Kentucky Primary Care Association

Legislative UpdateMay 17, 2019

Overview: Session OverviewLegislation & Issues- Federal ReportLooking Ahead

Red Shirts & Rage

Session OverviewBy the Numbers:- House Controlled by GOP 61-39- Senate Controlled by GOP 29-9

2019 Regular Session - “Short” 30-day Session—Organizational Session- Convened January 8 & Adjourned March 28- New Laws Become Effective June 27

-Top Issues: School Safety, Pension Reform, Tax Reform, School Safety & Social Issues- Organizational Session

Session Overview - OrganizationHouse

GOP Leaders- Speaker Osborne- Speaker Pro-Tem Meade- Majority Floor Leader Carney- Majority Caucus Chair Miles- Majority Whip McCoy

Democrat Leaders- Minority Floor Leader Adkins- Minority Whip Jenkins- Minority Caucus Chair Graham

Senate

GOP Leaders- President Stivers- President Pro-Tem Givens- Majority Floor Leader Thayer- Majority Caucus Chair Adams- Majority Whip Wilson

Democrat Leaders- Minority Floor Leader McGarvey- Minority Caucus Chair Turner- Minority Whip Parrett

House Health & Family Services- 19 members, 8 are freshmen

Kimberly PooreMoser - (H) - ChairDanny Bentley - (H) Tina Bojanowski - (H) Adam Bowling - (H) George Brown Jr - (H) Tom Burch - (H) Daniel Elliott - (H) Deanna Frazier - (H) Robert Goforth - (H) Joni L. Jenkins - (H) Scott Lewis - (H) Mary Lou Marzian - (H)

Melinda Gibbons Prunty – (H)Josie Raymond – (H)Steve Riley – (H)Steve Sheldon – (H)Nancy Tate – (H)Russell Webber – (H)Lisa Willner – (H)

Senate Health & Welfare

● Ralph Alvarado - (S) - Chair● Stephen Meredith - (S) - Vice Chair● Julie Raque Adams - (S) ● Tom Buford - (S) ● Danny Carroll - (S) ● Julian M. Carroll - (S) ● David P. Givens - (S) ● Denise Harper Angel - (S) ● Alice ForgyKerr - (S) ● Morgan McGarvey - (S) ● Max Wise - (S)

Session Overview - Political Overview

- Teacher Unrest Continues- House Seat Contested- Major Pension Reform Never Considered- Quasi Pension Reform Controversy

Red Shirts & Rage—Part 2

2019 Session Issues - Lead Issues

Big Issues

SB 1/HB 1 - School Safety

HB 354/HB 458/HB 268 -Budget/Taxes

HB 358 - Quasi-entity Pension Reform

Business Issues - Passed

SB 7 - Arbitration Clauses - Employment Contracts

HB 4 - Administrative Regulation Reform

SB 18 - Accommodation for pregnancy/childbirth

SB 57 - Felony Expungement Expansion

Big Issues - Failed

SB 2 - Allow for venue change on civil actions

SB 3 - School council reforms

SB 5 - Move the state elections to even years

HB 3 - Public assistance reforms

2019 Session—Healthcare—MCO’s v. Providers;Public Health & CHFS Re-Org.

2019 Session Issues – Providers v. MCO’s

Bills - Passed

-SB 54 – Prior Authorization

-SB 110 – Credentialing Organizations

- SB 149 – Multiple External Reviews

Bills - Failed

-SB 139—Pharmacy

-SB 42 – Limit MCO’s

-SB 112 – Medicaid Co-payments

2019 Session Issues – CHFS Re-Org

Bills - Passed

-SB 167 – Health Info & Analytics

-SB 182 – Licensure & CON

-HB 513 – Substance Use Disorder

Bills - Failed

-SB 181 — Misc. re-org.

2019 Session Issues - Public Health

Bills - Passed

-HB 11 – Tobacco Use & Schools

-SB 30 – Colon Cancer Screening

-SB 18 – Accommodations for Pregnancy/Childbirth

-SB 84 – Licensure of midwives

Bills - Failed

-SCR 154 – Hep A Response

-HB 136 - Authorizing Medical Marijuana

-Several Bills to tighten age requirements, tax or otherwise restrict tobacco & vaping.

- Where we are now● Special Session on Pensions on the Horizon● Relationship between Governor and General Assembly● Statewide Elections: Primary on May 21

Looking Ahead

FOR IMMEDIATE RELEASE: April 4, 2019 CONTACT: Barrasso Press Office (Barrasso) – (202) 224-6441 Molly Morrisey (Smith) – (202) 224-9857

Barrasso, Smith Introduce Bipartisan Rural Health Clinic Modernization Act

Bill provides regulatory relief for rural health clinics and improves reimbursement rates.

WASHINGTON, DC –Today, U.S. Senators John Barrasso (R-WY) and Tina Smith (D-MN) introduced the bipartisan Rural Health Clinic Modernization Act (S. 1037). The bill provides regulatory relief for rural health clinics while also improving reimbursements for these important facilities. “As a doctor from a rural state, I want all patients to have access to high-quality care wherever they live,” Sen. Barrasso said. “Rural health clinics have a long record of making sure that folks in rural communities receive primary care close to home. I am proud to help lead this bipartisan effort to strengthen rural health clinics so they will continue to serve patients in Wyoming and across rural America.” “We need to do everything we can to make sure that people in rural areas are able to get healthcare,” Sen. Smith said. “While there have been significant changes in the health care system, many of the laws focusing on Rural Health Clinics haven’t been updated in over 40 years. Our bipartisan bill would fix some of the old rules that are in need of these upgrades. For example, it expands the ability of physician assistants and nurse practitioners to provide care in these clinics. This legislation is really about making sure at the end of the day people are going to be able to get the vital care Rural Health Clinics provide in underserved, rural areas.” Rural Health Clinics (RHCs) were established through the Rural Health Clinic Services Act of 1977. The purpose of RHCs was to address the shortage of health care providers serving in rural communities, including advanced practice clinicians. There are approximately 4,100 rural health clinics operating in the United States. Rural Health Clinics are an important part of the rural health care safety net, with facilities heavily dependent on Medicare and Medicaid reimbursement.

RHC Modernization Act– What does it do?

Designed to pass, not to make a statement. Uncontroversial and cost free provisionsSec. 2 ~ Modernizing Physician, Physician Assistant, and Nurse Practitioner Utilization Requirements.

Modernizes physician supervision requirements in RHCs by aligning scope of practice laws with state law. Allows PAs and NPs to practice up to the top of their license without unnecessary federal supervision requirements that apply only because the PA or NP is practicing in a RHC. Sec. 3 ~ Removing Outdated Laboratory Requirements

Removes a requirement that RHCs maintain certain lab equipment on site, and allows RHCs to satisfy this certification requirement if they have prompt accessto lab services. Sec. 4 ~ Allowing Rural Health Clinics the Flexibility to Contract with Physician Assistants and Nurse Practitioners.

Removes a redundant requirement that RHCs employ a PA or NP (as evidenced by a W2) and allows RHCs to satisfy the PA, NP, or CNM utilization requirements through a contractual agreement if they chose to do so.

Sec. 6 ~ Including Facilities Located in Certain Areas

Gives states authority to designate areas as rural for purposes of the RHC program.

RHC Modernization Act of 2019 – What does it do?Cost Provisions Sec. 5 ~ Allowing Rural Health Clinics to be the Distant Site for a Telehealth Visit.Allows RHCs to offer telehealth services as the distant site (where the provider is located) and bill for such telehealth services as RHC visits. Sec. 7 ~ Raising the Cap on Rural Health Clinic Payments.

Increases the upper limit (or cap) on RHC reimbursement to:

-$105 in 2020

-$110 in 2021

-$115 in 2022

-And by MEI each year thereafter.

What is the ask?● Please cosponsor the RHC Modernization Act of 2019

First signed into law by President Jimmy Carter in 1977, the RHC program was designed to improve access to health care in rural,underserved areas. Over forty years later, we are happy to report that there are approximately 4,400 RHCs, providing quality care to rural and underserved patients. However, the program is in desperate need of modernization if we are to succeed for another forty years.The rural health clinic reimbursement model is supposed to be based on costs, but due to the increasingly burdensome and outdated statutory language regarding the upper limit (often referred to as the cap), some rural health clinics are reimbursed far below their actual costs to deliver care. Since 2012, 388 rural health clinics have closed impacting around 3.87 million residents’ access to care.These closures are primarily driven by this inadequate and arbitrarily low cap on reimbursement. The Rural Health Clinics Modernization Act of 2019 makes vital changes to Medicare reimbursement policy by increasing this upper limit to a level that better reflects the cost of delivering care in rural America. If we cannot fix this policy, we fear that manymore RHCs will close and millions more residents will lose access to care. The Rural Health Clinics Modernization Act of 2019 also addresses certain outdated aspects of the RHC statute and Conditions forCertification (CfC) that are currently written with a 1977 understanding of medicine. These changes include:

○ aligning federal scope of practice laws for Physician Assistants and Nurse Practitioners with state scope of practice laws;

○ modernizing the currently-outdated lab and “emergency kit” requirements; and

○ allowing RHCs to be the distant-site in a telehealth visit.Together, these provisions will strengthen the RHC program and better enable RHCs to continue their mission of providing health care in the rural and underserved regions of our country.

NACHC’s 2019 Legislative Agenda

Community Health Center Funding – Mandatory

Community Health Center Funding – Appropriations

Workforce Program Extensions – National Health Service Corps and Teaching Health Centers program

Other Key Issues, including 340B, Medicaid, Behavioral Health and Telehealth

Community Health Center Funding

In 2015 & 2018, CHC advocates succeeded in getting 2-year extensions (Gray & Green )

CHCs were only funded through the annual budget prior to 2010 (Blue)

2010: Congress created a dedicated 5-year fund for growth in CHCs (Orange)

• Required spending, unless Congress changes the law• Special 5-year, $11 billion fund created in ACA to boost health center

capacity• Extended twice since 2010, each time for two years (in MACRA & BBA) • Currently $4.0 billion/year (FY19)• Will expire September 30, 2019 without Congressional action

Community Health Center Fund“Mandatory” funding

Arguments for Early Action

● Without sustainable and predictable funding, health centers will continue to experience operational and service related impacts, placing our patients’ care in jeopardy.

● For example, at my health center…(tell your local story about recruitment challenges, layoffs, cutbacks on programs and services, etc.)

● Health centers are small businesses and need to be able to plan for the future, we cannot wait until the last minute to know whether or not the funding will be there.

What is Our Ask?

We need Members of Congress to cosponsor at least one bill to extend long term and stable funding:- CHIME (S. 106/ H.R. 2328)- Senate HELP (S. 192)- Sanders-Clyburn bill (S. 962/H.R. 1943)

Advocacy Push:Go to www.hcadvocacy.org/takeaction

Appropriations

• Annual process, up to Congress (Appropriations Committees) to determine amount

• Congress currently working on 12 FY20 appropriations bills – our funding is including in the Labor, Health and Human Services, Education and Related Agencies Bill (Labor-HHS)

• Prior to ACA, this was the only source of federal grant funding for Health Center Program

• Currently $1.63 billion/year (FY19)

“Discretionary” Funding

Appropriations Season Success!

• House letter closed at 278 signatures on March 28

• Senate letter closed at 68 signatures on April 5

• House Appropriations draft bill contains additional $50 million for CHCs to ramp up HIV prevention via PrEP –Stay tuned for more from the

Online Resources

State and Congressional District Maps, State Fact Sheets

NACHC WebpageNACHC Blog

NACHC Policy Papers

NACHC Fact Sheets

For these and other materials, go to www.nachc.org/policy-matters

Questions???