Transcript Federal Administrative Policy Update

New Mexico Primary Care Association
2011 Annual Meeting and Conference
Bureau of Primary Health
Care Update
June 16, 2011
Vanessa Shaw, MPH, MA
Chief, Central Valley Branch, Southwest Division
U.S. Department of Health and Human Services
Health Resources and Services Administration
Bureau of Primary Health Care
Today’s Presentation
National Overview
• Health Center Program Performance
• Primary Health Care Focus
New Mexico
• Impact
• Funding
Primary Health Care Updates
•
•
•
•
Organizational Structure
Policy
Funding
Quality and Data
Additional HHS and HRSA Resources
HRSA Priorities
2
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
3
Health Center Program Overview
Calendar Year 2009
18.8 Million Patients
 92% At or Below 200% Poverty





38% Uninsured
63% Racial/Ethnic Minorities
Over 1 Million Homeless Individuals
865,000 Migrant/Seasonal Farmworkers
165,000 Residents of Public Housing
73.8 Million Patient Visits
 1,131 Grantees – half rural
 7,900+ Service Sites
Over 123,000 Staff
 9,100+ Physicians
 5,700+ NPs, PA, & CNMs
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Source: Uniform Data System, 2009, Service Sites: HRSA Electronic Handbooks Scope Repository 12/31/2009
Health Center Program
National Presence
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Health Center Program Overview
National Impact
Source: Health Center Data: Uniform Data System, 2009. National Data: U.S. Census
Bureau, 2009 Current Population Reports and Current Population Survey.
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Health Center Performance
Calendar Year 2009
Among Health Center Patients:
• 67.3% entered prenatal care in the first trimester
• Rate of low birth weight babies (7.3%) continues to be lower than
national estimates (8.2%)
• 68.8% of children received all recommended immunizations by
2nd birthday
• 63.1% Hypertensive Patients with Blood Pressure<= 140/90
• 70.7% Diabetic Patients with HbA1c <= 9
• $600 Total Cost per Patient
• $131 per Medical Visit
For more information: http://www.bphc.hrsa.gov/policiesregulations/performancemeasures/index.html
Source: Uniform Data System, 2009
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Health Center Performance
2009 Health Center Patient Survey
o Over 80% reported the overall quality of services
received at the health center were “excellent” or
“very good.”
o Over 80% reported that they were “very likely” to
refer friends and relatives to the health center.
o Over 75% reported the main reason for “going to
the health center for healthcare instead of
someplace else” was because it was convenient
(28%), affordable (25%), and provided quality
healthcare (22%).
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Primary Health Care
Measures of Success
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Primary Health Care
Drivers of Success
• Technical Assistance and Support
• Grantee - Project Officer Relationship
• Application Guidance and Electronic Support
• Management and Administrative Support
• Decision Support and Work Environment
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New Mexico State Health Centers
Calendar Year 2009
New Mexico State Health Center
Grantees
Map and Data to be
inserted
In 2009, 15 Health Centers
Served 274,397 patients:
•
•
•
•
•
•
Source: Uniform Data System, 2009
37.45% were uninsured
89.03% were at or below 200% of
poverty
57.06% Female
•
58.90% nationally
27.51% Children < age 18
•
32.78% nationally
10.92% Seniors age 65+
•
6.89% nationally
Served by (FTEs):
–
–
122.96 Physicians
95.27 Nurse Practitioners, Physician
Assistants, and Certified Nurse Midwives
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New Mexico State Health Centers
Calendar Year 2009
PERFORMANCE
Among New Mexico State Health Center
Patients:
•
•
•
•
•
•
65.08% entered prenatal care in the 1st
trimester
Rate of low birth rate: 5.79%
70.24% of children have received all
recommended immunizations by second
birthday
77.54% Diabetic Patients with HbA1c <= 9
68.75% Hypertensive Patients with Blood
Pressure <= 140/90
$621.73 Cost per Patient; $153.43 per
Visit
Source: Uniform Data System, 2009 and HRSA Health
Center Quarterly Report, March 31, 2011.
FUNDING
• $37.99 M base operational
grants (FY ‘09)
• $19 M in ARRA grants
•
•
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•
$4.96 M – Increased Demand for
Services
$12.82 M – Capital Improvement
Projects
$1.22 M - Facilities Investment
Program
45,533 additional patients served
via ARRA
29,319 additional uninsured patients
served via ARRA
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Primary Health Care Updates
Organizational Structure
Policy
• Recent Program Policies
• Anticipated Program Policies
Funding
• American Recovery and Reinvestment Act
• Affordable Care Act
• Fiscal Year 2011 Funding and FY 2012 President’s Budget
Quality and Data
• Medical/Health Home Initiative
• FTCA and Patient Safety/Risk Management
• UDS
Additional HHS and HRSA Resources
HRSA and BPHC Priorities
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Organizational Structure Updates
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Bureau of Primary Health Care
New Structure Purpose and Goals
• Build on current structure but prepare for program
growth
• Promote integration of BPHC’s service delivery
programs
• Improve coordination of internal and external
technical assistance and training activities
• Provide increased administrative service and
support for grantees and staff
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Bureau of Primary Health Care
New Organizational Structure
OFFICE OF THE
ASSOCIATE ADMINISTRATOR
Office of
Administrative
Management
Northeast
Division
Office of
Policy and Program
Development
Office of
Quality and Data
Central Southeast
Division
North Central
Division
Office of
Special
Population Health
Southwest
Division
Office of
Training &Technical
Assistance
Coordination
Division of
National Hansen’s
Disease Program
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New Organizational Structure:
Primary Health Care Divisions
• Transition from Three to Four Divisions
• Project Officers for:
– Health Centers
– State/Regional Primary Care Associations
– FQHC Look-Alikes
• Technical Assistance and Support
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New Organizational Structure:
Primary Health Care Divisions
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Southwest Division
Regions: 6 and 9
Division Director: Angela Powell
Operations Director: Cynthia Phillips
• Five Branches:
– Central Southwest Branch: Texas
– Central Valley Branch: Arizona, Central
California and New Mexico
– East Southwest Branch: Arkansas, Louisiana
and Oklahoma
– North Pacific Branch: Nevada and Northern
California
– South Pacific Branch: Southern California,
Hawaii and the Pacific Islands
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Policy Updates
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Recently Released Policies
• Process for Becoming Eligible for Medicare
Reimbursement under the FQHC Benefit
• Health Center Collaboration
• FINAL Federal Tort Claims Act (FTCA) Health Center
Policy Manual
• HRSA Patient-Centered Medical/Health Home Initiative
• HIV Testing in Health-Care Settings
• Free Clinics Federal Tort Claims Act (FTCA) Program
Policy Guide
To Access these and other policies, visit:
http://www.bphc.hrsa.gov/policiesregulations/policies/index.html
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2011 Anticipated Policy Topics
• FINAL Requirements for Medical Malpractice Coverage for
Free Clinics (Spring 2011)
• FINAL Governance (Spring 2011)
• DRAFT Change in Scope for Non-Traditional Facilities
(Spring 2011)
• DRAFT Sliding Fee Discount Program (Summer 2011)
• DRAFT Sub-Recipients/Sub-Contracts (Fall 2011)
• DRAFT Quality Improvement/Assurance (Fall 2011)
Final and draft policies open for comments will be posted at:
http://www.bphc.hrsa.gov/policiesregulations/policies/index.html
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Funding Updates
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American Recovery and Reinvestment Act
Health Center Awards to Date
• 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).
• Awarded $121 million for 99 grants to expand Health
Information Technology (HIT).
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American Recovery and Reinvestment Act
Health Center Program Outcomes
• What have we accomplished so far?
o 4.3 million patients served
o More than 2.4 million uninsured patients served
• What’s next?
o 1,600+ New or Improved Health Center Sites
o 650+ Health Centers with new equipment or health
information technology systems
o 380+ Health Centers with new/enhanced certified
EHRs
Source: HRSA Health Center Quarterly Report March 31, 2011
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Affordable Care Act:
Support for Health Centers
• The Affordable Care Act provides $11 billion in funding over
the next 5 years for the operation, expansion, and
construction of health centers throughout the Nation.
• $9.5 billion is targeted to:
– Support ongoing health center operations.
– Create new health center sites in medically underserved
areas.
– Expand preventive and primary health care services,
including oral health, behavioral health, pharmacy, and/or
enabling services, at existing health center sites.
• $1.5 billion will support major construction and renovation
projects at community health centers nationwide.
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Affordable Care Act:
Other Key Health Center Provisions
o National Health Service Corps and Workforce
Programs
o Teaching Health Centers
o School-Based Health Centers
o Negotiated Rulemaking for Shortage Designation
o Community-Based Collaborative Care Networks
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Fiscal Year 2011 Funding
 The appropriation for the Health Center Program in Fiscal
Year (FY) 2011 is $1.585 billion which is a $600 million
reduction from FY 2010.
 When combined with the Affordable Care Act funding, the
overall amount available for health centers in FY 2011 is
approximately $400 million above the 2010 fiscal year
funding level.
 Includes continued support for the 127 health center sites
and more than 1,100 Increased Demand for Services grants
initially established through the Recovery Act.
 The U.S. Department of Health and Human Services (HHS)
reviewed its operating plan and has made adjustments.
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Fiscal Year 2012
President’s Budget
 $3.3 billion for Health Centers, including $96
million for FTCA coverage
 $50 million for School-Based Health Center Capital
grants
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Quality and Data Updates
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Patient Centered Medical/
Health Home (PCMHH) Initiative
• Encourages and supports health centers to transform their practices
and participate in the PCMHH recognition process to:
– improve the quality of care and outcomes for health center populations;
– increase access; and
– provide care in a cost effective manner.
• HRSA/BPHC will cover recognition process fees and provide
technical assistance resources for practice transformation.
• Participation is strongly encouraged and provides an opportunity for
health centers to achieve PCMH recognition.
For further information on the PCMHH Initiative:
•
PCMHH Initiative PAL:
http://www.bphc.hrsa.gov/policiesregulations/policies/pal201101.html
•
BPHC Helpline: [email protected] or 1-877-974-BPHC (2742)
•
PCMHH email: [email protected]
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FTCA Program Updates
• FTCA Consolidated Policy Manual
o Primary source for information on FTCA grantees
and related stakeholders
o Consolidates, clarifies and synthesizes existing
FTCA policy documents and statutory language
o Available at:
http://bphc.hrsa.gov/policiesregulations/policies/pin201101.html
• Application Review/Deeming in EHB
o 2011 Requirements for FTCA Deeming available in PAL
2010-06:
http://www.bphc.hrsa.gov/policiesregulations/policies/pal201006.html
o For TA on submitting FTCA Applications in EHB contact:
Email: [email protected] Phone: 1-877-974-2742
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Risk Management and
Patient Safety Web Resources
ECRI risk management and patient safety resources are
available to Health Center Program grantees and Free
Clinics at no cost. Resources include:
• Risk management courses
• Continuing medical education (CME) credits at no cost to
health care providers
• Links to archived audio-conferences/webinars to supplement
evidence-based risk management training
• Guidance articles, self-assessment tools, ready-made training
materials on patient safety, quality and risk management for
the health center and free clinic setting
• Risk & Safety E-news
Visit: www.ecri.org/clinical_RM_program.
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2011 UDS Reporting
New/revised 2011 clinical measures approved January 3, 2011.
New Measures:
1. Weight Assessment and Counseling for Children and
Adolescents
2. Adult Weight Screening and Follow-up
3. Tobacco Use Assessment and Cessation Counseling
4. Asthma – Pharmacological therapy
Revised Measures:
1. Diabetes HbA1c Control
2. Childhood Immunizations 2 years
Review PAL 2010-12 for additional details:
http://www.bphc.hrsa.gov/policiesregulations/policies/pdfs/pal201012.pdf
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UDS Web Tools
UDS Website:
http://www.hrsa.gov/data-statistics/health-center-data/index.html.
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•
o Data analysis tools
o Data download functionality
UDS Grantee/State/National Summaries
Health Center Trend Reports
State and National Roll-up Reports
Reporting and Training Resources
UDS Mapper: www.udsmapper.org
• HRSA has developed a mapping and support tool driven
primarily from data within the Uniform Data System (UDS)
• Webinar trainings on using Mapper functionality available:
http://www.udsmapper.org/webinars.cfm
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Additional HHS and HRSA
Resources
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Partnership for Patients:
Better Care, Lower Costs
New HHS-supported public-private partnership that will
help improve the quality, safety and affordability of health
care for all Americans.
Goals:
• Keep patients from getting injured or sicker.
• Help patients heal without complication.
Partners include:
• Hospitals and national organizations representing
physicians and nurses;
• Patient and consumer organizations; and
• Employers, unions, health plans and States.
For more information visit:
www.HealthCare.gov/center/programs/partnership
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Technical Assistance (TA)
Resources
• National and state-based support for training and
technical assistance:
o Primary Care Associations
o Primary Care Offices
o National Cooperative Agreements
• Federal TA Support:
• Project Officer
• TA Calls/Trainings
• Onsite Consultant Support
• BPHC TA Website
For more information visit the NEW BPHC TA Website:
http://www.bphc.hrsa.gov/technicalassistance/index.html
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Competing and Non-Competing
Continuation Technical Assistance
• Budget Period Progress Report (BPR)
Technical Assistance:
http://www.bphc.hrsa.gov/policiesregulations/continuation/index.html
• Service Area Competition (SAC)
Technical Assistance:
http://www.hrsa.gov/grants/apply/assistance/sac/
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Bureau of Primary Health Care
Help Line
Single point of contact to assist grantees and stakeholders
with information in the following areas:
• BHCMIS – System in EHB (Electronic Handbook)
• Health Center Quarterly Reporting (HCQR)/ARRA 1512
• Reporting Uniform Data System (UDS)
• Federal Torts Claims Act (FTCA) for Health Centers and
Free Clinics
Phone: 1-877-974-BPHC (2742)
Email: [email protected].
Available Monday to Friday (excluding Federal holidays),
from 8:30 AM – 5:30 PM (ET), with extra hours available
during high volume periods.
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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
o HRSA will review and approve/disapprove requests through EHBs
o 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
o Go to https://grants.hrsa.gov/webexternal/login.asp
o If you have registered before, you do not have to register again.
o 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: [email protected]
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HRSA Priorities
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FY 2011 HRSA Strategic Priorities
• Improve Access to Quality Health Care and Services
– Community/new site development
– Expansion planning
– Patient-centered medical/health home development
• Strengthen the Health Workforce
– Workforce recruitment and retention
– Meaningful use adoption
• Build Healthy Communities and Improve Health Equity
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Health Center Program Overview
Calendar Year 2016
Million Patients
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

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

% At or Below 200% Poverty
% Uninsured
% Racial/Ethnic Minorities
Homeless Individuals
Migrant/Seasonal Farmworkers
Residents of Public Housing
Million Patient Visits


Over


Source: Uniform Data System, 2016
Grantees –
rural
Service Sites
Staff
Physicians
NPs, PA, & CNMs
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Thank You!
Questions?
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Vanessa Shaw, MPH, MA
Chief, Central Valley Branch, Southwest Division
U.S. Department of Health and Human Services
Health Resources and Services Administration
Bureau of Primary Health Care
5600 Fishers Lane Rm. 16C-26
Rockville, MD 20857
Telephone: 301.594.4282
Email: [email protected]
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