Following the latest in reimbursement news, we recently covered the $80 million in funding for Navigators in Federal Marketplaces for plan year 2022. Now, thanks to a portion from the $1.9 trillion economic stimulus package passed in March, $1 billion in funds are going to federally funded community health centers. Although these funds may be used for COVID-19, they are not limited to just that. According to a report by Maureen Groppe, the $1 billion in funds can also be used to “build new facilities, renovate or expand existing ones, and purchase new equipment.” This will be a two two-fold endeavor, in that it is both updating existing infrastructure, as well as providing updates that will allow expansion to reach more patients that need the support. According to HHS Secretary Xavier Becerra, “This historic influx of funding for infrastructure improvements will allow [community health centers] to continue the critical work of connecting underserved patients and communities with high-quality health care.”
Community health centers provide care to the most underserved population. Currently in the United States over 1250 community health centers, 1,362 federally funded health center organizations operate in more than 8000 locations and serve 29 million patients in all 50 states and all US territories.
This setting of care makes up a substantial share of the nation’s primary care visits. One-fourth of all primary care visits for the nation’s low-income population are provided by these health centers. Because of these funds in community health centers, consumers will have more primary care options for communities in need.
Medicare and Medicaid’s official definition of community health centers is federally qualified health center (FQHC). FQHCs include all organizations receiving grants under Section 330 of the Public Health Service Act. Some other benefits include:
- Enhanced Medicare and Medicaid reimbursement.
- Eligibility to purchase prescription and nonprescription medications for outpatients at reduced cost through the 340B Drug Pricing Program.
- Access to the Vaccine for Children program.
Pharmacy services are provided in these health centers and these pharmacies are allowed to participate in the federal 340B Drug Pricing Program. The underserved and at-risk population typically found in community health centers, makes this population in dire need of pharmacy services and pharmacists.
Pharmacists participate on the pharmacy and therapeutics committees of the health center and assist formulary issues, and the 340B program, formulary development and maintenance, provider education, as well as facilitating patients’ participation in pharmaceutical manufacturers’ safety net programs. Community health center pharmacists’ role improves patient compliance as well. Health Centers have until June 24 to apply to receive funding. Are community health centers a relevant setting of care for your drugs, or biologics? Do you understand these settings of care and how your Products will be reimbursed? Do you have the right coding strategy in place to implement coverage where it is needed? Are your claims consistently being approved or are you running into consistently denied claims because of insufficient documentation? Let the GIRS Payer Advocacy Compass® develop, initiate, and follow through on the reimbursement strategy you need to make the most of this funding, as well as upcoming reimbursement trends for the remainder of 2021 and beyond.
Disclaimer: The information in this blog is based on payer information which is dynamic. It is accurate at the time of posting but should not be construed to be reimbursement or legal advice. CPT® is the trademark of the American Medical Association (AMA).
Sources:
- https://fynefettle.com/community-health-centers-score-1-billion-from-hhs-for-upgrades/
- Community health centers are getting $1 billion in federal funding (usatoday.com)
- https://www.pharmacytimes.com/view/community-health-centers-a-pharmacists-perspective
- http://www.nachc.org/wp-content/uploads/2020/01/Chartbook-2020-Final.pdf
About GIRS
For more than 19 years, GIRS has been assisting medical technology manufacturers with their market uptake and reimbursement strategies so that patients can have access to the care that they need. To implement successful market access strategies, the GIRS Value Discovery Landscape Assessments® team and the Payer Advocacy Compass® team work together to develop and implement foundation reimbursement landscape and payer advocacy strategies to obtain positive coverage, appropriate payment, and innovative payer contracting arrangements to improve market uptake. For more information, email us at info@girsinc.com or call us at 901-834-9119.