FQHC LINK

An Opinion – Advocate for Universal Health Care

John Ruiz — Thu, 23 Feb 2012 16:47:43 +0000

Surely if we can find money to pay for wars we should be able to find funds to pay for universal health care. Just as President Johnson declared a war on poverty, we need to declare a war on the lack of health coverage for all. We are almost there; Medicare, Medicaid, and CHIP are models for the solutions we seek. Issue one: Profit driven increase in health care costs. Issue two: Healthcare workforce equity. Issue three: Culture change that recognizes health care as a basic human right. Setting medical loss ratio, shared savings models, and open market health exchanges are but small partial answers to the current fragmented health care system until we implement the real long term solution: Universal Health Care. We must lay the groundwork and lead the way, start talking to your Senators and Congresspeople today. Do it for yourself,do it for your children, do it for your grandchildren, do it for our future citizens. Let us be the greatest generation ever. Advocate for Universal Health Care!

NEW – So what the Heck is an ACO?

John Ruiz — Fri, 17 Feb 2012 14:58:33 +0000

An Animated Conversation About ACOs. Accountable Care Organizations are a continuing source of interest to both health care providers and consumers. Kaiser Health News calls them “the hottest three-letter word in health care.” Now WBUR’s CommonHealth blog has put together a video animation that walks viewers through how ACOs work and what that means for consumers. The blog promises that this is only the first installment of what they’re calling “Wonk Cinema.” Enjoy.

What’s New – New Analysis and Interactive Tool from the Kaiser Family Foundation Illustrate Variations in How Coverage Expansions Will Affect Local Communities

John Ruiz — Wed, 15 Feb 2012 20:54:58 +0000

The interactive tools includes a calculator that allows individuals and families to estimate how much they could receive in tax credits under the ACA to help pay for their insurance in the health insurance exchanges in 2014. The zip code interactive tool allows users to enter in their zip codes and see the percentage of people in their communities who could be helped by subsidies to help pay for private insurance or eligible for Medicaid starting in 2014 under the ACA.

The new analysis reveals wide variation across local communities in the share of the population that could benefit from coverage expansion in the Affordable Care Act (ACA) starting in 2014. In parts of Florida, New Mexico, Texas, Louisiana, and California, as much as 40% of the non-elderly population could benefit from the expansion of Medicaid or through tax credits to help purchase coverage in the new health insurance exchanges. By contrast, many parts of states such as Massachusetts, Hawaii, New York and Connecticut – which already have high levels of employer-sponsored insurance or reforms that make coverage more accessible and affordable – will see as little as 2% of the population benefitting from the ACA’s coverage expansion. More here

Breaking News CMS will re-examine ICD-10 timeline

John Ruiz — Wed, 15 Feb 2012 04:56:49 +0000

Modern Healthcare.com reports the acting head of the CMS on Tuesday signaled that the agency will extend the timeline on ICD-10 implementation. After speaking to attendees at the American Medical Association Advocacy Conference in Washington, acting CMS Administrator Marilyn Tavenner told reporters that the CMS will “re-examine the timeframe” through a rulemaking process. She did not say when that rulemaking process will begin but said the CMS would send details about the process in the coming days.

“There’s concern that folks cannot get their work done around meaningful use, their work around ICD-10 implementation and be ready for exchanges,” Tavenner said. “So we’re trying to listen to that and be responsive.”

NEW must read !!– HRSA announces new caps for salary amounts charged to HRSA funds for HRSA funded projects. NEW Feb 11 – Contains language and examples from the most recent FY 2012 SAC for AA.

John Ruiz — Fri, 10 Feb 2012 18:07:54 +0000

The amount of an individual’s salary charged to a HRSA funded project is capped at $179,700 per year. While the announcement does not limit the salary amount paid by an organization from other funding sources, it does have implications for financial budgeting and reporting. The announcement, implications, and recommendations follow.

As posted on the HRSA EHB: Per the Consolidated Appropriations Act, 2012 (P.L. 112-74) H.R. 2055 -297 enacted December 23, 2011, HRSA funds from this Act may not be used to pay the salary of an individual at a rate in excess of $179,700 per year (the Executive Level II salary of the Federal Executive Pay scale). If your organization has received HRSA funds from this Act and your HRSA project includes a salary that exceeds the rate of $179,700 per year, please contact the project officer and/or grants management specialist listed in your notice of award. Please note, the salary limitation also applies to personnel working part-time on a HRSA project. For example, if an individual works 50% of their time on the HRSA project, the salary rate limitation is $89,850.

Implications:

Total Budget concept. Currently Health Centers funding applications are structured using a “total budget” concept where the applicant specifies funds requested as both federal and non-federal revenue sources on forms 424 and 424A for the scope of project included in the application. Similarly, applicants are also required to identify all non- federal revenue sources indicated on the income analysis form (patient charges, third party revenues, and other sources). The expectation is that federal and non-federal revenues are utilized to cover the costs of the program operations. Given that there is not a clear delineation in the application of how those revenue sources (federal and non-federal) will be applied to specific expenditures within the budget presented for the project scope, to date funded FQHCs have had some flexibility to allocate federal funds for specific costs associated with the program expenditures.

Recommended actions:

Independent of the “total budget” concept, these changes in the law will require health centers to demonstrate compliance with the new law regarding limitations on salaries charged to HRSA funded projects. Barring any changes HRSA may make to the Section 330 budget application, or subsequent reporting, it will be incumbent on FQHCs to ensure their auditor is aware of the changes in the law for compliance with circulars A-133 and A-122 of their annual financial audits. It is also recommended that FQHCs seek appropriate financial guidance with expert consultants to both ensure appropriate application of the law and documentation to demonstrate compliance.

For the Specific Language in the Law: H.R. 2055 -297 sec. 203

New Feb. 11, 2012 – Language Found in the Most Recent Service Area Competition (HRSA -12-169) FY 2012 SAC AA

iii. Budget (page 19)

A complete budget presentation in HRSA EHB will include the following:

• SF 424A: Budget Information – Non-Construction Programs:

• Form 2 – Staffing Profile: Complete this form for the first year of the proposed project. See Appendix A for detailed instructions.

Salary Limitation:

The Consolidated Appropriations Act, 2012 (P.L. 112-74) enacted December 23, 2011, limits the salary amount that may be awarded and charged to HRSA grants and cooperative agreements. Award funds may not be used to pay the salary of an individual at a rate in excess of Executive Level II. The Executive Level II salary of the Federal Executive Pay scale is $179,700. This amount reflects an individual’s base salary exclusive of fringe and any income that an individual may be permitted to earn outside of the duties to the applicant organization. This salary limitation also applies to subawards/subcontracts under a HRSA grant or cooperative agreement.

As an example of the application of this limitation: If an individual’s base salary is $350,000 per year plus fringe benefits of 25% ($87,500) and that individual is devoting 50% of their time to this award, their base salary should be adjusted to $179,700 plus fringe of 25% ($44,925) and a total of $112,312.50 may be included in the project budget and charged to the award in salary/fringe benefits for that individual. See the breakdown below:

Individual’s actual base full time salary: $350,00050% of time will be devoted to project

Direct salary

$175,000

Fringe (25% of salary)

$43,750

Total

$218,750

Amount that may be claimed on the application budget due to the legislative salary limitation: Individual’s base full time salary adjusted to Executive Level II: $179,70050% of time will be devoted to the project

Direct salary

$89,850

Fringe (25% of salary)

$22,462.50

Total amount

$112,312.50

v. Staffing Plan and Personnel Requirements (page 20)

In HRSA EHB, staffing and personnel information will be provided through Form 2: Staffing Profile,

Reminder: Award funds may not be used to pay the salary of an individual at a rate in excess of Executive Level II or $179,700. An individual’s base salary, per se, is NOT constrained by the legislative provision for a limitation of salary. The rate limitation simply limits the amount that may be awarded and charged to HRSA grants and cooperative agreements. Please provide an individual’s actual base salary if it exceeds the cap. See the sample below.

Name	Position Title	% FTE	Annual Salary	Amount requested
J.Smith	Chief Executive Officer	50	179,700 *	89,850
R. Doe	Nurse Practitioner	100	75,950	79.950
D. Jones	Data/AP Specialist	25	33,000	8,250

*Actual annual salary = $350,000

Whats New – Medicaid: a year of excruciating decisions

John Ruiz — Sat, 14 Jan 2012 02:36:39 +0000

“The fundamental problem all states face is that while Medicaid rolls continue to grow, federal support for the jointly-funded program is not keeping pace — and neither is state revenue. More than $100 billion in extra federal support under the 2009 stimulus program ran out last July. As a result, state Medicaid spending jumped 29 percent between budget years 2011 and 2012 to make up for the loss of federal funds.” read more here

What’s New – Fiscal Year 2012 Final Consolidated Appropriations Bill Flat Funds Health Center Program

John Ruiz — Sun, 18 Dec 2011 07:12:12 +0000

Health Resources and Services Administration (HRSA) – The bill funds HRSA at program level of $6.5 billion, which is $41 million below last year’s level and $848 million below the budget request. Within this total, Community Health Centers are funded at $1.6 billion – the same as last year’s level. House Appropriations Chairman Hal Rogers praised the passage of the Conference Report on the Consolidated Appropriations Act of Fiscal Year 2012 (House Report 112-331) – the final funding legislation of the year. The report passed on a vote of 296-121. The Senate passed the same FY’12 omnibus spending bill on a 67 to 32 vote. Health and Human Services – The Department of Health and Human Services receives a total of $69.7 billion in the bill, which is nearly $700 million below the last year’s level and $3.4 billion below the President’s budget request. Although flat funded, the Health Center program will receive an additional $1.2B as part of the the Affordable Care Act Health Center Trust Fund for a total Health Center Program funding at $2.8B, a $200M increase from last years $2.6B that will permit further expansion of program services to 1.5 more people in need. For a summary, please visit: http://appropriations.house.gov/UploadedFiles/12.14.11_Final_FY_2012_Appropriations_Legislation_-_Detailed_Summary.pdf

What’s New – STATES CUT COMMUNITY HEALTH CENTER FUNDING

John Ruiz — Mon, 12 Dec 2011 04:28:13 +0000

Just as demand for services at community health centers has been projected to increase — both because of the recession and the health law’s expansions in access to medical care – state funding for these centers has reached a seven-year low for fiscal year 2012, according to a new report. At the federal level, the situation is more complicated. In FY 2011, there was a nearly 28 percent decrease in the annual appropriations for community health centers, down $604 million from $2.19 billion in 2010, according to the NACHC. However, at the same time, the 2010 health law provided $11 billion for expansion of health center services and some of that money has helped to offset the loss http://capsules.kaiserhealthnews.org/index.php/2011/12/states-cut-community-health-center-funding/

What’s New – Automatic Budget Cuts Put Public Education, Health Care on the Line.

John Ruiz — Fri, 09 Sep 2011 15:15:18 +0000

Automatic Budget Cuts Put Public Education, Health Care on the Line.

Medicare, community and migrant health centers, and health services for American Indians would be trimmed by 2 percent. That amounts to $123 billion in a ten-year time period for Medicare alone. Most of the cuts would come from reducing the amount of reimbursements the federal government gives to health care providers, not directly from Medicare recipients. But it would make it more challenging for the elderly to find doctors, some experts say. Entitlement programs such as Medicaid and Social Security, however, would remain sheltered, as would funding for veterans programs, income tax credits and food stamps. Funding for these safety net programs is considered mandatory and would not be affected by the sequester.

What’s New – HRSA Associate Administrator makes the right decision.

fqhc — Fri, 26 Aug 2011 16:45:09 +0000

Ever since the New Access Point (NAP) awards were announced earlier this month, there has been some significant unhappiness. Looking down
the list of grant awards, it is immediately evident that those centers serving special populations are particularly well represented. This should surprise no one, since the federal 330 legislation dictates proportionality between the various programs. Because the ARRA stimulus funding had no such requirement, the ARRA projects receiving non-ARRA continuation funding skewed the distribution away from the legislatively mandated levels. After the many NAP applications were received, Congress provided a reduced pot of funding for HRSA to distribute. Thus the grants had to be awarded in a way that would meet the legislative mandate. Based on the smaller pool of funds available for applications not directed at one of the underfunded special populations, a record high score of 102 was required for funding. We should not blame the HRSA/BPHC for legislatively mandated decisions outside of their control. Particularly when the HRSA Associate Administrator for the BPHC, Jim Macrae, and his team have been so diligent in making the right decisions for the health centers and their patients for the right reasons. Listen to the Audio.