New York State’s Federally Qualified Health Centers and Health Care Reform

1. New York State’sFederally Qualified Health Centersand Health Care Reform Presentation to the State Hospital Review and Planning Council By Elizabeth Swain, CEO Community Health Care Association of New York State July 22, 2010

2. What are FQHCsand FQHC Look-Alikes • A federal financing model • A clinical model • A federal designation • 70 FQHCs in New York State with 1.4 million patients • 1,300 FQHCs in US serving 20 million patients in 2010

3. What are Federally QualifiedHealth 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

4. 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 Required FQHC Services

5. Essential Federal Requirements of FQHCs—Mandated Services • Comprehensive set of services, 24/7, board certified physicians, must meet clinical outcome measures and productivity requirements • Must provide care to people regardless of their ability to pay, on a sliding scale • Cultural and linguistic access

6. Essential Federal Requirements of FQHCs—Mandated Services • Located in a designated underserved area • Must be governed by a Board of Directors whose members are at least 51% consumers of the FQHCs services

7. Cost Effective Model of CareImproves 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

8. Cost Effective Model of CareImproves Health Outcomes • Quality outcomes, reduce ethnic and racial disparities in health outcomes • Communities with FQHCs have fewer inappropriate ER visits and avoidable hospitalizations

9. Reduction of AvoidableEmergency Department Visits* • Communities with FQHCs have fewer inappropriate ED visits • Counties with an FQHC had 25% fewer uninsured ED visits • Counties with FQHCs had fewer ED visits for ambulatory care sensitive conditions *Rust George, et al. “Presence of a CHC and Uninsured Emergency Department Visit Rates In Rural Counties.” Journal of Rural Health, Winter 2009 25(1):8-16

10. FQHC Designation as aCommunity Asset • In 1989, Congress created FQHC law • “Cost based” reimbursement for all Medicaid & Medicare visits • Designation created to protect federal grant funds for the uninsured

11. FQHC Designation as aCommunity Asset • FQHC receives a federal grant to cover cost of uninsured care (10-20% of FQHC’s total budget) • Federal Tort Claims Act (FTCA) • 340B drug pricing—discounted pharmaceuticals • Direct grant funding from HRSA to FQHC

12. FQHCs and the Health Care Reform Law • Summary of significant FQHC provisions • What the health care reform law and its FQHC provisions could mean to New York State

13. Why the Federal Investmentin FQHCs? • The FQHC Model has demonstrated great value to feds and states with strong health outcomes and reduced costs • The model reduces disparities in health outcomes • Cost containment strategies • Demonstrated capacity to grow and increase access to primary care services

14. Unprecedented ResourcesOver 5 Years* • $11B expansion for FQHC program (Operational and capital needs) • $1B in FY 2011 (Beginning Oct. 1, 2010) • Additional $9.5B, FY 2012-201 • $1.5B for National Health Service Corps • $15B for creation of Public Health Trust Fund • IT initiatives, CMS initiatives, Workforce initiatives *All NYS FQHCs eligible for expansion resources, all other health centers eligible for new access point funding.

15. Impact for New York State’sPrimary Care Safety Net • Significant opportunities • Severe underdevelopment of the primary care safety net • High potential for strong New Access Point, Expanded Medical Capacity and New Services grants • Medicaid and insurance exchange coverage will increase numbers of insured patients at all FQHCs

16. FQHCs In New York State • More than 70 health centers (with 457 sites) provide a comprehensive set of services including primary and preventive care, pediatrics, Ob/Gyn, dental health, mental health and enabling services • Community, migrant and homeless health centers serves as the family doctor and healthcare home for nearly 1.4 million state residents in 2009.

17. FQHCs In New York State • Most health center patients have family incomes below the federal poverty level • 74% are racial or ethnic minorities • One in four is not a native speaker of English • Health centers provide care to all, regardless of insurance status or ability to pay • Located in federally designated underserved communities

18. FQHCs In New York State • Every health center must establish a sliding fee scaled based on patients’ ability to pay for care • Every health center, by law, must be governed by a community board • Majority must be health center patients

20. Medicaid* Expansion • Expands Medicaid to 133% of the Federal Poverty Level (FPL) in 2014 • No categorical restrictions • 16 million newly insured Americans • 1 million in New York • New York State held harmless against losses—all expansion states are protected *The single largest source of FQHC revenue.

21. Payment Protectionsand 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

22. 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

23. New Preventionand 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

24. Opportunities to Work Together • Sustain and expand health center care to growing numbers of newly insured residents • Create community-based residency training programs to encourage medical and nursing school students to pursue careers in primary care at health centers

25. Opportunities to Work Together • Expansion of dedicated resources for recruiting primary care clinicians under NHSC • Increased resources for health center expansion and improvements • Includes study of FQHC and other provider conversion to 330s

26. Opportunities to Work Together • Enhanced support to health centers technology, increased ability to tackle major cost drivers in the system • Chronic disease • Obesity • Smoking • Continue Medicaid reform initiatives begun in 2008

27. Thank You CHCANYS is here to help. Elizabeth Swain, CEO (212) 710-3802 eswain@chcanys.org www.chcanys.org