by Craig Kennedy

Late last week Senate Majority Leader Harry Reid (D-NV) released his “manager’s amendment” to the Senate’s health care reform package.  The Senate has been considering the base reform bill, called the Patient Protection and Affordable Health Care Act, for several weeks but everyone has been waiting for the final agreements to be struck and offered as an amendment by Reid (the manager’s amendment).  Turns out there was a lot more than just health center issues in the amendment, but I’ll keep this post to those that directly impacted health centers (the actual amendment is nearly 400 pages long).

The official NACHC response from President and CEO Tom Van Coverden hits the high points of the manager’s amendment, so this will hopefully offer a bit more detail for those interested.

First, the amendment added $10 billion in GUARANTEED funding for Health Centers and the National Health Service Corps over the next five years (FY11-FY15). The actual breakdown is that $7 billion is for regular health center operating grants; in other words, base grant adjustments, NAPS, EMCs, service expansions, etc.  However, another $1.5 billion is for health center construction, and it doesn’t say how each year would be spent, just that $1.5 billion is for construction.  That is great news and gives HRSA tremendous flexibility in designing assistance for health center construction needs.  The last $1.5 billion is for the NHSC, and starts with an increase of $295 million and ramps up through the five years.  All of this is thanks to Senator Bernie Sanders (I-VT) for pushing so hard.

Second, the Reid Amendment restored the Menendez Amendment to the bill. You may remember that Senator Bob Menendez (D-NJ) drafted and passed an amendment during consideration of the bill in the Senate Finance Committee.  The amendment, which would mandate that all plans within the newly created exchanges (read: private health plans) would have to pay health centers their Medicaid PPS, passed as part a combined amendment with Senato Blanche Lincoln (D-AR).  The language was then inadvertently dropped when the package was merged with the HELP Committee package, but this, along with mandatory contracting with safety net providers, was the highest of priorities for NACHC in health care reform.  Glad it’s back in!

Third, the Reid Amendment improved the Medicare payment language that was already in the Senate bill. While Senator Jeff Bingaman (D-NM) drafted and passed the full MATCH Act for health centers in the Finance Committee, it too was dropped before the package made it to the floor.  However, this wasn’t inadvertent.  There were objections to the language and it was significantly changed for the worse.  The Reid Amendment improves the language, but there is still a whole lot of work left before we can truly say the reform package helps health centers Medicare payment rates.

Finally, I know blog posting are supposed to be short, so I’ll list the remaining provisions that are in the base text or the Reid Amendment:

1. Essential Community Providers (base) – mandatory contracting with all 340B providers, which includes CHCs.
2. Teaching Health Centers (base) – Enabling residency training at health centers.
3. Negotiated Rule-Making for MUA Designation process (base) – Calls on HRSA to work with stakeholders as they redesign the MUA/HPSA process.
4. Coordinated Care Networks (Reid) – This is a newer version of the old HCAP program.  Health Centers and public hospitals would be are the core of this newly authorized system.

These are just some of the issues that we’re following and where they stand today.  We’re very pleased with the additions that the Reid Amendment makes, and we’ll be working to support this bill going forward.