Sliding Fee Scales and QHPs – FAQs

Shawn Frick from NACHC states:

We have been getting quite a few questions about how/if sliding fee discounts at health centers can be applied to the new QHP enrollees when their insurance begins on January 1.  The simple answer to this is to remember that the application of the sliding fee discount is related to FPL and family size and not to a person’s insurance status.  Frankly, I was also confused on this as well and had to reminded.  Please pass this along to your appropriate PCA staff and health centers.

Below are 2 FAQs from HRSA that addresses the issue: 

26. NEW: May health centers offer different sliding fee discount scales (SFDS) based on eligibility for subsidies through the Marketplace or insurance status?  

No. Sliding fee requirements apply to individuals based solely on income and family size. Therefore, individuals of comparable income and family size would need to be treated uniformly. See the response to FAQ #27 below for a specific example.  

27. Are patients who are covered by a QHP eligible for sliding fee discounts? If so, how is the sliding fee discount schedule (SFDS) applied?  

Health centers are required to determine patient eligibility for sliding fee discounts based solely on the patient’s income and family size. Some of these eligible patients may also have third party health insurance, such as a qualified health plan (QHP), which does not cover or only partially covers health care services, HRSA-13-279 Fiscal Year 2013 Health Center Outreach and Enrollment Assistance resulting in “out-of-pocket” costs (e.g., co-insurance or co-pays). In these cases, the health center would apply the sliding fee discount by charging the patient in a given SFDS pay class an amount no greater than

what would be charged to a patient that has no public or private insurance. For example, insured health center Patient A receives a health center service. His/her insurance co-pay, under his/her QHP, is indicated to be $60 for this service. The health center has also determined that this patient is at 160% of the federal poverty guidelines (FPG), and thus, also qualifies for the health center’s SFDS. Under the SFDS, a patient at 160% FPG would be charged $45 for this same service. Thus, the health center would have Patient A pay no more than $45 out-of-pocket, consistent with its SFDS.  

Please note that health centers are responsible for ensuring adherence to Federal and state laws and regulations and for following the terms and conditions of their contracts with third party insurers. Health  centers with questions on the applicability of federal and state law and/or the terms and conditions of their private payor contracts should consult with private legal counsel. 

Here is the link to all the recent FAQs:  http://bphc.hrsa.gov/outreachandenrollment/

 

Learn about the Health Insurance Marketplace in Chinese (Mandarin)

The White House Initiative on Asian Americans and Pacific Islanders (AAPIs) invites you to join our Google Hangout in Chinese on Thursday, January 23, 2014 at 3:00 pm ET.

One in seven Chinese Americans lacks health insurance. With almost half of all Chinese Americans report speaking English less than very well, Chinese Americans are among the highest limited English proficient populations in the nation. To help provide information to limited English proficiency communities, the White House Initiative on AAPIs is hosting a series of online Google+ Hangouts in AAPI languages. The next Hangout will be in Mandarin.

Access to quality, affordable coverage is critically important to AAPI individuals and families, and now, it will be more accessible than ever through the Affordable Care Act and the new Health Insurance Marketplace.

During the Hangout, representatives from the U.S. Department of Health and Human Services will answer your questions and provide information on how to obtain health care coverage through the new Marketplace. We’ve already hosted a Hangout in Korean and Vietnamese, and we are looking forward to our first Hangout in Mandarin.

The Chinese language Hangout will take place on Thursday, January 23, 2014 from 2:00 – 3:00 PM CST (1:00 – 2:00 PM MST). We hope you will join us by watching live at a local viewing party or online by joining our Google Hangout.  You may also submit your questions during the event via the Google+ ‘Ask a Question’ feature, or in advance via email, or Twitter at @WhiteHouseAAPI. More information on the in-language Hangouts can be found at WHIAAPI’s website, and more information about enrolling can be found at HealthCare.gov.

Date: Thursday, January 23, 2014
Time: 2:00 PM – 3:00 PM (Central)

The event will be live streamed on our Google+ event page. http://bit.ly/ChineseACA

Enroll America Hosts Virtual Town Hall for Healthcare Providers – Jan. 16, 2014

As we approach the March 31st enrollment deadline, Enroll America will be kicking off their Provider Week of Action with a virtual town hall on Thursday January 16th. Town halls will be held at 9:00AM, 12:00PM, 4:00PM, and 9:00PM EST. You can click on a start time to register for that respective session. For more information, you may contact Heidi Emerson at hemerson@nachc.org.

New HHS Enrollment Report

HHS released enrollment numbers for the new Health Insurance Marketplace through December 28.  More than 6 million Americans have now either signed up for a private health insurance plan or for Medicaid/CHIP, including the nearly 2.2 million who signed up for private insurance through the Marketplace.  Nearly 1.8 million of these consumers signed up for private plans in December.  That’s nearly five times as many people as signed up in October and November combined.

The report includes, for the first time, demographic information on enrollees.  Through December, 30 percent of those who enrolled were under age 35, with 24 percent being between the ages of 18 and 34 – consistent with the proportion of the population in this age group and in keeping with where Massachusetts enrollment was at this point.   More importantly, it is a sign of a clear demand for health insurance and reflects the hard work of Navigators, CACs, and other assister groups to help consumers successfully enroll.

Press release: Nearly 2.2 million Americans selected plans in the Health Insurance Marketplace from October through December

For the report: Health Insurance Marketplace: January Enrollment Report

For related blog post: The enrollment story behind the numbers  

Share Your Story!

Please use the new Share your Story collection tool on the new “Get Covered” page to help your patients submit their own stories, or direct consumers to this new tool so consumers can share their personal stories about enrolling in and using their new coverage.  The Share your Story collection tool can also be reached through the new “Got Covered” widgets and badges.

Invite your Congressional Members for a Visit to your Health Center – Congressional calendars

Congressional Calendars

2014 U.S. Senate Calendar

2014 U.S. House of Representatives Calendar

All Congressional Members will be visiting their home districts during the March 19-23 NACHC P & I Forum in Washington, DC.  Thursday, March 20 is reserved for Congressional Visits with House and Senate Staff members who deal with Health Care.  Check the calendars above to ask your Congressperson to visit your Health Center this winter or spring before the campaign cycle for 2014 begins.

2014 NURSE Corps Loan Repayment Program application cycle is now open

The 2014 NURSE Corps Loan Repayment Program application cycle is now open. The application cycle will close on February 27, 2014, at 7:30 pm, ET.

Eligibility is open to registered nurses and advanced practice registered nurses (e.g., nurse practitioners) who have qualifying educational loans, and who are dedicated to serving the Nation’s medically underserved populations in health professions shortage area (HPSAs).

NURSE Corps Loan Repayment award recipients receive 60 percent of their unpaid nursing student loans for 2 years of full-time service, and an additional 25 percent of the original balance for an optional third year. The program is seeking applicants who are interested in serving those most in need, and remaining in a HPSA beyond their service commitment.

A funding preference will be given to applicants with the greatest financial need, defined as those qualified applicants whose debt to salary ratio (i.e., total qualifying educational loans divided by base annual salary) is 20 percent or greater. Applicants will then be grouped into funding preference tiers. Starting with the first tier, awards will be made in order of decreasing debt to salary ratio until funds are expended. If an applicant is a registered nurse or an advanced practice registered nurse, the type of facility and HPSA score will also be a factored into the funding preference. To learn more about the funding preferences, please review the FY 2014 NURSE Corps Loan Repayment Program Application and Program Guidance.

Technical assistance conference calls have been scheduled to address questions. Encourage applicants to mark their calendars for the following conference calls:

  • January      30, 2014 from 1:00 pm – 3:00 pm, CT (12noon – 2:00pm MT)
  • February      13, 2014 from 7:00 pm – 9:00 pm, CT (6:00pm – 8:00pm MT)

Further information on the times and login information will be available on the website.  Continue to check the NURSE Corps Loan Repayment Program website.

Attend the 2014 NACHC Policy & Issues Forum on March 19-23 in Washington, DC

Amanda Pears Kelly, in an email from The Campaign to Save America’s Health Centers Update, says:

“While Congress is currently scheduled to be on recess during the conference this year, you still need to attend P&I.  The P&I is the first and best opportunity for Advocates to be briefed on the 2014Health Center policy agenda and get the most up-to-date information on what Health Centers can expect in the months ahead.  This year, you will have a real opportunity to meet and build relationships with key congressional staff. Meeting with staff will be especially important this year as it is the STAFF that ultimately makes recommendations to their bosses (YOUR Members of Congress) about how policy should be written and which policy deserves their support.  As you know, staff change frequently on the Hill, and advocacy always works better when staff has a face to go with the voice they will be talking to.  In this environment, numbers matter and we NEED you to come to Washington with the enthusiasm to deliver a strong Health Center message on Capitol Hill. Make your reservation and register for the P&I today!

More conference info here: http://meetings.nachc.com/policy-and-issues/

National Emergency Preparedness Standards Proposed by CMS

The Centers for Medicare & Medicaid Services (CMS) has proposed a rule to establish national emergency preparedness requirements for Medicare and Medicaid providers and suppliers. The rule would require FQHCs and RHCs to develop an emergency plan that includes training and testing.   Subscribers with access to the e-Library should review PIN 2007-15: Health Center Emergency Management Program Expectations for guidance on developing and implementing an emergency management plan.

Here is the link for the PIN document:  http://bphc.hrsa.gov/policiesregulations/policies/pdfs/pin200715.pdf

HRSA Grants available now

HRSA-14-083  Ryan White HIV/AIDS Program Part B AIDS Drug Assistance

HRSA-14-098  Ryan White HIV/AIDS Program Part F Dental Reimbursement Program (DRP)

HRSA-14-019   Traumatic Brain Injury State Implementation Partnership Grant Program