2016 on the Hill for Health Centers

It’s been a big year on Capitol Hill for our nation’s health centers. One may have thought that, following an historic victory in 2015 getting a 2-year extension of funding, this “off year” would be a time for resting on our laurels and rebuilding for the fights to come in 2017. While certainly plenty of time and energy has been devoted to looking ahead to the big questions on the table next year, this year itself has been filled with important policy debates, record-breaking advocacy, and some important legislative wins for health centers.

Early in the year, health center advocates descended on Capitol Hill for the 2016 Policy and Issues forum in Washington, DC, where NACHC highlighted health center innovation in a well-attended Congressional Briefing, and put the spotlight on the workforce challenges being faced at health centers with the release of a new research report. Health Center advocates succeeded in breaking records on our annual appropriations letters – with over 300 House Members signing onto the Bilirakis-Green letter in the House and over 60 Senators signing onto the Stabenow-Wicker letter in the Senate. With that many members on record, both House and Senate appropriations committees passed FY2017 legislation keeping health center funding level, in line with NACHC’s official request.

Following action in those Committees, the appropriations process stalled out over larger political conflicts (and indeed, is technically still underway – the government is operating under a stop-gap “continuing resolution” until next April). But even as work on the funding issues slowed, health centers were at the center of several other debates and conversations on health policy on the Hill.

Efforts to fund a response to the Zika virus, especially in Puerto Rico and the other U.S. territories, finally were passed into law in late September after months of back and forth on Capitol Hill. The final package contained $40 million for health centers in Puerto Rico and the territories, which was allocated last week.

The opioid epidemic that has been raging throughout much of the nation moved Congress to take action this year, culminating in the eventual passage of the Comprehensive Addiction and Recovery Act (CARA) which outlines a number of new measures to combat the epidemic. Health Centers have been on the front lines of that fight for years, and last year, 271 health centers were funded specifically to expand and enhance their substance use disorder treatment services.

Alongside the debate over substance use disorder policy, Congress spent a lot of time this year looking at the mental health system. Bills were passed in the House and Senate, and eventually reconciled into a larger package that passed at the end of the year. While advocates were not successful in securing a requirement for same-day billing for mental health visits under Medicaid (a top – but expensive – priority for health centers), the bill did contain several provisions of note. In particular, it included both a long-sought provision expanding health centers FTCA Medical liability coverage, or FTCA coverage, to volunteer providers, as well as a provision allowing health centers to assign patients to Accountable Care Organizations (ACOs) at the FQHC level. More on both of those provisions and what they mean for health centers here.

Even with all the different pieces on the chess board in 2016, we’ve spent an equal or greater amount of time (especially since the November elections) focused on what lies ahead in 2017. Big issues will need to be dealt with, and could have enormous implications for health centers and their patients. In particular, the two-year extension of funding mentioned earlier is up this fall, meaning a loss of 70% of federal grant funds to health centers (and elimination of the National Health Service Corps and Teaching Health Centers programs) if Congress fails to take action. Equally critical, the Medicaid program will be very much “on the table” given the expansion under the ACA and the desire on the part of many in Congress to fundamentally restructure the program.

More than 1,000 advocates joined our team for a Policy and Advocacy Webinar last week (missed it? Here’s the recording), during which we reviewed the election, some of the new faces in DC, our top priorities and the outlook for 2017. This is now something we’ll be doing on a monthly basis moving forward. Here’s the link to register for the next one, which will be at 3:30 PM EST on January 18th. As we enter a complex and uncertain year, these webinars, as well as our new “Making the Case” Resource Hub website, are the best ways to stay in touch and stay engaged.

From our team to yours, happy holidays and happy new year. Rest up, we’re going to have our hands full in the new year!

 

 

 

Approps

Zika

Opioids

Mental Health

Cures

 

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 Election 2017 Outlook Memo 12.28.16 (updated 12.28.16)

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.