As the ranks of the uninsured grow and hospitals, health centers and other public health providers struggle to meet demands, Washington is providing some relief. Beneficiaries of the recently enacted stimulus package and the 2009 appropriations bill include hospitals, health centers and even the Office of Pharmacy Affairs (OPA).
As part of a six-month spending measure lasting through October 1, 2009, OPA received $1.47 million under the FY 2009 Omnibus appropriations bill. The funding is one-half the $2.94 million stipulated in a Senate version of the bill. OPA and 340B advocates have been encouraging Congress and HRSA to provide additional funding to the agency to help it address a number of unmet needs in 340B program operations.
OPA has said it would use the additional funding to begin an annual verification of data submitted by 340B-covered entities for the OPA web site. The accuracy of the data is critical because pharmaceutical manufacturers, wholesalers and Medicaid agencies rely on this information to determine which facilities are eligible for the 340B program.
It also will use the funds to monitor the accuracy of 340B price files and to publish policies on 340B ceiling price calculations. The U.S. Health and Human Services Office of Inspector General has published a series of reports that discovered price overcharges by manufacturers and inaccurate information on the OPA web site.
While OPA begins to implement long-needed 340B program improvements, 340B health care providers are getting a critical cash infusion. The Obama administration announced March 20 that an additional $268.8 million would be made available to the states in fiscal 2009 and 2010 for disproportionate-share hospital (DSH) payments thanks to a two-year 2.5 percent increase included in the stimulus bill passed in February. The growth in funding will raise the DSH allotments provided to the states to reimburse hospitals for uncompensated care to $11.33 billion in FY 2009.
Community health center bonanza
Community health centers, meanwhile, will split $340 million from the stimulus package this fiscal year and next to meet a surge in patient demand. The Health Resources and Services Administration (HRSA) announced last month that in addition to helping the centers hire more staff and improving infrastructure, the grant money will provide supplemental payments for the growing number of uninsured patients who seek care at health centers.
The funding comes on top of $160 million the government already awarded in “Increased Demand for Services” grants, for a total of $500 million going to the nation’s 1,200 health centers.
Those grants, in turn, came on the heels of $155 million that the administration released toward construction of 126 new community health centers. The building projects, which will eventually total $1.5 billion, are also funded by the stimulus legislation. Altogether, spending on health centers will total a whopping $2 billion.
According to the National Association of Community Health Centers, the grants represent “the largest one-time investment in the 45-year history of health centers.” HRSA says the $340 million in grants for existing centers can be used to hire nurses, pharmacists and other personnel. The money can also be spent on expanded pharmacy services, as long as the services are within the health center’s scope of project.
[Please see related article on p. 10.]
Unanswered, however, is how HRSA’s proposal to restrict and narrow the definition of a 340B patient will affect President Obama’s plans to expand care at community health centers. Those guidelines could make it more difficult for the health centers to use 340B-priced drugs when treating their greatly expanded patient populations. (Please see Monitor, March 2009)
Tracking the money
The Obama Administration has set up a Web site (www.hhs.gov/recovery) to help Americans track healthcare dollars provided by the $787 billion stimulus package. In all, the Department of Health and Human Services (HHS) will receive about $137 billion of the total stimulus funding. HHS has also established a new Office of Recovery Act Coordination to oversee the spending.
Former HRSA Deputy Administrator Dennis Williams has been selected to head the office. Dr. Williams, a career government official, has worked closely with OPA for years and is well-versed on healthcare safety-net issues. As HRSA’s deputy administrator since 2002, Williams was the senior official at HRSA overseeing 340B matters, and testified at a 2005 Congressional hearing focused on program inadequacies.
Electronic health records coming to clinic near you
The $1.5 billion in construction grants for federally funded health centers and health center-controlled networks cover facility construction, renovation, equipment, and acquisition of health information technology. HRSA will determine the types and magnitude of the projects. Stimulus-funded incentives to adopt health information technology will be available to providers at rural health clinics and federally qualified health centers whose patient populations are at least 30 percent “needy.” Providers could receive up to $63,750 toward the allowable costs of implementing and operating electronic health records.