On Wednesday, November 30, the House plans to vote on a newly released, more robust version of the 21st Century Cures Act, a comprehensive bill that packages together a wide variety of health policy provisions related to medical research, drug development, mental health, opioid addiction, foster care and Medicare, among others. A comprehensive summary is available to help walk through each section of the legislation.
There are at least three major changes include in the bill that will be of great benefit to community health centers.
- FTCA for Volunteers: Included in the mental health title of the bill is a provision which health center advocates and NACHC have fought for over nearly a decade – known as the Family Health Care Accessibility Act. That provision extends Federal Tort Claims Act (FTCA) coverage to licensed medical practitioners who wish to volunteer at health centers. Health center employees have long been covered by FTCA for medical malpractice purposes, yet health center volunteers have never been eligible for this coverage. While increasing the number of volunteer practitioners at health centers certainly doesn’t resolve all of the workforce challenges health centers face, it is an important step forward.
- Medicare ACO Legislation: Section 17007 of the bill is a provision that would make it easier for health centers to participate in Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program (MSSP), by allowing FQHCs and rural health clinics to directly assign their patients to ACOs. Currently, in order for a Medicare beneficiary to be assigned to an ACO he or she must receive at least one primary care service from a physician participating in an ACO. As a result, while individual physicians at an FQHC may assign patients to an ACO, these assignments cannot be made when a patient’s primary caregiver is not a physician, and the FQHC cannot make these assignments at the organizational level. The original Senate version of this legislative language was introduced in 2015 as the Rural ACO Provider Equity Act (S.2261) by Senators Thune (R-SD), Cantwell (D-WA), and Murray (D-WA) and passed the Senate unanimously last December. More recently, an identical House version, H.R. 5667, was introduced by Reps. Lynn Jenkins (R-KS) and Linda Sanchez (D-CA).
- Opioid Funding: the bill provides $1 billion over 2 years for grants to states to supplement opioid abuse prevention and treatment activities, such as improving prescription drug monitoring programs, implementing prevention activities, training for health care providers, and expanding access to opioid treatment programs. Several of these grant programs were newly authorized earlier this year in the Comprehensive Addiction and Recovery Act (CARA), including programs which will help expand health center access to the opioid overdose reversal drug, naloxone.
While the bill is expected to pass by a wide margin on the House floor it is likely to encounter some resistance in the Senate, where several Senators have expressed serious concerns over the bill’s funding mechanisms and/or content, including Senators Elizabeth Warren (D-MA) and Charles Grassley (R-IA), both of whom have publically stated that they cannot support the bill in its current form. Those issues are still being resolved and a vote on the legislation is expected this week.
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