiting health centers in about ten different states! BIG thank you to those who’ve shared their stories. As mentioned in previous posts, inviting a Member of Congress for an in-person visit is a vital advocacy tool and a great way to strengthen a relationship that could potentially last for decades. Keep in mind, the House and Senate will be on recess from now until September 6th. So, for the next seven weeks, Members will back home in their districts, making this a great time to reach out. Here are a few short notes from the field about recent health center visits:


During the Memorial Day recess, Senator Orrin Hatch (R-UT) visited Wayne Community Health Center’s (WCHC) KAZAN Memorial Clinic in Escalante, UT. The Association for Utah Community Health (AUCH) says, “Besides our ongoing relationship with the Senator, one of our hospital partners, Intermountain Healthcare, reached out earlier to the Senator to facilitate visits to Health Centers and Rural Hospitals in Southern Utah. By cooperating with community partners, the visit transformed from something that might happen into a set date and time. The bulk of the work for the health center visit fell on Wayne Community Health Center in inviting patients, the media, and local elected officials.” A few tips they offered were to have a plan, document the visit, and cultivate a relationship with their staff. AUCH also worked diligently to promote the visit on social media. In a video posted on Senator Hatch’s Twitter and Facebook pages, he describes WCHC as, “a fantastic rural health center.”

Senator Hatch at KAZAN Memorial Clinic. Photo courtesy of AUCH

Senator Hatch at KAZAN Memorial Clinic. Photo courtesy of AUCH.

Tip #1 and #2: For more on AUCH’s perspective of Senator’s Hatch’s visit as well as their tips for planning a tour, read President Pro Tempore Orrin Hatch Blog. Also, be sure to let NACHC and your state’s PCA know about any upcoming Congressional visit so you’re armed with the latest information regarding your Member. Don’t forget 2016 health center visits by your Rep., Senator, and/or delegate are one criteria used to determine 2017 NACHC Congressional Awards.


On June 1st, Senator John Cornyn (R-TX) convened a roundtable discussion at Community Health Center of Lubbock (CHCL) to discuss local partnerships that support Lubbock’s mentally ill and homeless individuals. He also highlighted components of his proposed bill, Mental Health and Safe Communities Act of 2015, which is designed to strengthen the mental health system and improve public safety. Following the discussion, Senator Cornyn toured the newly opened health center and held a joint press conference. Senator Cornyn also included CHCL’s CEO in a short video on his Facebook page.

Senator John Cornyn at Community Health Center of Lubbock. Photo courtesy of Facebook.

Senator John Cornyn at Community Health Center of Lubbock. Photo courtesy of Facebook.

Tip #3 and #4: If your Member’s office reaches out to you for some feedback on an issue or bill(s), feel free to reach out to us (federalaffairs@nachc.org). We are happy to provide you with requested information, background information on the Member, and some up-to-the-minute insight on what is currently percolating on Capitol Hill. Do your best with posting on social media as your Member may include you in their social media outlets as well. If possible, coordinate coverage with member’s communications staff so they can simultaneously promote.


Also on June 1st, Congressman G.K. Butterfield (D-NC) attended the ribbon cutting ceremony of Roanoke Chowan Community Health Center’s (RCCHC) newest site, Creswell Primary Care Clinic in eastern North Carolina. RCCHC did an all-around great job with publicizing the event by posting on their website’s RCCHS News, tweeting, posting photos on Facebook, and inviting the local news. Rep. Butterfield’s office made sure to tweet about it too.

Butterfield

Rep. G.K. Butterfield at Roanoke Chowan Community Health Center. Photo courtesy of Twitter.

Tip #5 and #6: Invite your Member to attend an event at your health center such as a ribbon cutting or ground breaking. In addition, alert local news sources of the event as they might feature the segment in the nightly news, similar to what WITN did with this event.


On June 3rd, Senator Richard Burr (R-NC) visited Piedmont Health’s PACE site in Pittsboro, North Carolina. Piedmont Health detailed the event on their Facebook page, “He (Senator Burr) talked with many participants while they were playing Bingo, saw the beautiful gardens and facilities and talked about this managed care model of providing service for seniors as a solid business model. He also saw the satisfaction of many happy participants and the depth of care that they received.” In addition, Carl Taylor, Director of the Pharmacy and Dr. Abby DeVries, Piedmont Health’s Medical Director spoke to Senator Burr about the benefits of the 340 B Program to community health center patients and the future of this program.  Both Piedmont Health and Senator Burr posted the experience on their respective social media sites.

Senator Richard Burr speaking with Carl Taylor, Dr. Abby Vries and Pharmacy intern, Felicia Charles from Piedmont Health. Photo courtesy of Piedmont Health.

Senator Richard Burr speaking with Carl Taylor, Dr. Abby Vries, Mike Fenley, and Pharmacy intern, Felicia Charles from Piedmont Health. Photo courtesy of Piedmont Health.

Tip #7 and #8: Show off your health center’s unique program(s) or service(s). Tell your story of how it came about and demonstrate your health center’s innovation to address the needs of your community. Make the most of this year’s National Health Center Week (NHCW) theme, “Celebrating America’s Health Centers: Innovators in Community Health.” Also, try to coincide the visit with one of NHCW’s focus days. For more information on this, please refer here.


For more how-to’s on inviting your Member and meeting tips, visit our Grassroots Advocacy website or read previous Congress Comes Home blogs (Part I and Part II). Refer to the NACHC 2016 Congressional Calendar to plan a congressional visit or tour. Don’t forget, August 7th through 13th is National Health Center Week (NHCW) and another opportune time to invite your member to tour your health center.

Do you also have a story to share? What tips and tricks have you learned in the process of scheduling and organizing Congressional visits? Do you alert the local press or utilize social media? Let us know by emailing your story, photos if available, and tips for fellow health centers to federalaffairs@nachc.org.

Congress Adjourns for the Summer – So Where Do We Stand?

By: NACHC Federal Affairs Team

With Members of Congress scheduled to attend the party conventions this week and next, and then to head back to their districts for the August recess, Congress will be out of Washington for the next seven weeks. With National Health Center Week looming, the recess is a great opportunity to get Members to come visit your health center. While Congress is scheduled to return to DC after Labor Day, reports indicate that depending on a number of factors, that session could be very short. So that all advocates are up to speed, we wanted to share some updates on key legislative issues as Congress heads home.

Appropriations

Last week, the House Appropriations Committee approved the Fiscal Year (FY) 2017 Labor, Health, and Human Services (LHHS) Appropriations bill. The bill was considered over two days and 30 amendments were considered. The legislation was ultimately passed by a vote of 31-19, with nearly all of the Democrats on the committee opposing the legislation. The timing of potential consideration and a final vote on the FY17 LHHS bill in the House is unclear.

The legislation contained the full health center funding request for fiscal year 2017 (FY17) of $5.1 billion in funding for health centers. This is level funding compared with FY16 and composed of $1.5 billion in discretionary funding from the Appropriations Committee and $3.6 billion in funding from the mandatory Health Centers Fund, which was extended last year by H.R.2, the Medicare Access and CHIP Reauthorization Act of 2015.

As you will recall, the Senate proposed FY17 LHHS bill allocated $100 million out of the $5.1 billion in available health center funding to be evenly split between mental health ($50 million) and opioid abuse ($50 million) expansion efforts. The House FY17 health center funding levels funding levels matched the Senate, but the bill did not specify $100 million the funds should be used for mental health and opioid abuse treatment. However, the House LHHS Committee report clearly indicates support for expansions in health centers in those two areas.

That is just one issue that will have to be resolved when the House and Senate begin negotiations over the summer and into the fall. It is widely expected Congress will move to pass a continuing resolution (CR) to extend funding at current levels before the end of the current fiscal year on September 30th. Reports from the Hill indicate Republican leadership is debating the length of time of the potential CR. It is unclear as to whether the CR will run until just after the election or into January – or even March – of next year. Either way, Congress does not appear to be ready to pass an omnibus bill (wrapping up all of the 12 appropriations into a single yearlong funding bill) at the moment. An omnibus will almost certainly not come up as an option until the elections are settled.

Opioids

Opioid legislation was one of the only bills actually passed into law before Congress adjourned. On an overwhelmingly bipartisan basis, both chambers passed the conference report on S. 524, the Comprehensive Addiction and Recovery Act (CARA), legislation that would seek to address the current opioid epidemic through a variety of grants and programs related to prevention, treatment, and recovery. NACHC previously sent a letter to House and Senate Conferees urging them to remove the federal restriction preventing both physician assistants (PAs) and nurse practitioners (NPs) from prescribing buprenorphine for the purposes of Medication-Assisted Treatment (MAT), and the final bill authorized NPs and PAs who meet certain criteria to prescribe buprenorphine for a period of five years – an important step forward. The bill briefly hit a snag when Democrats and the President voiced serious concerns about the lack of new funding provided for these programs, but ultimately the bill garnered nearly unanimous support in both the House and Senate and was signed into law with the hopes that further funding would be included as part of the appropriations process later this year.

Mental Health

In addition to passing opioid legislation, the House moved forward with a broader mental health bill, voting 422-2 to pass H.R. 2646, the Helping Families in Mental Health Crisis Act, a bill to strengthen federal infrastructure for mental health, improve Medicaid coverage for adults and children receiving treatment in an institution for mental disease (IMD), clarify HIPAA regulations, and bolster federal, state, and local grants and programs to address mental illness. Of particular importance to health centers is a provision to extend FTCA liability protections to health professional volunteers serving at community health centers. NACHC is working with Senate health center champions to ensure this language, introduced in the Senate as S. 2151 , the Family Health Care Accessibility Act, is included in their version of mental health legislation which may be considered when Congress reconvenes in the fall. NACHC also advocated for provisions to require that states allow same-day billing by Medicaid for behavioral health and physical health services (some states currently allow this, some don’t), but those provisions were watered down due to cost concerns. The future of mental health legislation depends on whether Congress is able to overcome legislative and political hurdles related to potential gun amendments, cost concerns, and a dwindling number of days in the legislative session.

ACO Parity for FQHCs

In a bit of good news from Congress, Congresswoman Jenkins (R-KS) and Congresswoman Linda Sanchez (D-CA) recently introduced H.R. 5667, the Rural ACO Provider Equity Act, a bill to allow FQHCs and rural health clinics to assign their patients to ACOs under the Medicare Shared Savings Program. The Senate version of the legislation, S. 2261, was introduced by Senators Thune, Cantwell, and Murray and passed the Senate unanimously on December 17, 2015. If this is an issue that is important to your health center we encourage you to ask your Representative to cosponsor the bill. To help you with those discussions, NACHC put together a one-page overview that you can use to explain the issue.

Zika

After nearly five months of on and off negotiations, Congress was unable to come to an agreement to fund the Zika response before adjourning for the summer. As expected, the last week of legislative business before recess resulted in a second failed vote in the Senate on the conference report passed by the House – the measure failed 52-44, short of the 60 votes needed for the bill to advance toward a final passage vote. Again this vote broke down largely along party lines, with Democrats pointing to several issues of concern within the Republican-led conference report, as detailed in this post, and Republicans blaming Democrats for voting down a bill that would have addressed the current crisis before the seven-week recess.

Also right before the summer recess, a bipartisan group of senators introduced legislation to create a permanent fund to address public health emergencies, The Public Health Emergency Response and Accountability Act, S.3280. Recognizing that public health emergencies like Zika are inevitable and Congress is not necessarily inclined to act quickly in the face such emergencies, the legislation would allow for Congress to provide immediate resources where they are needed most. Similarly, the House included in its draft of the FY2017 Labor, Health and Human Services (LHHS) Appropriations bill a provision to create the “Infectious Diseases Rapid Response Reserve Fund” to make funds available through the annual appropriations process, which could be tapped into quickly to respond to future infectious disease emergencies. While these can be viewed as positive developments, as with the original funding request to address the Zika virus, we will be waiting until after Labor Day to see where Congress will go from here.