Health reform safety net


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  • Many of the provisions are amendments or replacement of text of the Public Health Service Act, first passed by Congress in 1944A bit tricky to figure out what the bill does without going back to the original language, plus you have to be aware of changes made to the reconciliation bill.
  • Many of these areas overlapExpanding insurance coverageExpanding safety net capacity Investments in currently-existing safety net infrastructure (CHCs, SBHCs, public health) Creation of new sites (Dave Myers indicated that it may lead to doubling of CHCs in the states, or Provisions that target specific groups of Americans who are vulnerableRural, PWD, Native Americans Renegotiating rules (broad category that essentially enables the other strategies) Give some examples, but there is a process for determining MUPs and HPSAs Will go over each of these in more detailSec 10504. Another approach worth mentioning is demonstration or pilot projects. Hard to bring out of the abstract because sometimes the purpose is a bit nebulous and there is not a name for these projects yet. For example: $2 million for a demonstration that “shall establish a 3 year demonstration project in up to 10 States to provide access to comprehensive health care services to the uninsured at reduced fees. The Secretary shall evaluate the feasibility of expanding the project to additional States.”(b) ELIGIBILITY.—To be eligible to participate in the demonstration project, an entity shall be a State-based, nonprofit, public privatepartnership that provides access to comprehensive health care services to the uninsured at reduced fees. Each State in whicha participant selected by the Secretary is located shall receive not more than $2,000,000 to establish and carry out the project for the 3-year demonstration period.
  • Allison went into detail about this last week.You should be aware that with state and national health reform Medicaid expansions combined, CHI is estimating about 244% percent increase in adult Medicaid statewide (assuming current penetration levels) – about 200,000 people. Many of these individuals may have already been using the SN as uninsured, but it brings up questions about pent-up demand. About the only place that we have to look is MA, and after their comprehensive health reform passed, many patients who had visited the SN as uninsured continued to be patients there, but there was an increase in the complexity of the cases.
  • 2nd area
  • SEC. 4101. SCHOOL-BASED HEALTH CENTERS.(a) GRANTS FOR THE ESTABLISHMENT OF SCHOOL-BASED HEALTHCENTERS.—(1) PROGRAM.—The Secretary of Health and Human Services (in this subsection referred to as the ‘‘Secretary’’) shallestablish a program to award grants to eligible entities to support the operation of school-based health centers. (2) ELIGIBILITY.—To be eligible for a grant under this subsection, an entity shall—(A) be a school-based health center or a sponsoringfacility of a school-based health center; and (B) submit an application at such time, in such manner, and containing such information as the Secretary may…”Per Debbie Costin at CASBHC:1.  Federal Authorization – The act authorizes the creation of a school-based health center grant program within the U.S. Department of Health and Human Services (yes! Yes! and YES!). This authorization cannot be eliminated or changed through the reconciliation process. We believe that a new “Office of School-Based Health Care” will be created by Secretary Sebelius within the next year or possibly two.  2. Appropriation - The new Office of School-Based Health Care, DHHS, is charged with distributing funds to SBHCs directly through a competitive application process, not through states. The amount authorized by the Act is $50 million a year for five years. HOWEVER, this amount must now be appropriated by Congress.  3.  Short-term “Emergency” Appropriation of $200 million ($100 million a year for two years) – This funding is currently mandated through the Act (does not need to go through the appropriation process), but can be changed or removed through the reconciliation process. The original intent was for these funds to get out quickly to SBHCs that are at risk of down-sizing or closing because of state budget cuts, knowing that it may take up to two years to create the permanent “program” (#1 above). Procedural issues in the Senate resulted in changes to the original amendment introduced by Senator Debbie Stabenow of Michigan.  The funding is currently restricted for construction.  4. The Act contains NO training and technical assistance provision. Therefore, there is no possibility of funding for NASBHC or state associations. The TA provision we were hoping for was included in the House bill which is now dead. 5. The Act contains NO mandate for SBHC reimbursement through Medicaid and CHIP.  NASBHC is still working with Congressman Sarbanes on a regulatory fix through CMS.  There is also the possibility that the Healthy Schools Act (S. 1034/ H.R. 2840) introduced by our own Senator Bennet, will be resurrected as a stand-alone bill or attached to another piece of legislation.
  • SEC. 4002. PREVENTION AND PUBLIC HEALTH FUND.(a) PURPOSE.—It is the purpose of this section to establish a Prevention and Public Health Fund (referred to in this section as the ‘‘Fund’’), to be administered through the Department of Health and Human Services, Office of the Secretary, to providefor expanded and sustained national investment in prevention and public health programs to improve health and help restrain therate of growth in private and public sector health care costs. (b) FUNDING.—There are hereby authorized to be appropriated,and appropriated, to the Fund, out of any monies in the Trearury not otherwise appropriated—(1) for fiscal year 2010, $500,000,000; (2) for fiscal year 2011, $750,000,000; (3) for fiscal year 2012, $1,000,000,000;(4) for fiscal year 2013, $1,250,000,000; (5) for fiscal year 2014, $1,500,000,000; and (6) for fiscal year 2015, and each fiscal year thereafter, $2,000,000,000.(c) USE OF FUND.—The Secretary shall transfer amounts in the Fund to accounts within the Department of Health and HumanServices to increase funding, over the fiscal year 2008 level, for programs authorized by the Public Health Service Act, for prevention,wellness, and public health activities including prevention research and health screenings, such as the Community Transformationgrant program, the Education and Outreach Campaign for Preventive Benefits, and immunization programs.(a) IN GENERAL.—The Secretary of Health and Human Services (referred to in this section as the ‘‘Secretary’’) shall provide forthe planning and implementation of a national public–private partnership for a prevention and health promotion outreach and education campaign to raise public awareness of health improvement across the life span. Such campaign shall include the dissemination of information that— (1) describes the importance of utilizing preventive services to promote wellness, reduce health disparities, and mitigate chronic disease; (2) promotes the use of preventive services recommended by the United States Preventive Services Task Force and the Community Preventive Services Task Force; (3) encourages healthy behaviors linked to the preventionof chronic diseases; (4) explains the preventive services covered under health plans offered through a Gateway; (5) describes additional preventive care supported by the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the Advisory Committee on Immunization Practices, and other appropriate agencies; and (6) includes general health promotion information. Not sure what it does to the US Preventive Services Task Force – redefines?
  • SEC. 5604. CO-LOCATING PRIMARY AND SPECIALTY CARE IN COMMUNITY-BASED MENTAL HEALTH SETTINGS.Subpart 3 of part B of title V of the Public Health ServiceAct (42 U.S.C. 290bb–31 et seq.) is amended by adding at the end the following:‘‘SEC. 520K. AWARDS FOR CO-LOCATING PRIMARY AND SPECIALTYCARE IN COMMUNITY-BASED MENTAL HEALTH SETTINGS.‘‘(a) DEFINITIONS.—In this section: ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible entity’ means a qualified community mental health program defined under section 1913(b)(1).‘‘(2) SPECIAL POPULATIONS.—The term ‘special populations’ means adults with mental illnesses who have co-occurring primarycare conditions and chronic diseases. ‘‘(b) PROGRAM AUTHORIZED.—The Secretary, acting through the Administrator shall award grants and cooperative agreements to eligible entities to establish demonstration projects for the provision of coordinated and integrated services to special populations through the co-location of primary and specialty care services incommunity-based mental and behavioral health settings. ‘‘(c) APPLICATION.—To be eligible to receive a grant or cooperativeagreement under this section, an eligible entity shall submit an application to the Administrator at such time, in such manner,H. R. 3590—562 and accompanied by such information as the Administrator may require, including a description of partnerships, or other arrangements with local primary care providers, including community health centers, to provide services to special populations.‘‘(d) USE OF FUNDS.— ‘‘(1) IN GENERAL.—For the benefit of special populations, an eligible entity shall use funds awarded under this section for— ‘‘(A) the provision, by qualified primary care professionals, of on site primary care services; ‘‘(B) reasonable costs associated with medically necessary referrals to qualified specialty care professionals, other coordinators of care or, if permitted by the terms of the grant or cooperative agreement, by qualified specialty care professionals on a reasonable cost basis on site atthe eligible entity; ‘‘(C) information technology required to accommodate the clinical needs of primary and specialty care professionals;Or ‘‘(D) facility modifications needed to bring primary and
  • 4203: Removing barriers and improving access to wellness for individuals with disabilitiesTitle III, Improving Medicare for Patients and Providers – contains rural protections
  • Commission is appointed by Congress and overseen by Academy of Sciences
  • Health reform safety net

    1. 1. Patient Protection and Affordable Care Act (HR 3590) & Health Care and Education Affordability Reconciliation Act (HR 4872)<br />Provisions affecting the health care safety net<br />April 12, 2010<br />CHI Staff Meeting<br />
    2. 2. Main provisions affecting the safety netHR 3590<br />Title II: Role of Public Programs<br />Title IV: Prevention of Chronic Disease and Improving Public Health<br />Title V: Health Care Workforce<br />2<br />
    3. 3. Access vs. coverage<br />For most people living in the U.S., health insurance provides the mechanism by which to gain access to health care, however…<br />Not everybody who has coverage, has access<br />Not everybody who lacks coverage, lacks access<br />3<br />
    4. 4. HR 3590 strategies for improving access<br />Expanding insurance coverage<br />Expanding safety net capacity<br />Targeting specific vulnerable populations<br />Renegotiating rules<br />4<br />
    5. 5. Mechanisms for expanding coverage<br />Medicaid expansion to 133% of the federal poverty level (FPL)<br />Individual mandate to have health insurance<br />Subsidies available to individuals >133-400% FPL to purchase health insurance<br />Creation of state health insurance exchanges<br />Incentives and penalties for firms to offer health insurance to their employees<br />5<br />
    6. 6. Expanding safety net capacity<br /><ul><li>Increased investment in
    7. 7. Community health centers (CHCs)
    8. 8. School-based health centers (SBHCs)
    9. 9. Public health
    10. 10. Co-location of primary and specialty care into community-based mental health settings
    11. 11. Health care workforce augmentation</li></ul>6<br />
    12. 12. Community health centers<br />$11 billion of new funding for health center program expansion<br />$9.5 billion to expand operational capacity<br />$1.5 billion for expanding and improving existing facilities and constructing new sites<br />7<br />
    13. 13. School-based health centers<br />Establish program under DHHS to award grants to SBHCs or SBHC sponsors<br />Annual $50 million authorized for fiscal years 2010 through 2013<br />Funds can be used for management and operation, payment of personnel salaries, leasing equipment and training<br />8<br />
    14. 14. Public health investment<br />Establish the Prevention and Public Health Fund for expanded investment in prevention<br />Authorized:<br />for FY 2010, $500,000,000;<br />for FY 2011, $750,000,000;<br />for FY 2012, $1,000,000,000;<br />for FY 2013, $1,250,000,000;<br />for FY 2014, $1,500,000,000; and<br />for FY 2015, and each fiscal year thereafter, $2,000,000,000.<br />$500 million for education and outreach on prevention<br />9<br />
    15. 15. Provision of community-based mental health services<br />Establishment of demonstration projects for the provision of integrated services to adults with mental illness<br />Co-location of primary and specialty care services in community-based mental and behavioral health care settings<br />$50 million for FY 2010 with continued authorization through FY 2014<br />10<br />
    16. 16. Nurse-managed health clinics<br />“…a nurse-practice arrangement, managed by advanced practice nurses, that provides primary care or wellness services to underserved or vulnerable populations and that is associated with a school, college, university or department of nursing, federally qualified health center, or independent nonprofit health or social services agency.”<br /> Section 5208, HR 3590<br />$50 million for FY 2010 with continued authorization through FY 2014<br />11<br />
    17. 17. Vulnerable populations addressed in bill<br /><ul><li>The uninsured
    18. 18. Medicaid and SCHIP enrollees
    19. 19. Rural residents
    20. 20. Individuals dually eligible for Medicare and Medicaid
    21. 21. Low-income Medicare beneficiaries
    22. 22. Individuals with disabilities
    23. 23. Indian Health Service beneficiaries</li></ul>12<br />
    24. 24. Renegotiating rules<br />Payment reform<br />Payment to community health centers<br />Disproportionate Share Hospital (DSH) payments<br />Establishes rulemaking committee to develop methodology and criteria for designation of medically underserved populations and health professions shortage areas (HPSAs)<br />13<br />
    25. 25. Payment reform examples (CHCs)<br />CHCs receive no less than Medicaid PPS rate from private insurers offering plans through the new health insurance exchanges<br />Eliminates Medicare payment cap on FQHC payments<br />14<br />
    26. 26. Payment reform example (DSH)<br />Reduce aggregate Medicaid DSH allotments by $14.1 billion between 2014 – 2020<br />DHHS to develop method for redistribution of DSH payments<br />Reduce Medicare DSH payments by 75% in 2014 and then increase based on the uninsured rate and uncompensated care provided<br />15<br />
    27. 27. Extra! Key National Indicators<br />Title V, Section G “Improving Access to Health Care Services” establishes a process for Key National Indicators<br />National Academy of Sciences will establish a Key National Indicators Institute or partner with an independent private nonprofit organization to implement the indicators system<br />Responsibilities:<br />Identify and select issue areas to be represented by key national indicators<br />Selecting the measures and identifying the data<br />Establish publicly available, Web-based database<br />16<br />
    28. 28. 17<br />My contact information: <br />Jeff Bontrager, MSPH<br /> Program Manager<br /> Center for the Study of the Safety Net<br /> 303.831.4200 x 205<br /><br />Questions and comments<br />