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Voicing the latest news on Communities in Need
In This Issue

Enrollment until 
Dec 23,2013 
for insurance starting on Jan 1, 2014 
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December 6, 2013 
Community Health Center Spotlight


Mt. Laurel Medical Center on receiving a Level 3  PCMH Designation by National Committee of Quality Assurance

The patient-centered medical home-one of modern health care's most important innovations-is a model of care that emphasizes care coordination and communication to transform primary care into "what patients want it to be." NCQA Patient-Centered Medical Home (PCMH) Recognition is the most widely-adopted model for transforming primary care practices into medical homes.


Clinicians, insurers, purchasers, consumer groups and others know the patient-centered medical home is a proven alternative to the nation's costly, fragmented delivery system. Research confirms that medical homes can lead to higher quality and lower costs, and can improve patient and provider experiences of care.


Congratulations again Mt. Laurel, what a wonderful achievement! 
MACHC Happenings
(1) Transformational Leadership Call

When: Tuesday, December 10th from 10 am - 11am

Call in- 1-866-740-1260  Access code: 4319483


(2) ACA Seminar

When: Wednesday, December 11th from 5:30 PM - 7 PM

The Latin American Community Center (LACC) and AARP Delaware are collaborating to present an Affordable Care Act Seminar in Spanish on December 11 from 5:30 p.m. to 7 p.m. at the LACC. Bilingual Delaware marketplace guides will also be at the event to answer questions about the marketplace. The event is free and open to the public, but registration is required. For more information, visit 


(3) MACHC Outreach Call

When: Friday, December 13th from 11 am- 12 pm

Call in- 1-866-740-1260  Access code: 4319483 


(4) MACHC Emergency Preparedness Call

December 17th, 2013 10:00 AM - 
4:00 PM
Call in- 1-866-740-1260  Access code: 4319483 

(5) DHMH HPP Emergency Preparedness Call

 December 19th, 2013 10:30 AM - 11:30 AM
Strategic Planning Committee Meeting
When: February 20th - 21st, 2014
Where: Turf Valley, Maryland
Policy, Advocacy and Legislation
National News

HHS Delays the Enrollment Period for the Second Year of the Affordable Care Act

The U.S. Department of Health & Human Services announced last week that they will push back the 2015 enrollment period for both state and federal health insurance marketplaces by a month. The new enrollment window would begin on November 15th, 2014 and end on January 15th, 2015,as opposed to the original enrollment period of October 15th through December 7th, 2014. The change is designed to give insurers more time to submit plan applications and evaluate their 2014 rates and enrollment numbers. HHS has already extended the current sign-up period to receive coverage beginning January 1st, 2014 to December 23rd of this year.

Hospitals around the country are increasingly starting palliative care programs, designed to relieve seriously ill patients' pain, stress and symptoms regardless of how long they have to live. While some patients are close to death, others are still receiving treatment to extend their days. And as they do, the palliative care team, including doctors, social workers, nurses and chaplains, tries to improve their quality of life 

QHP Contracting Assessment: Your Responses Needed!

Last week, NACHC emailed all health center and look-alike CEOs with a link to a brief but all-important survey/assessment about contracting issues with Qualified Health Plans (QHPs) under the new ACA law. The information you provide will help inform NACHC advocacy efforts around ensuring best contracting practices for health centers and be used to develop new training and technical assistance for health centers. This brief assessment is co-sponsored by both your PCA and NACHC, and we deeply appreciate your timely response. If you did not receive the email or need help accessing the survey, please contact Allison Abayasekara at NACHC.


The Obama administration's overhauled healthcare website got off to a bumpy relaunch Monday as a rush of consumers caused an uptick in errors and forced the administration to put thousands of shoppers on the site on hold. ... Bataille said about 375,000 visitors went to the site before noon, about double the normal traffic for a Monday morning. The volume caused pages to load slowly and the rate of errors to spike. About 10 a.m. EST, federal officials turned on a new queuing system that alerts some visitors to the site to come back later.
The enrollment records for a significant portion of the Americans who have chosen health plans through the online federal insurance marketplace contain errors - generated by the computer system - that mean they might not get the coverage they're expecting next month. The errors cumulatively have affected roughly one-third of the people who have signed up for health plans since Oct. 1, according to two government and health-care industry officials. The White House disputed the figure but declined to provide its own. 

Funding supports new primary care sites in 236 communities to serve more than 1.25 million additional patients
The U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius today announced $150 million in awards under the Affordable Care Act to support 236 new health center sites across the country. These investments will help care for approximately 1.25 million additional patients.
The White House announced early Sunday that, given the recent improvements in the site, most shoppers should be able to have an experience like Issa's. By 10 a.m., however, the Web site seemed to be struggling with high traffic. Federal health officials said they saw an increase in error rates and a slowdown in response times and decided to deploy "queueing" software designed to limit the number of users permitted on the site at one time. 
Oregon has spent more than $40 million to build its own online health care exchange. It gave that money to a Silicon Valley titan, Oracle, but the result has been a disaster of missed deadlines, a nonworking website and a state forced to process thousands of insurance applications on paper. Some Oregon officials were sounding alarms about the tech company's work on the state's online health care exchange as early as last spring. Oracle was behind schedule and, worse, didn't seem able to offer an estimate of what it would take to get the state's online exchange up and running 

Cost Of Health Care Law Is Seen As Decreasing
The rollout of President Obama's health care law may have deeply disappointed its supporters, but on at least one front, the Affordable Care Act is beating expectations: its cost. Over the next few years, the government is expected to spend billions of dollars less than originally projected on the law, analysts said, with both the Medicaid expansion and the subsidies for private insurance plans ending up less expensive than anticipated. 
A New Wave Of Challenges To Health Law A federal judge in the District of Columbia will hear oral arguments on Tuesday in one of several cases brought by states including Indiana and Oklahoma, along with business owners and individual consumers, who say that the law does not grant the Internal Revenue Service authority to provide tax credits or subsidies to people who buy insurance through the federal exchange.  At the same time, the House Judiciary Committee will convene a hearing to examine whether Mr. Obama is "rewriting his own law" by using his executive powers to alter it or delay certain provisions. The panel also will examine the legal theory behind the subsidy cases: that the I.R.S., and by extension, Mr. Obama, ignored the will of Congress, which explicitly allowed tax credits and subsidies only for those buying coverage through state exchanges. 
State News
Delaware Affordable Care Act Toolkit NOW AVAILABLE HERE!!!!!!

Use the Subsidy Calculator

Use the subsidy calculator on to get an estimate of the tax subsidy you might be eligible for when you buy coverage on Delaware's health insurance marketplace. 


Maryland Health Connection Mobile Updates:
Text "Connected" to 96000 to get the latest SMS updates on Maryland Health Connection right on your phone. 

Report from the Maryland Health Benefit Exchange about Maryland Health Connection, the state-based health insurance marketplace, as of Friday, November 15, 2013


Maryland Health Connection is introducing a new reporting approach this week to align with monthly reports from the U.S. Department of Health and Human Services. In weeks such as this week when a federal report is released, Maryland Health Connection will provide additional detail on the data on enrollment in qualified health plans, as well as more detailed statistics on website usage and the call center.

In addition, each week, Maryland Health Connection will continue to report a regular set of metrics, including number of accounts created, and numbers of Marylanders who have chosen plans for enrollment in private insurance and Medicaid. Consistent with federal reporting, these reports will cover data through the previous Saturday.

We are six weeks into a six-month open enrollment period. Highlights from today's report include:

* Through November 9, more than 53,000 Marylanders have created identity-verified accounts, and there have been more than 410,000 unique visitors to the website;

* Total enrollments in qualified health plans increased 36% during the week ending November 9 to a total of 1,743 individuals;

* For the first month of enrollment, 55% of enrollments in qualified health plans in the first month are women, more than one-third of enrollments in qualified health plans in the first month are individuals under age 35, and 55% are under age 45; and

* Counting Medicaid pre-enrollments, new Medicaid eligibles, and individuals who have selected qualified health plans for enrollment, more than 90,000 Marylanders are on track for coverage beginning January 1, 2014 under the Affordable Care Act.

Monthly Report

On Wednesday, the U.S. Department of Health and Human Services reported that from October 1 through November 2:

* 10,917 applications were submitted in Maryland for coverage;

* Among Marylanders included on submitted applications, 5,923 were determined eligible for Medicaid and 3,498 were determined eligible to purchase private health insurance (1); and

* 1,284 Marylanders had selected a health plan for enrollment (2).

Supplementary Information on Enrollments in Qualified Health Plans, 10/1-11/2

  • Total Qualified Health Plan Enrollment: 1,278

Enrollment by Age:

  • < Age 18: 102
  • 18-25: 70
  • 26-34: 273
  • 35-44: 261
  • 45-54: 277
  • 55-64: 285
  • >65: 10

Enrollment by Gender:

  • Male: 45%
  • Female: 55%

Enrollment by Metal Level

  • Catastrophic: 6
  • Bronze: 332
  • Silver: 486
  • Gold: 215
  • Platinum: 239

Information on the Call Center and Website, 10/1-11/2

  • Total Calls: 48,452
  • Average Wait Time: 32 seconds
  • Average Call Handle Time: 10:37 minutes
  • Unique Website Visits: 375,873
  • Website Visits: 683,266
  • Page Views: 2,118,830





Finance & Business

The White House is offering more money to insurance companies as an incentive for them to let people keep insurance policies that were to have been canceled next year. The administration floated several proposals on Monday to "help offset the loss in premium revenue and profit" that it said might occur if insurers went along with President Obama's request to reinstate canceled policies   


New SHOP Enrollment Process

CMS is offering a "direct enrollment" process to allow small employers and their employees to get the benefits of the SHOP Marketplace coverage quickly. Now small businesses can handle the whole process-applying, shopping, and enrolling-by directly contacting an agent, broker, or an insurance company that offers a SHOP Marketplace plan. With this "direct enrollment" process, small businesses don't have to create online accounts, or wait to hear about their eligibility from the SHOP Marketplace before enrolling. 

For employers who are interested in taking advantage of the Small Business Healthcare Tax Credit, they will need to apply and be determined eligible prior to filing taxes in order to access the tax credit.

Starting in November 2014, small business owners and employees will be able to apply and enroll in SHOP coverage online, for coverage that takes effect in January 2015.

The Latest News on ACA
What's the LATEST 
on the ACA this week?



*A new toolkit from Access Community Health Centers and the University of Wisconsin-Department of Family Medicine aims to improve mental health care within primary care.




Marketplace Tech Update

On Dec. 1, the general contractor and systems integrator under Jeff Zients offered an operational progress report on our work to improve over the past five weeks. We want to highlight the many measurable improvements we've made to the site as well as acknowledge that more work remains to be done. As we've said, with any web project there is not a magic moment but a process of continual improvement over time and we will continue to work to make enhancements in the days, weeks and months ahead.  

Because of the numerous upgrades in software and hardware over the last month, as of Dec. 1, is able to handle approximately 50,000 users at the same time and more than 800,000 users a day. Response times are under 1 second. Error rates are down well under 1%. The system is stable, with uptimes exceeding 90%. The underlying infrastructure of is much stronger today than it was a few weeks ago.

While we still have work to do, we've made significant progress. The team is continuing its ongoing work and will keep you up to date on our efforts.  The full Progress and Performance Report which provides data on how the system is performing can be found here.

CMS is having daily conversations with issuers to get feedback on 834 forms.  We are still working closely with insurers to identify the few remaining outstanding problems so they get accurate and timely enrollment information from consumers signing up for coverage.  We are mindful of consumers who want coverage in January and may be experiencing frustration because they haven't heard from their plan yet due to a technical issue. CMS is reaching out directly to consumers who've selected a plan to let them know to be in touch with their plan, pay their first premium to ensure coverage and know plans are working hard to make sure their new customers are covered as well.  If consumers are not sure if they are enrolled, they should call our customer call center or the insurer of their choice so they can get covered by Jan 1.

This week we posted additional blogs and a fact sheet on our ongoing work to improve

New Resources

Helping Consumers who have attempted but have Not Completed Enrollment: Tips for In-person Enrollment Assisters

As we begin December with a vastly improved web experience, we are mindful of the valuable work assisters are providing to consumers to make sure those consumers who experienced frustration over the past several weeks are able to resolve their issues and complete their enrollment and confirm that those who have enrolled know their next steps to make sure they get coverage.

We encourage assisters to continue their work to increase the number of outreach and education events to reach new consumers.  We also suggest that assisters pay particular attention to those consumers who still need questions answered in order to complete their enrollment. To that end, we have created a new tip sheet for Assisters that details the process step-by-step for assisters to follow to help consumers in specific situations. The specific scenarios addressed are as follows:

     I.    The consumer is stuck somewhere in the application

     II.   The consumer submitted a paper application but hasn't heard anything

     III.   The consumer only wants to submit a paper application

     IV.  The consumer is eligible for Medicaid or CHIP

The new Assister Tips resource document can be found on the Resources for Assisters page on

Understanding MAGI and the New World of Eligibility

CMS posted new materials on this week that can help assisters to understand how the new MAGI rules work, what the changes are to household composition and income counting, and also how Medicaid and CHIP interact with the Marketplace.

  • Affordable Care Act Overview: A Primer for Medicaid/CHIP Eligibility Workers (12 MB PowerPoint)
    This educational slide deck provides an overview of the coverage changes under the Affordable Care Act through a Medicaid and CHIP lens. It is designed as a tool for application assisters, state Medicaid/CHIP eligibility workers, and others who need to understand the Medicaid and CHIP-related changes and how they fit into the broader landscape, including the new health insurance Marketplaces, the availability of advance payments of premium tax credits and cost-sharing reductions, private insurance market reforms, and the shared responsibility payment.
  • Household Composition and Income Eligibility Rules: Detailed Rules for Medicaid/CHIP Eligibility Workers (20MB ZIP)
    This slide deck and accompanying trainer's manual provide detailed information on the new Medicaid and CHIP household composition and income eligibility rules under the Affordable Care Act. These materials explain in great detail the household composition rules, including filer and non-filer household rules and the household income rules related to Modified Adjusted Gross Income (MAGI) and countable and non-countable income. The materials provide user friendly household scenarios designed to assist eligibility and enrollment staff in understanding how to apply the new Medicaid/CHIP eligibility rules.

Regional Office Expanded Role: Caseworkers

In addition to their efforts to support outreach and education efforts, Regional Office staff will also be responding to inquiries referred to them by the Call Center by providing consumers that have concerns about the application and eligibility process with tips to help ensure a smooth online application process.  To elevate a challenging consumer case into the casework system - please call the Call Center and provide them detailed information.

Outreach, Education, and Enrollment Assistance Tips

We are two months into the six month open enrollment period.  Given that, we want to share assister best practices including efforts to hold "classroom style" enrollment events in addition to or in place of one-on-one assistance appointments where assisters only work with one individual at a time, adhering to privacy and security standards.  For example, Assister #1 walks a group through portions of the application and Assister #2 offers to work one-on-one when an individual raises his or her hand with a question. In addition to tailored specific events, we encourage assisters to host and participate in events open to the public. If an assister is unable to assist consumers during an enrollment event based on capacity, we want to share the best practice of setting up follow up appointments to maximize that enrollment opportunity. Please continue to share with us your best practices for outreach and education, as well as enrollment assistance, and we will continue to share them with the group.





 For other helpful outreach and enrollment resources, please click here.


Grants & Funding Opportunities

Health Centers Can Sign Up for Children's Health Literacy Resource

As you know, health literacy skills start early in life and are an important part 

of caring for and educating children and adolescents. First Book offers a collection of children's books that combine lessons in literacy with lessons on practicing healthy behaviors.  The program works with health professionals like you to ensure low-income kids have access to brand new, high-quality books they need to succeed.  By joining the First Book network, you'll have ongoing access to free and deeply discounted new books for the children you serve. Click here to sign-up. After signing up, keep an eye on your inbox for a welcome email from First Book and instructions on how to start selecting from the wide variety of great titles. Questions may be directed to (866) READ-NOW or by email to  


Community Health Center Executive Fellowship

Application Deadline: Prior to First Session, January 15, 2014

This 11-month distance learning program is sponsored by the University of Kansas Medical Center, Department of Health Policy & Management, in collaboration with the Greater Midwest Association of Primary Health Care and the Kansas Association for the Medically Underserved. The Fellowship is designed to prepare emerging leaders for increasingly responsible management positions in community health centers.  Leveraging interactive online technology, students are able to expand their knowledge and develop the professional skills necessary to respond to the dynamic challenges that exist in the community health environment. The program offers two options:


  • Option 1: By completing all six modules you will received a certificate from the University of Kansas and a lapel pin designating you a "CHC Executive Fellow." Tuition in 2014 is $4,500, plus cost of books, travel/lodging for Capstone in Washington, D.C., plus $150 for meals and transportation.
  • Option 2: Individual module(s) are available for people who may not want (or have time for) the entire curriculum or the CHC Executive Fellow designation, but just want to focus on one or more particular critical areas. Tuition for individual modules is $950 each plus cost of books.  Check the academic calendar on the program's website to see when the module(s) you're interested in are scheduled.


Please email Marsha Killian for more information and/or to begin the application process. 


FY 2014 Rural Health Network Development Planning Grant Program: HRSA-14-043

Application Deadline: January 16, 2014

The Office of Rural Health Policy (ORHP) has announced this funding to assist in the development of an integrated healthcare network.  For the purposes of this grant program, a rural health network is defined as an organizational arrangement among at least three separately owned regional or local health care providers that come together to develop strategies for improving health services delivery systems in a community.  Networks can include a wide range of community partners including social service agencies, faith-based organizations, mental health agencies, charitable organizations, educational institutions, employers, local government agencies or other entities with an interest in a community's health care system. Successful applicants may request up to $85,000 for one year to create a foundation for their infrastructure and form a coordinated plan among members to address important regional or local health needs.  ORHP expects to fund approximately 15 grantees. There will be a technical assistance call on Tuesday, December 3 at 1:00 pm ET:


Meeting Name: Rural Health Network Development 

Planning Program 

Web connection: Click here

Toll-free call-in number: (800) 475-0512

Participant Passcode:  5732913


U.S. Department of Health and Human Services announces new funding opportunities to support the primary care workforce

To help expand and support the nation's supply of primary care practitioners, HHS Secretary Kathleen Sebelius today announced the availability of funds for two programs that receive funding under the Affordable Care Act. 

Robert Wood Johnson Foundation Executive Nurse Fellowship
Application Deadline: January 14, 2014 (3:00 pm ET)  
The Robert Wood Johnson Foundation Executive Nurse Fellows program is a three-year advanced leadership program for nurses who aspire to lead and shape health care locally and nationally. Fellows strengthen and improve their leadership abilities related to improving health and health care. Interested health center nurses should feel free to contact Cheri Rinehart, PACHC President & CEO and a graduate of the program, for more information, including other PA health center alumni of the program.


Debunk the Myths: Grant Application Video Series

Federal grants can be excellent funding opportunities for your project, but not understanding the process can lead to a great deal of frustration. This video series will debunk common myths and assist you with your grant applications.

FY 2014 Service Area Competition (SAC) Technical Assistance

Service Area Competition - New, Competing Continuation, and Supplemental (HRSA-14-021, HRSA-14-022, HRSA14-023, HRSA-14-024, HRSA-14-025, HRSA-14-026, HRSA-14-027, HRSA-14-028)

Through the Service Area Competition (SAC), HRSA will award approximately $468 million in funding to an estimated 310 SAC applicants. A SAC application is a request for Federal financial assistance to support comprehensive primary health care services for a competitively announced underserved area or population. All available service areas (see below) are currently served by Health Center Program grantees whose project periods are ending in FY 2014.

Application Deadlines

Project Period Start DateHRSA Announcement Deadline (11:59 PM ET)HRSA EHB Deadline (5:00 PM ET)
November 1, 2013HRSA-14-021July 24, 2013August 7, 2013
December 1, 2013HRSA-14-022July 31, 2013August 14, 2013
January 1, 2014HRSA-14-023August 14, 2013August 28, 2013
February 1, 2014HRSA-14-024September 11, 2013September 25, 2013
March 1, 2014HRSA-14-025October 9, 2013October 23, 2013
April 1, 2014HRSA-14-026October 30, 2013November 13, 2013
May 1, 2014HRSA-14-027December 4, 2013December 18, 2013
June 1, 2014HRSA-14-028January 8, 2014January 22, 2014

*Please click on the title for more information regarding the various grants. 



Bureau of Primary Health Care Loan Guarantee Program

Application Deadline: Applications accepted on an ongoing basis
Loan program to Section 330 health centers to obtain a loan guarantee for the financing of a medical facility construction, renovation and modernization.
Patient Centered Medical Home (PCMH) Corner 

Weekly Questions and Answers around PCMH to help you!


a)      What is an acceptable manual process to flag when orders (x-rays, lab, etc.) are overdue? There are a number of options you can use, but not limited to the ones mentioned here: 1. Use an Excel spreadsheet that documents what orders were placed and have someone responsible for checking the status of the orders and indicating that status in the spreadsheet. The spreadsheet can indicate the date the order is due and if that order hasn't been received by the due date then follow up needs to occur and the cell with the information can be color coded to show the lateness; or 2. The spreadsheet can be printed off and highlighted with a regular highlighter marker to show which orders need follow up. It is critical, though, that whatever process exists that it is documented.It must include what staff person is responsible for flagging and following up on the overdue orders, how the specific action takes place in the organization, and at what point does the flagging occur, eg., what is the turn around time to receive the results of the order.

b)      In measuring patient experience, how can care coordination/whole person care/self management support be factored in our patient satisfaction questionnaire? You may consider the following questions to include on the survey: 1. "Did you receive any reminders about your care between office visits?"; or 2) "Did your provider seem up-to-date about the care that you received outside of the clinic?" - gets to were the results returned, were they provided to the patient's provider, emphasizing that care coordination piece occurring on the back end and affecting the patient's experience within the practice; or 3) "If you had any lab tests during your last visit, did you receive a phone call, email, or letter letting you know what the results of the lab test was?"; for whole person care/self management support, 4. "Did anyone ask during your last visit talk with you about specific goals for your health?" - can also be asked after visit occurs; or 5. Did anyone ask during your last visit if there were things that make it difficult for you to take care of your health?" - Again assessing, is your practice providing that self management support, addressing barriers to care during the visit; or 6. "Did anyone during your last visit ask you about a personal problem, family problem, alcohol us or drug use?" - again, focusing on the whole person care aspect.

Clinical Quality 
  1. 1.       2014 Clinical Quality Measures (CQMs) - Reporting to CMS Requirement
a)      All Eligible Providers (EPs) will be required, whether they are participating in Stage 1 or Stage 2 of the CMS EHR Incentive Programs, to report using the new 2014 CQMs criteria. This is so EPs can demonstrate meaningful use.


b)      EPs must report on 9 of the 64 approved CQMs. The selected CQMs must cover at least 3 of the National Quality Strategy domains.

c)       All Medicare-eligible providers beyond their first year of demonstrating meaningful use must electronically report their CQM data to CMS. Medicaid EPs participating in the Medicaid EHR Incentive Program will electronically report to their state.

d)      The following links contain the 2014 Recommended CQMs for Pediatric/Adults and how to compute the numerator & denominator.

 i.     Pediatric:

 ii.      Adult:

iii.      Final CQMs (numerator/denominator):

Health Observances This Week
December is World AIDS Awareness Month 

The World Health Organization established World AIDS Day in 1988. World AIDS Campaign is the leading international organization which plans and implements the observance.

See how individuals and communities are participating in the Facing AIDS photo campaign.

Follow the blog for news about World AIDS Day 2013.

Has your FQHC joined the 
National Branding Campaign?


With more than 43 billion people  eligible to enroll in private insurance starting this October 1, FQHCs strive to create an identifiable unifying identity for themselves. This is where the National Branding Campaign for Our Health Centers comes into place. 

The campaign is a national branding effort to strengthen recognition of our Health Centers as a unified and nationwide network of quality community-based primary care providers.  Initially created at the state level by the Pennsylvania Association of Community Health Centers (PACHC) and its membership, the National Association of Community Health Centers has expanded the campaign nationwide.


The FQHC Brand Components  

MACHC recently hosted a Branding Webinar for MD and DE Health Centers with CEO of PACHC, Cheri Reinhart and Event and Communications Coordinator, Kirsten Keyes, as guest speakers. If you missed the webinar and would like access, please click here.

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Copyright 2013. All Rights Reserved.