Ryan White & Health Care Reform Future Paths for Integration, Expansion, and Innovation

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Ryan White Health Care ReformFuture Paths for
Integration, Expansion, and Innovation

• Harvard Law School Health Law and Policy Clinic
  
• Treatment Access Expansion Project
• In collaboration with
• AIDS Foundation of Chicago, National AIDS
  Strategy Coalition, HIV Prevention Justice
  Alliance, HIV Medicine Association, Project
  Inform, Ryan White Medical Providers Coalition

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• This webinar is sponsored by the Treatment Access
  Expansion Project (taepusa.org), AIDS Foundation
  of Chicago, HIV Prevention Justice Alliance, and
  the Coalition for a National AIDS Strategy
  (nationalaidsstrategy.org).
• One of many groups supporting the Coalitions
  efforts, Bristol-Myers Squibb has generously
  sponsored this teleconference, with no review or
  editorial discretion as to topics or content
  discussed.

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Presentation Outline

• Introduction (and moderating)
• Robert Greenwald, Harvard Law School TAEP
• Part 1 The Changing Landscape
• Amy Killelea, Harvard Law School TAEP
• Part 2 Opportunities for Sustaining/Expanding
  HIV Care under Health Care Reform
• Andrea Weddle, HIVMA Amy Killelea
• Part 3 Next Steps and Advocacy Efforts
• Anne Donnelly, Project Inform
• Part 4 Resources

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Part 1The Changing LandscapeThe Future of Ryan
White Funded HIV Care under Health Care Reform
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Ryan White Funding is Not Enough to Meet
Increased Need
Number of People Living with AIDS in the US vs.
Ryan White Funding (adjusted for inflation)
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What Does Health Care Reform Mean for HIV/AIDS
Care and Treatment?

• Medicaid Expansion
• Starting in 2014, no longer have to be disabled
  to
• be eligible for Medicaid
• Most low-income, uninsured people will now be
• automatically eligible for Medicaid (133 FPL
  14K for an individual and 29K for family of
  four)
• Includes a new Essential Health Benefits Package

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What Does Health Care Reform Mean for HIV/AIDS
Care and Treatment?

• Increased Access to Private Insurance
• Pre-existing Condition Insurance Program
• State-based exchanges (starting in 2014)
• Subsidies for those with income up to 400 FPL
• Elimination of many harmful and discriminatory
  insurance practices
• E.g., No higher premiums based on health
• Individual and employer mandates

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What Does Health Care Reform Mean for HIV/AIDS
Care and Treatment?

• New Investments in Care and Prevention
• Community health center expansion
• 11 billion over five years
• Prevention and Public Health Fund
• 750 million in FY 2011
• Health care workforce investments

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What Does Health Care Reform Mean for Ryan White
Clients?
2014
2008

• Medicaid
• Expands to most
• people up to 133 FPL
• Eliminates disability
• requirement

Ryan White Program

• 30 were uninsured
• 68 had incomes at
• or below 100 FPL
• 22 had incomes
• between 101 and
• 200 FPL
• 34 were insured
• through Medicaid
• 12 had private
• insurance

• Private Insurance
• Subsidies to purchase
• insurance for people
• with income up to
• 400 FPL
• Elimination of pre-
• existing condition
• exclusions

Health Care Reform
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What Does Health Care Reform Mean for Ryan White
Providers?
Starting in 2014, the Role for Ryan White Will
Change Because Most People Will Have Insurance
Coverage

• Greatest challenges
• Medicaids provider reimbursement rates
• New reimbursement systems
• Greatest opportunities
• Relief to an increasingly underfunded Ryan
  White Program
• New investments in community-based care
• Potential for new reimbursement systems and
  funding
• streams for Ryan White providers (RWPs)

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Part 2 Opportunities for Sustaining/Expanding
HIV Care under Health Care Reform
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• ) Making the Medicaid Expansion
• Work for People with HIV and AIDS

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Implementation Opportunities

• Essential Health Benefits
• Floor of benefits available to newly-eligible
  beneficiaries
• Must be comprehensive enough to meet the needs of
  people with HIV and AIDS and other chronic
  conditions
• Comprehensive prescription drug benefit
• Mental health, substance abuse, and support
  services
• Prevention
• Demonstration Projects
• Center for Medicare and Medicaid Innovation
  (CMMI) coordinated and integrated care projects
• Medicaid Health Home program
• HRSA/CMS evaluation of RW model of care
• Outreach
• RWPs will continue to be first line of
  information for newly-eligible Medicaid
  beneficiaries

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Opportunities Beyond Health Care Reform for
Building a Robust HIV Care System

• Health Homes
• Medical home certification for RWPs
• Provider Reimbursement (fee for service and
  managed care)
• Advocate for enhanced rates for HIV providers
• Ensure payment for coordination of care
• Medicaid Defense
• Protect optional benefits and provider payment
  levels
• Limit exceptions to maintenance of effort
  requirements
• Ongoing Ryan White Advocacy
• To provide essential wrap-around care, treatment
  and support services

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2.) Making Private Insurance Reforms Work for
People with HIV and AIDS
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Designing Insurance Exchanges that Meet the Care
and Treatment Needs of People with HIV and AIDS

• Essential Health Benefits Package
• Among others, ensuring comprehensive prescription
  drug benefit, mental health and substance abuse
  services
• Maximizing access to support and prevention
  services
• Integration of RWPs into provider networks
• Patient navigation
• Maximize potential of 3rd-party billing and
• reimbursement

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3.) Integrating HIV/AIDS Care and Treatment into
the Health Center Program
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Leverage New InvestmentsHealth Care Reform
Allocates 11 Billion to Community Health Centers
Enhanced Training and Technical Assistance
New Access Point Grants
11 Billion
Construction and Renovation
Expansion of Services
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Overlapping Populations of FQHCs and Ryan White
Funded Clinics
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Overlapping Missions of FQHCs and Ryan White
Funded Clinics
Health Center Program Mission Health centers are
community-based and patient-directed
organizations that serve populations with limited
access to health care regardless of ability to
pay.
Ryan White Program Mission The Ryan White
Program supports cities, states, and local
community-based organizations that provide
HIV-related services to those who do not have
sufficient health care coverage or financial
resources for coping with HIV disease. Ryan White
fills gaps in care not covered by other sources.
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The Basics

• What is an FQHC?
• A community health center that meets federal
  requirements and
• receives significant grant funding and
  other federal benefits
• Serves federally designated medically underserved
  population or located in federally designated
  medically underserved area
• Serves all residents of service area regardless
  of ability to pay
• Provides full continuum of primary and preventive
  care services
• Governed by an independent community-based board
  of directors, a certain percentage of which must
  be health center consumers
• Funding to become a new FQHC grantee only
  available when New
• Access Point grant funding announcements are
  released by HRSA
• What is an FQHC Look Alike?
• A community health center that satisfies FQHC
  requirements and receives many, but not all, FQHC
  benefits, but has not been awarded a grant
• Look Alikes are in a good position to apply for
  grant funding (and full FQHC status) when new
  grants are announced by HRSA

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Becoming or Collaborating with an FQHC

• Who can Apply?
• A private non-profit or public agency that serves
  a federally designated medically underserved area
  or population
• How Can I Collaborate with an Existing FQHC?
• Referral arrangement
• Established/contractual arrangements
• Co-location arrangement
• Purchase of services agreement
• Sub-recipient arrangement

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Benefits and Challenges

• Benefits of becoming/collaborating with an FQHC
  include
• FQHC specific grant funding
• Enhanced Medicaid and Medicare reimbursement for
  services
• Opportunity for RWPs to continue to provide
  wrap-around services
• Opportunity for RWPs to ensure smooth
  transitions
• Opportunity to fill gaps in HIV medical provider
  expertise and experience
• Challenges of becoming/collaborating with an
  FQHC
• Changing mission and expanding services beyond
  HIV and AIDS
• Requires bridges between Ryan White and Health
  Center Programs
• Restructuring governing board
• Costly and labor-intensive application process
• In collaboration agreement, difficult for FQHC
  benefits (e.g., cost-based
• reimbursement) to go to collaborating partners

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4.) Other Opportunities for Integrating HIV/AIDS
Care, Treatment, and Providers into Broader
Health Care Systems
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Other Opportunities

• Ensure that HIV/AIDS providers benefit from
  National Health Service Corps investments
• Build on federal investment in developing HIV
  centers of excellence
• Seek demonstrations, pilot projects, and grants
• E.g., new payment mechanisms for coordinated
  care
• E.g., medical home demonstration projects
• E.g., Community Transformation Grants

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Part 3Next Steps and Advocacy Efforts
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What You Can Do

• Educate yourself about health care reform and
  what it means for the HIV/AIDS community
• Defend health care reform!
• E.g., Medicaid Expansion, Prevention and Public
  Health Fund
• Join the HIV Health Care Access Working Group
• Maximize effective state implementation of health
  care reform
• E.g., Sound implementation of Medicaid expansion
  and private insurance exchanges
• Connect with other health advocates working on
  the state level
• Start conversations on collaboration/ integration
  with FQHCs
• With Your board Your community Neighboring
  FQHCs
• Ensure you are accessing all existing resources
• Stay tuned
• Follow up T/A and webinars
• Guidance from HRSA

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What Questions Should the HIV/AIDS Community
Consider Going Forward?

• Is my organization (or where I get my care)
  poised to maximize funding streams/opportunities?
• What populations are currently served and what
  does it mean to expand to others?
• What services are currently provided and is there
  the capacity to expand?
• What models of care are already in place and do
  these models fit into health care reform models?
• What FQHCs exist in the area and what is the
  relationship with them?
• What HIV services do they provide (e.g., HIV
  testing)

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Part 4Available Resources
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What Resources Are Available?

• HRSA Resources, www.hrsa.gov
• Planning grants
• T/A
• NACHC Resources, www.nachc.org
• Trainings and T/A, including FQHC 101
• Guidance documents
• Primary Care Organizations
• Treatment Access Expansion Project,
  www.taepusa.org
• HIV Medicine Association, www.hivma.org

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What Resources Are Available?

• Health Care Reform Resources
• Kaiser Family Foundation, www.kff.org
• FamiliesUSA, www.familiesusa.org
• Healthcare.gov, www.healthcare.gov

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What Resources Are Available?

• AIDS Advocacy Resources
• Coalition for NHAS, www.nationalaidsstrategy.org
• HIV Prevention Justice Alliance,
  www.preventionjustice.org
• Dose of Change AIDS Advocacy Skills Building,
  www.doseofchange.org