FY23 Spending Bill Approved
Last last month, Congress voted to finalize an FY23 budget and avert a government shutdown. The legislation contains several provisions related to community health centers and health care. A comprehensive summary can be found here.
Key Takeaways are:
- Community health centers will receive a $110 million increase (+6%) in discretionary funds, and Congress has earmarked how it wants some of these funds to be used.
- Earmarks approved included funding requested by Great Salt Plains Health Center and Variety Care.
- Requires Medicare to cover services provided by Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) at FQHCs, at the Medicare PPS rate, starting January 1, 2024. Also, because of the way the bill is drafted, state Medicaid programs will also be required to reimburse FQHCs for these services – at Medicaid PPS rates – starting January 2024.
- Requires Medicare to pay FQHCs at hospital rates for providing intensive outpatient behavioral health services (defined as 9 or more hours of these services per week for the same patient).
- Requires state Medicaid agencies to provide children age 18 and younger with 12 months of continuous coverage in Medicaid and CHIP.
- Requires States to re-start Medicaid eligibility redeterminations by April.
- If states abide by CMS rules about how to conduct these redeterminations, they will be eligible for a higher FMAP between April - December 2023. The higher FMAP rates will be based on a scaling down of the current 6.2% increase that is currently tied to states’ agreements to not disenroll anyone from Medicaid.
- Extends COVID-era telehealth flexibilities under Medicare through the end of CY 2024.
- Increases National Health Service Corps (NHSC) funding by $4 million (a 3% increase).
- Increases funding for Certified Community Behavioral Health Clinics (CCBHCs) by 22%
- Eliminates OTP requirement that patients have an OUD for at least one year before receiving treatment.
View a summary of FY2023 Omnibus Law provisions.
59th Oklahoma Legislature sets House Committee, leadership appointments
House Speaker Charles McCall, R-Atoka, was elected on January 3 by the full House to his fourth two-year term as speaker. This makes McCall the longest-serving speaker in state history. Speaker Pro Tempore Kyle Hilbert, R-Bristow, was also elected Tuesday by the full House to his first full term as speaker pro tempore, the Senate's second ranking officer. Session will begin Monday, February 6.
Read more.
Update on Timeline for Medicaid Redeterminations
The Centers for Medicare and Medicaid (CMS) issued an
informational bulletin on the provisions included in the Consolidated Appropriations Act, 2023, related to the Medicaid continuous enrollment condition. The new March 31, statutory end date of the continuous enrollment condition means that states could begin their 12-month unwinding period and initiate the first Medicaid renewals as early as February 1, 2023. Then beginning April 1, states claiming the temporary FMAP increase will be able to terminate Medicaid enrollment for ineligible individuals following a redetermination.
Phase 2 of Good Faith Estimate Process On Hold Indefinitely
The requirement that health centers enforce the second phase of the No Surprises Act and include costs for services provided by non-health center providers in the good faith estimates (GFEs) they give to uninsured and self-pay patients is
on hold indefinitely.
- The law which contains the GFE requirements – called the No Surprises Act – was enacted in late 2020, It officially requires that that all providers – including but not limited to health centers– begin giving all patients GFEs starting this past January (2022).
- When they began implementing the law, CMS immediately acknowledged that the GFE deadlines were largely unrealistic, so they said they’d exercise “enforcement discretion.” That means that while the requirements are officially on-the-books, CMS would delay enforcing them until some point after the Jan. 1, 2022 legal effective date.
- To indicate how long they would delay enforcing the legal deadlines, CMS broke the GFE rules into three phases:
- Phase One – GFEs must be provided:
- Only to uninsured and “self-pay” patients, and
- Only include costs for services/items that are provided and billed directly by the health center.
- Phase Two – GFEs for uninsured and self-pay patients must also include costs for services that the patient receives from outside (non-health center) providers during an “episode of care” that is coordinated by the health center.
- Phase Three: GFEs must be provided to patients who plan to bill their insurance.
- Phase One has been in effect since this past January. CMS had previously indicated that it would begin enforcing Phase Two (including costs for non-health center providers in the GFEs for uninsured and self-pay patients) starting next month. However, in a document released on December 2, CMS stated that it would delay enforcing the Phase Two requirements until it finalizes a regulation implementing those requirements.
As these processes will likely take years, health centers can safely assume that they will not be required to adhere to Phase Two requirements for the foreseeable future. Phase Three requirements (providing GFEs to insured patients) are also on hold indefinitely pending the development of IT systems to automate the process.
The
CHC Toolkit on Good Faith Estimates will be updated to reflect these changes.
340B Pharmacy Restrictions Chart + Toolkit
To keep health centers apprised of pharmaceutical restrictions on 340B drugs, the National Association of Community Health Centers (NACHC) has created a chart to document the timeline of these restrictions. NACHC will continue to update the chart as needed. Please see the latest chart
here. Health centers who are submitting the 340B data to 340B-ESP should know that it is taking at least six weeks after they begin submitting the data for their 340B pricing to be re-instituted at contract pharmacies.
A toolkit is also available from Colleen Meiman and Steve Carey, policy advisors to primary care associations.
The online toolkit on Responding to 340B Contract Pharmacy Restrictions is intended to provide health centers with consolidated and up-to-date information on:
- The status of contract pharmacy restrictions,
- Strategies for mitigating the impact of the restrictions,
- Making an informed decision about whether to submit data to 340B-ESP, and
- What a CHC should expect if it begins to submit data.
Please note that:
- This document has been reviewed by NACHC staff and revised to reflect their input.
- The toolkit is a “living document” that will be updated regularly as new information and resources become available.
- Please direct any questions/ concerns/ suggestions to colleen@fachc.org.