by Anne Morris, MPH
Nearly two years ago in 2009, we outlined Health Center priorities for National Health Reform. We strongly advocated for an investment in accessible, affordable, and high-quality primary and preventive care for all; we also championed support for the workforce who will deliver this care. Through Health Reform and standalone bills, we’ve seen some pretty impressive legislative activity seeking to improve the supply and distribution of the primary care workforce. Here are the key workforce highlights from 2010.
National Health Service Corps
The Affordable Care Act (ACA) provided $1.5 billion in new, dedicated funding for the National Health Service Corps (NHSC) over five years and reauthorized the program in perpetuity. This provision is thanks in particular to the efforts of Senator Bernie Sanders (I-VT) in the Senate and many leaders in the House, including then-Majority Whip Jim Clyburn (D-SC) and then-Energy and Commerce Committee Chairman Henry Waxman (D-CA). The National Health Service Corps Trust Fund is in addition to existing discretionary funding (approximately $142 million in FY 2010). As we reported in an earlier blog post, the Health Resources and Services Administration (HRSA) has initiated the FY 2011 application process for its NHSC Loan Repayment Program and is implementing three notable programmatic changes made through the ACA: (1) providers may serve on a full-time or part-time basis, (2) the annual maximum loan repayment amount has increased, and (3) Corps personnel can count a certain percentage of their time spent teaching towards their service obligation. HRSA estimates that by the end of FY2011, over 10,800 providers will be supported through the NHSC. NACHC continues to urge health centers that are not already listed as NHSC sites or do not have their personnel vacancies listed (irrespective of HPSA score), to update that information.
Teaching Health Centers
ACA also authorized and funded a five-year payment program – totaling $230 million – to support accredited primary care residency training operated by community-based entities, including health centers. Championed primarily by Senator Jeff Bingaman (D-NM), the Teaching Health Center Graduate Medical Education (THCGME) Program defines “primary care” broadly to include family medicine, internal medicine, pediatrics, internal medicine-pediatrics, obstetrics and gynecology, psychiatry, general dentistry, pediatric dentistry, or geriatrics. Approximately $150,000 (per resident FTE payment amount) will be available to offset the costs of training new residents at a newly-established THC or an expanded number of residents at an existing THC. NACHC and other stakeholders advocated for the broadest interpretation possible of eligibility criteria for this program, and we’re pleased to see that HRSA will allow certain consortia to participate in addition to health centers who hold the accreditation for their programs. NACHC continues to track other key issues for health centers. One issue that has yet to be resolved – which we are closely tracking – is whether teaching hospitals will be able to secure Medicare GME funding for a THC resident’s inpatient time above their cap, which would likely make the program more financially feasible for health centers and their residency program partners. The deadline for applications for year one funding closed last week, and NACHC looks forward to learning which health centers ultimately decided to apply and stands ready to assist these health centers and others who seek to position themselves for future application cycles.
Workforce Investment through the Prevention and Public Health Fund
Earlier this year, Secretary Sebelius and HRSA Administrator Mary Wakefield also announced that half of the ACA’s Prevention and Public Health Fund FY 2010 funding ($250 million) would be utilized to increase the number of primary care providers (physicians, advanced practice nurses, and physician assistants) and strengthen the primary care workforce. This one-time infusion of Prevention and Public Health Fund dollars will expand existing health professions training efforts at HRSA and invest in new initiatives authorized in the ACA (e.g., nurse-managed health clinics).
Federal Tort Claims Act Coverage for Volunteers
On September 27, 2010, the House nearly unanimously approved H.R. 1745, the Family Health Care Accessibility Act, which would extend Federal Tort Claims Act (FTCA) malpractice coverage to health practitioners volunteering at Section 330-funded health centers. This bill was sponsored by Representatives Tim Murphy (R-PA) and Gene Green (D-TX), who have been tireless champions for this issue and for health centers. The House previously approved a similar measure twice as part of larger legislation, but due to process issues, the bill never became law. While the House vote of 417-1 signaled strong, bipartisan support for FTCA volunteer coverage, H.R. 1745 unfortunately met with some resistance in the Senate, which required unanimous consent (the agreement of every senator) to move health care legislation during this year’s lame duck session. Because at least one Member on the Senate HELP Committee expressed concerns about the bill, the Committee did not to consider the bill and consequently H.R.1745 never made it to the Senate floor. NACHC staff continues outreach efforts to HELP Committee staff to learn about opportunities for future consideration of the FTCA bill and to address any outstanding concerns or questions.