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New York State s Federally Qualified Health Centers and Health Care Reform: Opportunities to Expand Access to Dental Ser

Introduction. The Community Health Care Association of New York State (CHCANYS) organizes, educates, and advocates on behalf of more than 60 health centers (FQHCs and Look-Alikes) located throughout New York State.Community, migrant and homeless health centers provide high quality, affordable and a

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New York State s Federally Qualified Health Centers and Health Care Reform: Opportunities to Expand Access to Dental Ser

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    1. New York State’s Federally Qualified Health Centers and Health Care Reform: Opportunities to Expand Access to Dental Services Presentation to The New York State Oral Health Coalition By Elizabeth Swain, CEO, CHCANYS November 5, 2010

    2. Introduction The Community Health Care Association of New York State (CHCANYS) organizes, educates, and advocates on behalf of more than 60 health centers (FQHCs and Look-Alikes) located throughout New York State. Community, migrant and homeless health centers provide high quality, affordable and accessible primary and preventive health care for more than 1.4 million New Yorkers at over 457 sites.

    3. What are Federally Qualified Health Centers or FQHCs? Patient-centered health care homes located in medically underserved areas that provide high quality, cost effective primary health care to anyone seeking care regardless of their ability to pay Must be governed by a Board of Directors whose members are at least 51% consumers of FQHC services

    4. Dental Services at FQHCs in 2009 585,982 dental users 741,062 dental visits 43 of NY’s FQHCs provide dental services onsite at their own facilities Employ 229.22 FTE dentists & 77.98 FTE hygienists Total cost of more than $100 million

    6. FQHC Designation as a Community Asset FQHC receives a federal grant to cover cost of uninsured care (10-20% of the total budget) Federal Tort Claims Act (FTCA) 340B drug pricing—discounted pharmaceuticals

    7. Required FQHC Services Physician, Nurse Practitioner, Physician Assistant care Laboratory & Pharmacy Case management Transportation for health services Preventive services Translation services Specialty, hospital referral and follow up Oral health care provided by Dentist, Hygienist Behavioral health (psychologists, MSWs) Substance abuse services

    8. Cost Effective Model of Care Improves Health Outcomes Comprehensive primary care model Patient centered, affordable, accessible Medicaid cost is 30% lower on average at FQHCs compared to other primary care providers* numerous citations Overall costs at FQHCs are 25% lower than other primary care practices* numerous citations

    9. Cost Effective Model of Care Improves Health Outcomes Quality outcomes, reduce ethnic and racial disparities in health outcomes Communities with FQHCs have fewer inappropriate ER visits and avoidable hospitalizations 70% of all NYS FQHCs have fully implemented electronic health records

    10. FQHCs and Health Care Reform: Over 5 Years* $11B expansion for FQHC program (Operational and capital needs) Trust Fund $1B in FY 2011 (Beginning Oct. 1, 2010) Additional $9.5B, FY 2012-2015 $1.5 B in capital $1.5B for National Health Service Corps $15B for creation of Public Health Trust Fund IT initiatives, CMS initiatives, Workforce initiatives

    11. 2011 $1 B Release from Trust Fund $250 million released in August 2010 for New Access Points (new & existing), 350 awards of <$650,000, applications are due in early December Up to $335 million released last week in Expanded Services (existing FQHCs) Increased access to oral health, behavioral health, pharmacy, vision, and enabling services Applications due January 6, 2011 $250 million to be released to fund ARRA commitments All of these funds will be ongoing

    12. 2012-2015 Operating Funds to be Released 2012 : $1.2 billion ($200 m) 2013 : $1.5 billion ($500 m) 2014 : $ 2.2 billion ($1.2 b) 2015 : $ 3.6 billion ($2.6 b) Each year will release new NAP, ES funds as well as funding the previous years’ awards Each year the FQHC base funds will continue to require reauthorization and reappropriation by Congress

    13. Impact for New York State’s Primary Care Safety Net Increase primary care capacity across NYS by more than 100% over five years – from 1.4 to 3 million users Historically, there has been a severe underdevelopment of the primary care safety net Health Care Reform provides significant opportunities High potential for strong New Access Point and Expanded Medical Capacity grants Medicaid and insurance exchange coverage will increase numbers of insured patients at all FQHCs Economic development engine

    14. Impact for New York State’s Primary Care Safety Net Medicaid* Expansion Expanded to 133% of the Federal Poverty Level (FPL) in 2014 No categorical restrictions 100,000 new Medicaid patients in New York NYS held harmless against losses—all expansion states are protected Payment Protections and Improvements Protects the Medicaid and Medicare payment enhancements for FQHCs Requires that FQHCs receive no less than their Medicaid PPS rate from private insurers in the exchanges Add prevention services to the FQHC Medicare payment rate Eliminates Medicare payment cap on FQHC payments

    15. Impact for New York State’s Primary Care Safety Net Teaching Health Centers Authorizes a new Title VII grant program for development of Teaching Health Centers at FQHCs Creates a new Section (340H) in the Public Health Service Act Strictly prohibits hospitals from receiving payments for Sec. 340H reimbursed time Appropriates $230M over 5 years for 340H New Prevention and Public Health Fund $5B over the next 5 years $500M will be appropriated during the first year, starting October 2010 Authorizes funding to services/programs in the Public Health Service Act, including FQHCs Title X Family Planning Program Prevention Service Block Grant, many others

    16. Health Care Reform’s Economic Impact Identified four “high-need” regions Long Island Western New York Finger Lakes (including Monroe County) Central New York Working to create New Access Points (existing or new FQHCs)

    17. CHCANYS’ Priority Counties Western New York Region Niagara County Orleans County Erie County Genesee County Wyoming County Chautauqua County Cattaraugus County Allegany County Long Island Region Nassau County Suffolk County Central New York Region Jefferson County Oswego County Oneida County Onondaga County Madison County Cortland County Herkimer County Tompkins County Cayuga County` Finger Lakes Region Monroe County Yates Country Wayne Country Ontario County Livingston County Seneca County

    18. CHCANYS’ Statewide Approach Economic Impact Analyses: local, regional state Market Workforce Assessments: local, regional and state Intensive NAP application technical assistance in four regions with limited existing access to comprehensive primary care

    19. Health Care Reform’s Economic Impact Analysis found that in 2009 the 14 existing health centers in the four targeted regions $323.8 million economic impact Employed 2,984 people By 2015, when health care reform is fully funded $446.6 million economic impact Employ 4,066 people

    20. Questions? Contact information: eswain@chcanys.org www.chcanys.org

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