The Eyes of the Nation on Massachusetts Federal ACA/ Supreme Court and State Priorities/ League Assistance/ Health Policy/ Sequestration/ OBRA

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1 The Eyes of the Nation on Massachusetts Federal ACA/ Supreme Court and State Priorities/ League Assistance/ Health Policy/ Sequestration/ OBRA Meeting of the Assembly June 14, 2012 James W. Hunt, Jr., President & CEO

2 League Mission To provide leadership to our membership in achieving their goals, and to promote accessible, quality, community responsive health care. 2

3 Massachusetts Community Health Centers 50 community health centers Over 280 sites reflect medical, dental, behavioral health, school-based and social services 800,000 patients 3

4 Massachusetts Community Health Centers Comprehensive and Responsive Care Quality of care continually exceeds national averages Model disease management programs National Medical Home Grant recipient Electronic Health Records 49 of Massachusetts 50 health centers have either purchased, implemented or are in the process of implementing EHRs League preparing for Meaningful Use and more under Health Reform Direct Economic Impact 2010 Health Center Expenditures $929 million Payroll $660 million Employees 11,000 Support additional jobs 5,482 Total economic engine approaching $1.8 billion 4

5 Global Health Care Environment Presidential & congressional elections --November 2012 Supreme Court holding on the ACA -- June 2012 Lame duck congressional session -- Y/N November 2012 Sequestration -- Y/N January 2013 Omnibus Reconciliation Act of 2013? 5

6 Presidential Cycle and Congress Republican nominee Congressional redistricting with loss of one seat United States Senate race Presidential Election November

7 ARRA, ACA & Re-Cap Increased Demand for Services ARRA Funds Nationally: $341 million MA $ 9 million Continuation of IDS et al in 2012 final federal budget New Access Points ARRA Funds Nationally: $160 million MA $ 1.3 million ACA Funds Massachusetts: 12 NAP applicants in 2011, including 3 FQHCs. Still pending additional awards to applicants with high scores. Announcements expected late June

8 ARRA, ACA & 2011 Re-Cap Capital Improvement Programs ARRA Funds Nationally: $852 million MA $ 27.7 million State M.O.B. law enacted and awaiting regulations Social Impact Bonds being considered Facility Investment Program ARRA & ACA FIP/CDP Funds Nationally: $508 million FIP/CDP Funds for Massachusetts: $123 million,16 sites HIT Funds for Massachusetts: $2.9 million ACA Funds: Large and Small Capital program proposals to HRSA with $700 million available for federally-funded health centers. Awards made May 1, 2012 with MA receiving 13 grants totaling $33 million 8

9 ACA Resources: A Question Mark $9.5 billion ACA appropriation for health center expansion continues in jeopardy FFY-12 Budget Reduction Act cut $600 million in operational support for health centers and back-filled the reduction with ACA funds intended for expansion FFY-13 President s budget proposes $3.1 billion for CHCs with withhold of $300 million and continues use of expansion funds to back-fill shortfall IMPACT: $1 billion in 2011 resources for NAPs, and EMC redirected to base appropriations : Pending further appropriations action 9

10 ACA Resources: A Question Mark Future Concerns Balance of CHC Trust Fund in question. Appropriations cliff to be hit in $1.5 billion in capital funding now fully committed with additional immediate national capital needs near $5.0 billion Additional capital needs will require new sources of financing Revised scoring methodology reduces Massachusetts opportunities $1.5 Expansion for NHSC NHSC soring changes impact MA CHCs Residency and expanded provider training Final rule on HPSA and MUA pending 10

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12 CMMS and Public Health ACA: $15 billion for Public Health Trust Fund cut by $5.0 billion Trust Fund could be in jeopardy in 2013 OBRA HIT Initiatives continue Multiple CMMS Initiatives Pioneer ACOs funded Duals pending at both the state and federal level 12

13 ACA Challenges President Obama released a deficit reduction plan last fall that includes structural reforms $1.5 trillion in tax increases $583 billion in spending cuts over 10 years $321 billion in health care cuts over a decade $248 billion from Medicare -$73 billion from Medicaid Presidents proposal to cut $3.5 billion cut to ACA s Prevention and Public Health Trust Fund over 10 years Includes cuts to skilled nursing facilities, home health agencies, inpatient rehabilitation and long-term care facilities 13

14 Deficit Control Act of 2011 Debt Deal $900 billion in discretionary spending cuts over the next ten years in order to increase debt limit for the next few months (split between security and non-security spending) Super Committee - Joint, bipartisan committee charged with identifying and proposing a $1.2 trillion package of savings aimed at reducing the national deficit Congress was unable to reach consensus and vote yes or 'no' to determine a savings package Since no action or partial cuts are made, significant across the board cuts, sequestration will be triggered in 2013 Health center and public health discretionary funding are vulnerable to potentially severe cuts and reductions 14

15 Ongoing Projects Support CHC HIT including Implementation of EMR/EHR at remaining sites PCMH training, TA, and payments Provide assistance to CHCs for ACO and ICO opportunities Proposed joint training and TA effort with UMMS Support HRSA/BPHC in improved CHC compliance with Need, Quality, and Governance requirements 15

16 Opportunities Leverage CHC 800,000 patient base to demonstrate through data, the quality and effectiveness of health center care Promote state investments in CHC rates and capacity and infrastructure building Work with NHP on Partners Affiliation Agreement Assist DentaQuest Foundation on expansion of dental advocacy nationally Seek CHC investments through Medicaid waivers Continue to support HRSA/BPHC/PCAs and NACHC nationally Provide leadership to Capital Link and Capital Fund on growing capital opportunities nationally 16

17 Opportunities Promote community-based residency training programs to attract medical, dental, nursing graduates to CHC careers Prepare centers for expanded resources dedicated to recruiting primary care clinicians under NHSC, League/BOA LRP, Partners/Kraft Center Study and provide TA to CHCs, Networks, MCOs, (NHP), on ACO, ICO and global payment 17

18 Strategic Threats Diminishing state funding and rates for providers and lack of fair payment by the state for publicly-assisted patients Global payments, ACO Regulations, and Incentive payments Remaining uninsured and coverage issues, select networks CHC uptick in Free Care (Adult Dental) Increased patient responsibility 18

19 Strategic Threats National primary care provider shortage, short/long term Continuing infrastructure needs (Facility, HIT) Recognition of social determinants of health, immigration issues Proliferation and impact of for-profit entities Sentiment: ACA attacks, Constitutional challenges Medicaid Adult Dental cuts Media Scrutiny 19

20 2012 Action Plan Upgrade TA and training opportunities for members, Partners Grant, State, and UMMS collaboration Expand web-based Training & Education Develop comprehensive 2013 state and federal health policy papers and budget requests Support NACHC, fellow PCAs and BPHC in maintaining ACA Increase advocacy and number of advocates Promote fairness to Massachusetts as HCR leader 20

21 2013 Action Plan Initiatives Seek new resources and fees to sustain League including collaborative initiatives and network(s) development Promote health centers as major partners in IT, ACO, and PCMH development with current and future health care entities and partners Promote MLCHC statewide Regional approach to services Assist CHCs with R&R and succession planning 21

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23 Developing Syndrome Massachu-sitis Wikipedia definition: A condition that presents itself after repeated exposure to Massachusetts long list of healthcare policy accomplishments. Cure: Listening to Tea Party Journalists pontificate on any topic related to health care policy for more than 2 minutes. 23

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25 Questions--Thank you James W. Hunt, Jr., President and CEO Massachusetts League of Community Health Centers 40 Court Street, 10th Floor Boston, MA

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