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RIHCA - Rhode Island Health Center Association

Public Policy - Federal Legislation

National Health Reform 2010

The Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act (Reconciliation Act) signed into law on March 23rd, 2010 by President Barack Obama together comprise the 2010 health care reform package

Oublic Policy Federal

The community health centers are poised to be central to the implementation of national health reform.  Our commitment and experience in providing primary care positions our health centers to be at the center of national health reform as it unfolds here in Rhode Island.  The legislation includes numerous provisions that impact community health centers both directly and indirectly, and makes significant changes to health care access and cost that will affect many Rhode Islanders. 
As of July 1, 2010: The new healthcare.gov website is up and running.  The website allows consumers to identify health insurance options, compare among available plans, and better understand the new law. 

Key Provisions of the Health Care Reform:

  • An individual mandate requiring most Americans to enroll in a qualified health plan, including public, private, or an Exchange based plan
  • Expansion of Medicaid eligibility for adults with income up to 133% of the federal poverty line by 2014 and stipulations requiring states to maintain eligibility levels for Medicaid and CHIP covered children through 2019
  • Gradual closure of the prescription drug coverage gap for Medicare Part D beneficiaries until the patient responsibility for all prescription drugs is capped at 25% in 2020
  • Abolition of the out-dated Medicare payment cap on reimbursements to federally qualified health centers and expansion of list of covered Medicare benefits for health center patients to include all the preventative services that Medicare covers for patients of other types of health care facilities
  • Creation of state-based American Health Benefit Exchanges, the marketplaces where uninsured individuals can evaluate a variety of federally qualified private plans and purchase affordable, high quality insurance that must contract with the community health centers
  • New regulations requiring full coverage of all preventative services and prohibiting premium discrimination based on gender or health status, exclusion due to pre-existing conditions, and imposition of lifetime or annual benefit caps
  • Increase in the funding of community health centers by $11 billion over the next five years to expand operational capacity, improve the behavioral, oral, and medical services provided by the health centers, and both expansion of existing sites and construction of new locations

  • Read more about the general provisions of health reform

Community Health Centers Provisions: 

Allocation of $11 billion dollars in additional funding to the Health Centers from FY2010 through 2015

  • Assigns $9.5 billion for health center program expansion and improvement, including doubling of the total health center patient capacity to an estimated 40 million patients by 2015
  • Remaining  $1.5 billion dedicated to assist with capital demands faced by the health centers, including the improvement of existing facilities and construction of new sites
  • Continued funding beyond FY2015 will be determined by health center costs and patient population

All qualified Insurance Exchange plans required to contract with community health centers (and all essential community providers)

  • Community health centers will be reimbursed by the private plans at a rate at least equal to the Medicaid reimbursement rate, allowing the health centers to continue to provide high quality, affordable care to a growing number of patients

Expansion of the list of preventative services covered by Medicare at community health centers to include all services covered at other types of facilities

Establish a new Medicaid reimbursement system for community health centers modeled after the Medicaid Prospective Payment System

  • New payment system determines an initial reimbursement based on the health centers’ two year average of providing care to Medicare patients and allows payment adjustment based on duration, intensity, and type of care
  • Eliminates outdated Medicare payment caps and requires CMS to create an annual update method to ensure outdated payment rates do not lead to financial losses for health centers

Recent analysis from the Geiger Gibson/RCHN Community Health Foundation Research Collaborative found increased access to and utilization of primary care at health centers will result in $238 billion in overall medical savings, including $61 billion in federal Medicaid spending. Cost savings associated with increased utilization of primary care is attributed to reductions in ambulatory and hospital-based care. Find the full report here: Strengthening Primary Care to Bend the Cost Curve: The Expansion of Community Health Centers through  Health Reform

Additional resources related to Community Health Centers and the 2010 Health Reform package:

Additional resources related to the health reform:

The American Recovery and Reinvestment Act

The economic stimulus package, has passed both the House and Senate and was signed into law Tuesday, February 17, 2009. The law provides funding for Community Health Centers to increase capacity, create jobs, improve infrastructure, and adopt electronic health records.

  • $1.5 billion in funding for community health center infrastructure needs, including information technology, for 330-funded Federally Qualified Health Centers (FQHCs), distributed through HRSA.
  • $500 million for “services provided by community health centers.” Funding for “currently unfunded but approved community health center applications” is likely, as well as funding for new sites and services areas, funding to increase services at existing sites, and to provide additional payments for increases in uninsured patients.
  • Investment in information technology may now be paid through new Medicaid incentives. Payments would be up to 85% of $75,000 per eligible provider over 6 years.
  • $500 Million over for primary care workforce investments. $300 million is for the National Health Service Corps; $200 million is for Title VII Health Professions and Title VIII Nurse Training programs.
  • Medicaid funding increased by $87 billion over two years, by increasing the federal portion of the Medicaid match (FMAP). Rhode Island is expected to get about $470 million from this adjustment.

Children’s Health Insurance Program (CHIP)

Reauthorization Act of 2009 (CHIPRA 2009) was enacted on February 4, 2009. This law reauthorizes the Children’s Health Insurance Program (CHIP). Some key provisions allow for increased federal funding and the ability to expand covered populations:

  • Increased federal match, so less state money required for match.
  • States can decide to include coverage for immigrant children who are legal permanent residents but who have been here less than 5 years.
  • States can expand coverage to include families with income up to 300% of the federal poverty guidelines (FPG).
  • Health centers would be eligible to apply for a demonstration grant program for community-based activities related to reducing childhood obesity, strengthening quality of care and health outcomes.

National Resources