Bureau of Primary Health Care Update

1. Region II Annual Primary Health Care Conference Community Health Centers… A Pathway to Healthcare Reform Bureau of Primary Health Care Update June 2, 2010 Gina Capra Director, Eastern Division U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care

2. Glad to be down the Shore…… in the Summer!

3. Really glad to be down the Shore…in June!

4. Today’s Presentation National Overview • Health Center Program Performance • Primary Health Care Focus Region II: NJ, NY, PR, VI • Impact • Funding Primary Health Care Updates • Policy • Funding • Quality and Data Additional HRSA Resources

5. Primary Health Care Mission Improve the health of the Nation’s underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary health care services

6. Health Center Program Overview Calendar Year 2008 • 17.1 Million Patients • 92% Below 200% poverty • 38% Uninsured • 40% Racial Minority; 33% Hispanic • 934,000 Homeless Individuals • 834,000 Migrant/Seasonal Farmworkers • 157,000 Residents of Public Housing 67 Million Patient Visits • 1,087 Grantees – half rural • 7,500+ Service Sites • Over 113,000 Staff • 8,441 Physicians • 5,100 NPs, PA, & CNMs Source: Uniform Data System, 2008

7. Health Center Program National Presence

8. Health Center Performance Calendar Year 2008 Among Health Center Patients: 65% entered prenatal care in the first trimester Rate of low birth weight babies (7.6%) continues to be lower than national estimates (8.2%) 70% of children have appropriate immunizations 73% Diabetic Patients with HbA1c <= 9 62% Hypertensive Patients with Blood Pressure <= 140/90 $588 Cost per Patient; $129 per Visit For more information: http://www.bphc.hrsa.gov/about/performancemeasures.htm Source: Uniform Data System, 2008

9. Primary Health Care: Performance Focus Areas Grantee Satisfaction Staff Satisfaction Quality & Timelinessof Business Operations Impact (“So What?”)

10. 2009 Primary Health Care Grantee Satisfaction Survey: Results & Priorities Results: 2009 grantee satisfaction has improved seven points, up to 74, from 2008. Top Priorities for Improvement Identified: • Process : Streamlined application guidances; PIN TA calls • Technology: Integrated TA website. • Relationship/Partnership: More integrated and collaborative relationship with PCAs; Renewed emphasis on importance of PO visits to communities. • Communication: Grantee listservs; revamped BPHC website. • Training/Education: Coordinated training plan to include archiving, reference packets

11. New Jersey Health CentersCalendar Year 2008 Map and Data to be inserted New Jersey Health Center Grantees In 2008, 18 Health Centers Served 348,585 patients: • 42.5% were uninsured • 94.8% were at or below 200% of poverty • 61.8% Female • 59.2% nationally • 33.4% Children < age 18 • 32.8% nationally • 5.1% Seniors age 65+ • 7% nationally • Served by 248 clinical FTEs: • 181.3 Physicians • 66.6 Nurse Practitioners, Physician Assistants, and Certified nurse midwives Source: Uniform Data System, 2008

12. New Jersey Health CentersCalendar Year 2008 PERFORMANCE FUNDING $34.3 M base operational grants (FY09) $46.5 M ARRA grants $2.6 M – New Access Point $6.8 M – Increased Demand for Services $17 M – Capital Improvement Projects $20.1 M - Facilities Investment Program 75,815 of additional patients served via ARRA 34,594 of additional uninsured patients served via ARRA Among New Jersey Health Center Patients: • 57.4% entered prenatal care in the 1st trimester • Rate of low birth rate 7.1% • 74.3% of children have appropriate immunizations • 69.2% Diabetic Patients with HbA1c <= 9 • 58% Hypertensive Patients with Blood Pressure <= 140/90 • $505.84 Cost per Patient; $143.96 per Visit Source: Uniform Data System, 2008 and HRSA Health Center Quarterly Report, March 31, 2010.

13. New York Health CentersCalendar Year 2008 Map and Data to be inserted New York Health Center Grantees In 2008, 50 Health Centers served 1,283,511 patients: • 27.9% were uninsured and 85.7% were at or below 200% of poverty • 59.1% Female (59.2% nationally) • 32.1% Children < age 18 (32.8% nationally) • 6.7% Seniors age 65+ (7% nationally) • Served by 1187 clinical FTEs: 794.6 Physicians and 393.2 Nurse Practitioners, Physician Assistants, and Certified nurse midwives Source: Uniform Data System, 2008

14. New York Health CentersCalendar Year 2008 PERFORMANCE FUNDING $110.7 M base operational grants (FY09) $96 M ARRA grants $7.1 M – New Access Point $19.8 M – Increased Demand for Services $53.5 M – Capital Improvement Projects $15.6 M - Facilities Investment Program 86,236 of additional patients served via ARRA 30,435 of additional uninsured patients served via ARRA Among New York Health Center Patients: • 73% entered prenatal care in the 1st trimester • Rate of low birth rate 8.6% • 76.1% of children have appropriate immunizations • 74.2% Diabetic Patients with HbA1c <= 9 • 63.3% Hypertensive Patients with Blood Pressure <= 140/90 • $675.04 Cost per Patient; $146.42 per Visit Source: Uniform Data System, 2008 and HRSA Health Center Quarterly Report, March 31, 2010.

15. Puerto Rico Health CentersCalendar Year 2008 Map and Data to be inserted Puerto Rico Health Center Grantees In 2008, 19 Health Centers served 349,319 patients: • 16.8% were uninsured and 97.2% were at or below 200% of poverty • 57.4% Female (59.2% nationally) • 35.2% Children < age 18 (32.8% nationally) • 11.7% Seniors age 65+ (7% nationally) • Served by 253.6 clinical FTEs: 253.6 Physicians Source: Uniform Data System, 2008

16. Puerto Rico Health CentersCalendar Year 2008 PERFORMANCE FUNDING $41.9 M base operational grants (FY09) $39.4 M ARRA grants $2.6 M – New Access Point $5.1 M – Increased Demand for Services $17 M – Capital Improvement Projects $14.7 M - Facilities Investment Program 7,292 of additional patients served via ARRA 1,482 of additional uninsured patients served via ARRA Among Puerto Rico Health Center Patients: • 80.3% entered prenatal care in the 1st trimester • Rate of low birth rate 13.2% • 79.3% of children have appropriate immunizations • 71.3% Diabetic Patients with HbA1c <= 9 • 67.7% Hypertensive Patients with Blood Pressure <= 140/90 • $428.91 Cost per Patient; $97.41 per Visit Source: Uniform Data System, 2008 and HRSA Health Center Quarterly Report, March 31, 2010.

17. U.S. Virgin Islands Health CentersCalendar Year 2008 Map and Data to be inserted U.S. Virgin Islands Health Center Grantees In 2008, 2 Health Centers Served 5,981 patients: • 49.1% were uninsured • 97.4% were at or below 200% of poverty • 65.8% Female • 59.2% nationally • 44.5% Children < age 18 • 32.8% nationally • 10.3% Seniors age 65+ • 7% nationally • Served by 7.8 clinical FTEs: • 5.7 Physicians • 2.1 Nurse Practitioners, Physician Assistants, and Certified nurse midwives Source: Uniform Data System, 2008

18. U.S. Virgin Islands Health CentersCalendar Year 2008 PERFORMANCE FUNDING $1.6 M base operational grants (FY09) $1M ARRA grants $0 – New Access Point $.29 M – Increased Demand for Services $.71 M – Capital Improvement Projects $0 M - Facilities Investment Program 145 of additional patients served via ARRA 216 of additional uninsured patients served via ARRA Among U.S.V.I. Health Center Patients: • 56% entered prenatal care in the 1st trimester • Rate of low birth rate 9.3% • 67.4% of children have appropriate immunizations • 67.2% Diabetic Patients with HbA1c <= 9 • 67.5% Hypertensive Patients with Blood Pressure <= 140/90 • $832.50 Cost per Patient; $288.40 per Visit Source: Uniform Data System, 2008 and HRSA Health Center Quarterly Report, March 31, 2010.

19. Primary Health Care Updates Policy • Current/Anticipated Program Policies • The Affordable Care Act (ACA) Funding • Recovery Act (ARRA) Funding • FY 2010-11 Funding Quality and Data • FTCA • UDS Additional HRSA Resources

20. Current/Anticipated Policies • FINAL FQHC Look-Alike Guidance (September 2009) • FINAL Public Agency Status (February 2010) • Draft FTCA PIN Consolidation (May 2010) • Draft Governance (Spring 2010) • Draft Telehealth Policy (Spring 2010) • Draft Non-Traditional Facilities (Spring 2010) • Draft Sliding Fee Policy (Spring 2010) • Draft Sub-Recipient/Sub-Contract (Summer 2010)

21. Affordable Care Act • The Affordable Care Act (ACA) provides $11 billion in funding for the operation, expansion, and construction of health centers throughout the Nation. • This increased funding will double the number of patients seen by health centers over the next 5 years, making primary health care available for an additional 20 million people.

22. Affordable Care Act • Other key ACA provisions for health centers: • Teaching Health Centers • Funding for National Health Service Corps • Nurse-Managed Health Clinics • Community-Based Collaborative Care Networks • Medicare Payment Changes

23. Health Center ARRA Funding • Awarded $156 million to support 127 New Access Point (NAP) grants. • Awarded $342 million to support almost 1,130 grants for Increased Demand for Services (IDS). • Awarded $853 million to support over 1,120 grants for Capital Improvement Program (CIP). • Awarded $520 million to support 86 grants under the Facility Investment Program (FIP). • Anticipate awarding approximately $80 million for Health Center Controlled Networks in June 2010.

24. Health Center ARRA Outcomes • What have we accomplished so far? • Approximately 2 million new patients served • Over 1 million new uninsured patients served • Over 7,000 health center jobs created/retained • What’s next? • Upcoming HCQR-5 Manual and technical assistance calls (next report due July 10, 2010) • Continued project status monitoring • Review/release of outstanding grant conditions Source: HRSA Health Center Quarterly Report March 31, 2010

25. Funding Opportunities • FY 2010 Funding • No new competitive funding opportunities • FY 2011 Funding • President’s budget request includes a total increase of $290 million: • Continue New Access Points and Increased Demand for Services funding initiated under ARRA • New funding opportunities for: • New Access Points • Behavioral Health Service Expansion • Planning Grants (if funds permit)

26. Quality and Data Updates

27. FTCA Program Update • FTCA Consolidated Policy Manual • Released for public comment, available at http://www.bphc.hrsa.gov/draftsforcomment/ftcamanual/ • Consolidates, clarifies and synthesizes existing FTCA policy documents and statutory language • Formatted as a single resource “manual” • Application Review/Deeming in EHB • Started for CY 2010 FTCA Deeming/Redeeming Cycle • Submission, review, notification within EHB • System upgrades expected for the 2011 submissions (submitted in 2010) for greater efficiency 

28. UDS Reporting • Updates on CY 2010 UDS reporting that include revised definition for agriculture and additional of Hepatitis C testing, therapy and treatment on Table 6A. See http://www.bphc.hrsa.gov/policy/pal1004 • 2010 UDS Reporting Instructions/Manual will be issued in September. • UDS trainings will be conducted in Fall 2010; schedule will be posted at http://www.bphc.hrsa.gov/uds. Additional assistance available by contacting: BPHC Help Desk at 1-301-443-7356 or email at BHCMISYS@hrsa.gov UDS Help Desk at 1-866-837-4357 (866-UDS-HELP)or email at udshelp330@bphcdata.net

29. UDS Web Tools Available now: • Redesigned UDS website at: http://www.hrsa.gov/data-statistics/health-center-data/index.html. • Data analysis tools • Data download functionality • UDS Grantee/State/National Summaries • Health Center Trend Reports • State and National Roll-up Reports Coming soon (Summer 2010): • Webinar training on using new UDS webpage functionality

30. Additional HRSA Resources

31. New National Health Service Corps Resources & Opportunities • Never been a better time to recruit and retain clinicians through the National Health Service Corps (NHSC). • Clinicians are eligible to apply to the NHSC Loan Repayment Program on a rolling cycle and will be funded on a first-come first-served basis until July 29, 2010. • Clinicians working in NHSC‐approved sites with HPSA scores as low as zero have greater opportunities and access to funding than ever before in the history of the program. Visit www.nhsc.hrsa.gov for more details. • Listen to the recent TA Call on NHSC Opportunities for Health Centers: Instant replay of the TA Call available at 1-866-400-9641 See slides:  http://nhsc.hrsa.gov/loanrepayment/healthcentercall.ppt

32. Technical Assistance Resources • National and state-based support for training and technical assistance: • Primary Care Associations • Primary Care Offices • National Cooperative Agreements • Federal TA Support: • Project Officer • TA Calls • Onsite Consultant Support • BPHC Website For more information: http://www.bphc.hrsa.gov/technicalassistance/

33. HRSA’s Electronic Handbooks (EHBs) • Grantees must electronically submit requests to change grant-related information (Prior Approval requests) and post award submissions (Conditions and Reporting Requirements) to HRSA through the EHBs • HRSA will review and approve/disapprove requests through EHBs • Automated notifications will facilitate review and approval processes • All members of the grantee organization who are responsible for submitting prior approval requests or other post award submissions must register in the HRSA EHBs • Go to https://grants.hrsa.gov/webexternal/login.asp • If you have registered before, you do not have to register again. • Contact the HRSA Call Center if you do not remember your username or password Phone: 877-Go4-HRSA/877-464-4772;301-998-7373 (9:00 AM to 5:30 PM ET M-F) HRSA Electronic Handbooks URL: https://grants.hrsa.gov/webexternal/home.asp Email: callcenter@hrsa.gov

34. Other Topics…Thank You!Questions?

35. Gina Capra Director, Eastern Division U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care 5600 Fishers Lane Rm. 15-99 Rockville, MD 20857 Telephone: 301.594.4327 Email: GCapra@hrsa.gov