Weekly E-Blast:  
Voicing the latest news on Communities in Need
In This Issue

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Let's Stay Connected
February 7, 2014 
Community Health Center Spotlight
MACHC Website Under Construction..... 


New Website COMING SOON!!!!


Technical Assistance Request Form 
(to be submitted prior to receiving any TA from MACHC)
MACHC Happenings
(1) Health/Wellness Fair:Beebe Healthcare Health Fair Rehoboth Beach Convention Center - DELAWARE 
When: Sat, Feb. 8, 9:00 AM until 3:00 PM

Sussex County:
 229 Rehoboth Avenue, Rehoboth Beach

For more information, CLICK HERE.


The next NACHC TeleForum will occur on Tuesday, February 11th at 2:00 PM EST. We invite and encourage all Health Center Advocates to join NACHC for this free call to receive new details on NACHC's crucial 2014 policy and advocacy campaign. This is a key call for all Health Center Advocates to join as we enter a year of unprecedented opportunities and challenges. To sign up to receive the call, click here . Advocates can also join the TeleForum directly by dialing 1-877-229-8493 and using the pin 15035.

(3) Strategic Planning Committee Meeting
When: February 20th - 21st, 2014
Where: Turf Valley, Maryland


(4) Information Session:Affordable Care Act Information Session PS DuPont School Workshop - DELAWARE 
When: Tue, Feb. 25, 6:00 PM until 8:00 PM

New Castle County:
 701 W 34th Street, Wilmington  

For more information, CLICK HERE.


(5) NACHC Policy & Issues Forum 
Please remember that NACHC's Policy & Issues Forum is scheduled for March 19 through 23 in Washington, D.C. We encourage all health centers to participate and schedule appointments with your Congressional delegation for Thursday, March 20. More details are forthcoming from NACHC.


MACHC's Annual Conference
When: Thursday, September 18th - Friday, September 19th, 2014 
Where: Dover Downs Hotel, Dover, DE 

Final Draft of ESF-8 Communications Plan Posted to HAN

DHMH, OP&R has just released a final draft of the ESF-8 Communications Plan, which has been published to the Maryland Health Alert Network (HAN) website along with a comment form. We are requesting partner feedback in order to finalize this plan. Please see the attached memo from Sherry Adams providing background information on the processes utilized to draft the plan, instructions for submitting your feedback, and the actions that OP&R will take to follow up.


The ESF-8 Communications Plan and comment form can be accessed by logging on to HAN and selecting the following folders: Documents/Communications/ESF-8 Communications Plan.


Please use the following email inbox to submit your comments form: Comments are due no later than February 28, 2014.


For questions or additional information about the ESF-8 Communications Plan, contact Alicia McClelland, DHMH Communications [W: 410-767-4493].


Statewide Inventory Assessment Project

DHMH, OP&R will be undertaking a statewide inventory assessment of all supplies and materials purchased with Hospital Preparedness Program (HPP) funds. This will involve visiting every facility that has purchased or received items funded by HPP. In preparation


 the assessment, OP&R staff will


 Inventory Management Forms submitted with End of Year Reports dated from FY08 to FY12 (BP1). Data collected from these reports will serve as the minimal items that will be captured during the inventory process.


Over the next few weeks we will be making contact with facilities to follow up on missing or incomplete Inventory Management Forms.

Integrated Public Health and Medical Preparedness Forum (IPHMPF)

Healthcare coalition partners are encouraged to join us for the next Integrated Preparedness Forum, to be held on February 24, 2014. The featured presenters will be Lisa Skolnick and Reanee Murriell of the Federal Bureau of Investigation (FBI). They will be speaking on the FBI Office of Victim Assistance's Response to Criminal Mass Casualty Events.

Save the Date: HPP Budget Period 3 Pre-Application Meeting

The Pre-Application Meeting for HPP Budget Period (BP) 3 has been scheduled for May 21, 2014 at the Maritime Institute Conference Center. A meeting agenda will be provided in the coming months.

Reminder: New Bimonthly Schedule for HPP Healthcare Systems Conference Calls

The HPP Healthcare Systems Partner Conference Calls have moved to a new bimonthly schedule. The first call of the year was held on January 16, 2014. Going forward, these calls will still be held on third Thursdays at 10:30am; however, they will take place on a bimonthly basis. Additional conference calls are scheduled for March 20, May 15, July 17, September 18, and November 20. Appointment notices will be sent out by Bonita Winchester-Bey.

II. Program Updates and Deliverables

National Healthcare Coalition Resource Center (NHCRC) Monthly Follow Up for Strategic Planning

NHCRC faculty will continue to engage in monthly follow-up to support healthcare coalitions with implementation of the priorities identified in the workshops. Partners are encouraged to attend and actively participate in these follow-up sessions in order to meet their coalition's goals and objectives. Contact your respective HPP Regional Coordinator


information about


 meeting times for your regional coalition.

III. Preparedness News

Proposed Rule: Emergency Preparedness Requirements for End Stage Renal Disease (ESRD) Facilities

The Centers for Medicare and Medicaid Services (CMS) has released a new rule that would establish national emergency preparedness requirements for Medicare- and Medicaid-participating providers and suppliers. This would include hospitals, ambulatory surgical centers, hospices, long-term care facilities, home health agencies, critical access hospitals, organ procurement organizations, and End Stage Renal Disease (ESRD) facilities, among others. The intent of the rule is to ensure that these organizations adequately plan for both natural and man-made disasters, and coordinate with federal, state, tribal, regional, and local emergency preparedness systems. It would also ensure that they are adequately prepared to meet the needs of patients, residents, clients, and participants during disasters and emergency situations.

The proposed rule would add additional requirements to the Conditions for Coverage for ESRD facilities and relocate the emergency preparedness Conditions for Coverage requirement established in the April 2008 Final Rule "Conditions for Coverage for End-Stage Renal Disease Facilities; Final Rule." An overview of the proposed rule's requirements is available at Comments on the proposed rule are due by 2/25/2014.

IV. Preparedness Trainings, Exercises and Events

DHMH MSAT G2 Satellite Phone Webinar Training and Drill Schedule

DHMH OP&R has scheduled two webinars to provide preparedness partners with up-to-date, hands-on training before quarterly MSAT testing begins in March. See the attached announcement for specific information regarding the training.

Webinar Schedule:

Regions I, II & V: February 18, 10:30-11:30am  [Calendar appointments have been sent to designated primary healthcare emergency planners.]

Regions III & IV: March 6, 1:30-2:30pm  [Calendar appointments have been sent to designated primary healthcare emergency planners.]

DHMH, in partnership with local health departments, state facilities and acute care hospitals, will begin quarterly testing of the MSAT wall-mounted satellite phones in March 2014. The objective of quarterly tests is to ensure that all agencies equipped with an MSAT are familiar with the use and functionality of the device.

March MSAT Drill Schedule

Regions I-II: March 11 (1-2pm)  

Region III: March 17 (10-11am)

Region IV: March 19 (2-3pm)

Region V: March 12 (11am-12pm)

A full testing schedule that includes test times has been posted to the HAN website and can be accessed by logging in to HAN, clicking the Documents tab, and selecting Communications folder/Appendix A/Statewide Quarterly Testing Calendar. For specific questions regarding testing of the MSAT satellite phone, please contact your HPP Regional Coordinator or Alicia McClelland at DHMH Communications [W: 410-767-4493].

Region III Alternate Care Site Cache Deployment Tabletop Exercise

Date: March 6, 2014

Time: 8:30am - 12:30pm

Location: MedStar Harbor Hospital [3001 S. Hanover Street, Baltimore, MD 21225]


The purpose of this exercise is to test the newly drafted Region III Maryland Alternate Care Site (ACS) Equipment and Supply Cache Activation Plan, which impacts hospitals, public health and other responders across Region III. The Plan outlines the process for activation, deployment and return of cache equipment and supplies located at the USAR warehouse. The exercise will provide participants an overview of the Plan and address stakeholder roles and responsibilities. For more information and to register, see the attached flyer.

Preparedness Trainings   -------------

ICS 400: Advanced ICS.

In coordination with the Department of Health and Mental Hygiene (DHMH), the Maryland Emergency Management Agency (MEMA), Active Learning and Exercise Branch invites you to participate in the ICS 400: Advanced ICS training course.


Dates: February 19-20, 2014

Time: 8:30am - 4:30pm

Location: Baltimore Public Safety Training Academy, Room 200 (3500 W. Northern Parkway, Baltimore, MD 21215)


Registration closes on February 12, 2014. For additional information and registration instructions, see the attached flyer.




MEMA Community Cybersecurity Courses

AWR 136: Essentials of Community Cybersecurity. This course provides individuals, community leaders, and first responders with information on how cyber attacks can impact, prevent, and/or stop operations and emergency responses in a community. The course also provides a cursory introduction to cybersecurity vulnerabilities, risks, threats, and countermeasures. It explains vulnerabilities of computer systems and networks and how these vulnerabilities can affect communities, organizations, and daily workplace operations.


Date: March 4, 2014

Time: 8:00am - 12:00pm

Location: James N. Robey Public Safety Training Center, 2200 Scott Wheeler Drive, Marriottsville, MD 21104


To register:


MGT 384: The EOC's Role in Community Cybersecurity. This course provides an awareness of how cyber events can impact communities. Participants will learn (1) the roles and responsibilities needed to detect, prevent and respond to cybersecurity incidents; (2) how the EOC and community can plan for and manage information needed for a cyber event; and (3) how cyber attacks can be used to affect, disrupt and/or complicate emergency responses.

Dates: March 4-5, 2014

Times: 1:00pm - 5:00pm (March 4), 8:00am - 5:00pm (March 5)

Location: James N. Robey Public Safety Training Center, 2200 Scott Wheeler Drive, Marriottsville, MD 21104


To register:




Active Shooter in a Healthcare Setting.

In coordination with the Department of Health and Mental Hygiene (DHMH), the Maryland Emergency Management Agency (MEMA), Active Learning and Exercise Branch invites you to participate in the Active Shooter in a Healthcare Setting training course.


Date: March 25, 2014

Time: 8:30am - 4:30pm

Location: Springfield Hospital Center, Central Conference Room, 6655 Sykesville Road, Sykesville, MD 21784


Overview: Active Shooter training for healthcare professionals which will give strategies for responding to a shooting situation. Guest speakers from Johns Hopkins will discuss a shooting incident that occurred at their facility. MEMA/MSP staff will provide training on developing plans within facilities.


Register: Registration closes on March 18, 2014, at 8:30am. To register, visit


For more information, see the attached flyer.




Free CDC Crisis and Emergency Risk Communication (CERC) Training on March 27


Who: You!

What:CDC Crisis and Emergency Risk Communication Training [sponsored by Fairfax County and the National Public Health Information Coalition]

Where: Fairfax County Government Center, 12000 Government Center Parkway, Fairfax, VA 22035

When: Thursday, March 27, 9 a.m. to 4 p.m.

Cost: Free!



About This Training: CERC training is a fast-paced, interactive course that gives participants essential knowledge and tools to navigate the harsh realities of communicating to the public, media, partners and stakeholders during an intense public health emergency. CERC sessions are presented across the U.S. and internationally to offer helpful guidance for communicating with people when the unthinkable happens to them, their family, their community or the nation. This rare in-person CERC training is the first to be conducted in the National Capital Region in several years. This session will be taught by Richard Sheehe, National Public Health Information Coalition CERC Project Manager and Senior Research Fellow at George Mason University's Center for Health and Risk Communication. More CERC information is available at:  and


Target Audience: Public information officers; federal, state, and local public health professionals; health care professionals; emergency medical services professionals; preparedness partners; and civic and community leaders 


Training Goals: Share communication strategies that will help to effectively prepare for and respond to public health emergencies; review and disseminate current crisis and emergency risk communication training curricula and tools; and train communicators in how to systematically plan, develop, implement, and evaluate crisis and emergency risk communication training activities.




Emergency Management of Radiation Accident Victims (REAC/TS) Training Course Rescheduled


The course has been successfully rescheduled for April 22-23, 2014.  For more information and to register, see the attached flyer




The United States Army Medical Research Institute of Chemical Defense (USAMRICD) and the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) are advertising the following training opportunities for 2014.

Medical Management of Chemical and Biological Casualties (MCBC) Course.  Dates: multiple dates in 2014

Field Management of Chemical and Biological Casualties (FCBC) Course.  Dates: multiple dates in 2014

CE, CME, CEH credits are available for these courses. See the attached flyers for additional details and registration information.

Policy, Advocacy and Legislation
National News

***Health Center Program Site Visit Guide Updated***

In response to health center feedback, HRSA has streamlined the Health Center Program Site Visit Guide to improve overall clarity and focus on program requirements. View the updated Health Center Program Site Visit Guide.

Background: The Health Center Program Site Visit Guide is the Bureau of Primary Health Care's standardized review instrument used to conduct Operational Site Visits and, when appropriate, other types of site visits at health centers. It includes review questions used by the team conducting the site visit to assess compliance with each program requirement, as well as to review progress on clinical and financial performance and capital grants (if applicable), and, when possible, to identify any best practices established by the health center. Health centers also may use this guide to assess compliance with program requirements and to identify clinical and financial performance improvement areas. 
 HRSA has issued Policy Information Notice 2014-01, "Health Center Program Governance" to convey and clarify requirements for Health Center governance.  

This Policy Information Notice (PIN) provides detailed information regarding Health Center Program governance requirements. The purpose of this PIN is to:

  • Convey and clarify statutory and regulatory requirements regarding the structure and functioning of governing boards for all Health Center Program grantees (e.g., section 330(e), (g), (h), and/or (i) grantees) and look-alikes;
  • Provide clarification regarding board requirements for public centers under co-applicant arrangements, including public centers funded or designated solely under sections 330(g), 330(h), and/or 330(i) to serve special populations; and
  • Outline the eligibility and qualifying requirements for Health Resources and Services Administration approval of a governance waiver for the fifty-one percent patient majority governance requirement for eligible section 330 grantees and look-alikes. This PIN also establishes Health Resources and Services Administration policy that eliminates the monthly meeting requirement from waiver consideration.

Currently funded health center grantees and currently designated look-alikes are encouraged to contact their Project Officer for further assistance regarding the governing board requirements and/or questions that specifically relate to their health center projects. If you have any additional questions or require further guidance on the policies detailed in this PIN, please contact the Bureau of Primary Health Care, Office of Policy and Program Development

HHS Secretary Sebelius and HRSA's Jim Macrae Discuss Outreach and Enrollment and HRSA Spend Plans- Recording and Transcript Available

Last Wednesday U.S. Secretary Sebelius and various Health Center representatives participated in a call to discuss Health Centers' importance to the success of the Affordable Care Act through outreach and enrollment activities. HRSA's Jim Macrae also reviewed plans for spending the nearly $700 million in new ACA funding. Those who missed last week's call can access a recording of the call as well as a transcript (click on title) Health Centers continue working to inform their communities about the importance of signing up for coverage and enrolling them in appropriate plans. Health Centers have already greatly contributed to the over six million Americans who have gained coverage since Oct. 1st. As you continue to enroll individuals in your community, please keep NACHC posted on local news articles, newsletters, press releases, photos, or general Health Center O&E stories by emailing Amy Simmons at

Also, don't forget to consult NACHC's O&E triage map to know where to send your O&E questions.

As out-of-pocket medical costs grow for many Americans, the insurance industry is offering a way to help and, at the same time, expand its business: by selling supplemental policies that may fill the gaps for consumers. Insurers are increasingly marketing these limited policies that pay cash after a hospital stay or specific disease diagnosis, such as cancer.
Insurers Face New Pressure Over Limited Doctor Choice
Insurers are facing pressure from regulators and lawmakers about plans that offer limited choices of doctors and hospitals, a tactic the industry said is vital to keep down coverage prices in the new health law's marketplaces. This week, federal regulators proposed a tougher review process for the doctors and hospitals in plans to be sold next year through, a shift that could force insurers to expand those networks.
Lawmakers Spar Over CBO's U.S. Health-Law Findings
Republicans at a House Budget Committee hearing said the report, released Tuesday, shows the health law will drive people out of the work force. Democrats countered that the report shows the law will give workers flexibility to leave jobs they are locked into because of health-care benefits. The sparring came in response to a Congressional Budget Office analysis concluding that subsidies in the law, combined with easier access to health care, would create incentives for many Americans to cut their work hours, leading to a net reduction of 1.5% to 2% from 2017 through 2024. 
Do you participate in the 340b program? Did you know the Office of Pharmacy Affairs (OPA) requires all 340b-covered entities to recertify their information each year in order to continue participating in the 340b program? Health Centers will begin the recertification process in February 10th and it is absolutely critical that contact information be updated by March 14th in order to get the latest information to ensure continued participation in the program.  For more information, stay tuned to the Policy Shop blog and the Office of Pharmacy Affairs website 

Gov. Terry McAuliffe used the occasion of his first bill-signing Wednesday to make a far-reaching pitch for Medicaid expansion as an economic development tool. Saying he's flexible about the details, hungry to find bipartisan compromise and "willing to work with anybody, around the clock, 24 hours a day, seven days a week," McAuliffe (D) said that the commonwealth should seize the chance to insure hundreds of thousands of low-income Virginians under the new health-care law - for their sake, and the sake of the economy . 

Between 1 million and 2 million Americans signed up for Medicaid last year because of the health-care law, according to a new report suggesting that many of the people who have joined the program since the initiative's rollout in October would have done so absent the law. The Obama administration has said that 6.3 million people were determined to be eligible for Medicaid between October and December. But the study, from health-care industry consulting firm Avalere Health, suggests that only a fraction of the enrollments are strictly the result of the health-care law 
State News
Check out the Delaware ACA Toolkit right here!

In this WHYY/newsworks story, Delaware State Librarian Annie Norman said she approached DHSS so the state's libraries could help inform Delawareans about the Affordable Care Act. Already, the libraries have hosted more than three dozen events and fielded more than 300 questions. For a list of Delaware marketplace enrollment events, go to: 



Md. Panel To Examine Problems With Health Exchange
The panel, which will hold its first public meeting Monday, will include five state senators and five members of the House of Delegates. A main focus will be overseeing the progress of fixing technological problems and helping as many people as possible sign up before an open enrollment deadline of March 31. Members will later look at what led to the problems in the first place with an aim toward preventing it from happening again in the future 

Finance & Business
The Congressional Budget Office earlier this week said this year's deficit is likely to be about a-third the size it was back in 2009 when the Great Recession bottomed out. A recovering economy is the main reason for the deficit's improvement, but moderating health care costs have also contributed. Harvard economist and health policy specialist David Cutler says getting the federal government's finances under control is all about health care. 
What Small Business Owners Should Know About The New Obamacare Report
Congressional budget analysts on Tuesday released revised estimates concerning the economic footprint of the health care law, spawning another round of headlines declaring that Obamacare will take a massive bite out of workers' hours and eliminate millions of jobs. Thing is, that's not what the report said at all. In fact, the nonpartisan group's predictions actually refute some of the warnings from small business leaders - namely, that the law will force employers to trim hours for their current workers and think twice about hiring new ones.
The Latest News on ACA
What's the LATEST 
on the ACA this week



I. Enrollment Campaign Update

February is Black History Month and we're proud to be working toward reducing the long standing disparities in health care in the African American community.  Also in February we're ramping up efforts to target moms to remind their sons and daughters why they need to get covered.  Here is a new video to accompany the campaign that may be useful in your own outreach: Reminder: It's Time to Get Covered in the Marketplace.

II. Best Practices to Maximize the Reach of Assisters - Make Every Contact Count

With less than eight weeks remaining in the open enrollment period, now is the time to continue to get the word out, educate consumers about the Marketplace, and enroll them in coverage.  Many assisters have focused on maximizing the impact and reach of their outreach and education efforts, resulting in more enrollments with minimal heavy lifting.  We encourage assisters to be creative with existing networks to leverage contacts to reach communities most in need of coverage.  Below is an example of an outreach "best practice" demonstrating this effort.  Just as President Obama, in Tuesday's State of the Union Address, asked every American who knows someone without health insurance to help them get covered by March 31st, Capital Area Agency on Aging is reaching consumers where they work and live, who in turn reach out to others who can benefit from enrolling in a Marketplace plan. 

Capital Area Agency on Aging in Louisiana is a Navigator grantee with past experience serving the Medicare-eligible population. They've capitalized on their existing networks to reach out to offer enrollment assistance to the staff of service providers they have worked with in the past: staff providing care in nursing homes, home health organizations, hospice providers, and hospitals.  They have also branched out to child care providers, early childhood educators, and preschools.  By targeting the staff that provide services to their existing client base and their clients' families, Capital Area Agency on Aging has identified a target audience of coverage-eligible consumers who in turn are connected to more citizens in similar circles.  By providing enrollment assistance to staff members at just one service provider, Capital Area Agency on Aging reaches the families, friends and colleagues to talk about the benefits of their new coverage.  By targeting communities this way, assisters ignite a grassroots ripple effect resulting in more enrollments. This creative leveraging of existing networks harnesses the power of word of mouth and builds trust within the community. 

III. New 2014 Federal Poverty Levels (FPLs) Released

Last week, HHS released the new 2014 Federal Poverty Levels (FPLs). They are available at:  The Federal Poverty Level is a measure of income that is updated every year by the Department of Health and Human Services. It is used by states and the Marketplace to determine a consumer's eligibility for QHP subsidies and for Medicaid and CHIP.  Currently, both states and the Marketplace are using the 2013 FPLs. Soon the Marketplace will begin using the newly released 2014 FPLs, for Medicaid and CHIP only. However, for QHP subsidy eligibility, the Marketplace will continue to use the 2013 FPLs until the next Open Enrollment period. When the 2014 FPLs are implemented, a consumer's eligibility for Medicaid and CHIP will be determined according to what is in the system when they apply. Consumers that applied prior to using the 2014 FPL will continue to have their income measured by the 2013 FPLs.

IV. New Resources College Students

There is a new resource page for College Students on, providing helpful information on what a college student needs to know about the Marketplace, including: what to do if he or she has a student health plan or coverage on a parent's plan; filing a tax return; ,and eligibility for Medicaid coverage.  We'll be providing further tips for assisters helping college students soon.  The new page can be found here: If I'm a college student, what do I need to know about the Marketplace?

Assister Resources

As a reminder, here is a list of several fact sheets recently posted to related to using new coverage, as well as various Q&As for assisters working with consumers on application and enrollment. We encourage assisters to use these materials with consumers and other stakeholders to increase consumer awareness about health insurance issues.

As a reminder, here are helpful links on regarding immigration:

  1. 1.     Information on Eligible Immigration Status Types
  2. 2.     More Information on Eligible Immigration Status Types
  3. 3.     Information for Naturalized or Derived Citizens
  4. 4.     Information on Immigration Documentation and how to correctly put it into the application
V. FAQ of the Week

Q: Some consumers have reported that the Marketplace is incorrectly flagging them as incarcerated based on information received from electronic data sources.  Incarceration makes someone ineligible for QHP enrollment. How can a consumer resolve inaccurate information related to incarceration status?

A: Marketplaces verify incarceration status using data from the Social Security Administration's Prisoner Update Processing System, the only national-level database that includes federal, state and local incarceration records that CMS has access to for the purposes of this verification. Consumer information is verified against this data using a combination of name, date of birth and social security number, all of which are mandatory matching elements.

The Marketplace is aware that the release dates in Social Security's incarceration records are not always up to date.  However, generally they are not more than two years out of date. The Marketplace is also aware that in certain cases consumers assert to have never have been incarcerated. To address this, we have modified the list of documents that a consumer may use to show he or she is not incarcerated to include documents that demonstrate that the consumer is living or active in the community, and therefore not incarcerated.  Thus, consumers without incarceration release documents are able to resolve the inconsistency as easily as possible. 

This is the list of documents that may be sent to resolve the inconsistency:

  • Unexpired State ID
  • Driver's License
  • Work ID
  • Passport
  • Paystubs
  • Cell Phone Bill
  • A lease that covers the benefit year or a rent receipt
  • Federal, State, or Local benefit letter
  • Bank or Credit card statement showing transaction history
  • Clinic, doctor, or hospital records or bills for services provided
  • Medical claim explanation of benefits provided
  • School record/schedule showing enrollment
  • Military Record
  • Signed notarized statement from individual with alleged false incarceration inconsistency indicating they are living in the community; the statement must include the individual's name, date of birth, address and phone number
  • Written statement from someone within the community which states the name, date of birth, address, phone number, and their relationship with the individual with alleged false incarceration inconsistency and that the individual is present and participating within the community
  • A written explanation of circumstances as to why the applicant does not have any of this documentation

To resolve the situation, a consumer should upload documents to their Marketplace account on or mail copies the information to:

               Health Insurance Marketplace
               Dept. of Health and Human Services
               465 Industrial Blvd.
               London, KY 40750-0001

If mailing the information, please include the barcode page that came with the consumer's eligibility letter, or write the consumer's Application ID number on the document that's submitted.

VI. Topic of the Week: Exemptions and Enrolling in Catastrophic Coverage

Under certain circumstances, an individual may qualify for an exemption from the individual shared responsibility payment, which means that he or she will not be required to pay a fee for not having health coverage. We remind assisters to make sure consumers review the options available to them through the Marketplace prior to submitting an exemption application. 

The following individuals are eligible for an exemption and will not have to pay a fee for not having health insurance:

  • Experience a short coverage gap (less than 3 months of the year)
  • The lowest-priced coverage available would cost more than 8% of your household income
  • Don't have to file a tax return because their income is too low (Learn about the filing limit.)
  • Experience a hardship (a list of circumstances that may qualify an individual for a hardship exemption can be found here), which includes not being able to afford health insurance or cancelation of an insurance plan and other Marketplace plans are unaffordable.
  • Are members of a:  Federally recognized tribe or are eligible for services through an Indian Health Services provider; Recognized health care sharing ministry; Recognized religious sect with religious objections to insurance

Additionally, individuals that are incarcerated and those that are not lawfully present in the U.S. will not pay a fee for not having health insurance.

Exemption Applications Eligibility for Catastrophic Coverage

The applications for exemptions are available through the Marketplace and can be found on, on the Get Official Resources page, in the Publications & Articles section.  The majority of these exemptions, except for those for recognized religious sects and most hardship categories, can also be claimed on your Federal income tax return. The process for how to apply for exemptions through the Marketplace can be found here.

In addition to the hardship application for individuals who cannot afford coverage (based on a formula to calculate household income and the cost of available plans), the Marketplace offers exemption applications for:

Individuals seeking an exemption should complete the exemption application and submit it by mail to CMS for processing at: 
                       Health Insurance Marketplace - Exemption Processing
                       465 Industrial Blvd.
                       London, KY 40750-0001.

After receiving the exemption application, the Marketplace will send an individual an eligibility determination notice. If the person is determined eligible for a hardship exemption, this notice will include a unique exemption certificate number (ECN) that the consumer will need to include on his or her federal income tax return. If the application was missing information or a required document, the Marketplace will contact the consumer to obtain the information.

After being determined eligible for the hardship exemption, the consumer will be able to view catastrophic plan information and enroll in a catastrophic plan outside of the Marketplace if he or she wants to do so. The consumer is NOT required to purchase a catastrophic plan.

Exemptions for Individuals Whose Plans Were Cancelled

Individuals seeking to purchase catastrophic coverage because their plan was cancelled must:

  • Download and fill out an application for a hardship exemption, indicating on the form that the reason for the application is cancellation of an individual policy and lack of other affordable coverage options in the Marketplace
  • Send the hardship exemption application and cancellation notice to the selected insurance company selling catastrophic plans

Information on the coverage cancellation hardship exemption, a toll-free number (1-866-837-0677) to call for assistance in understanding the options, the application for a hardship exemption, and a list of catastrophic plans available, by geographic area, may be found on under the topic "What if my individual health insurance plan is changing or being cancelled?" and "Cancelled plan? You've got coverage options."  More information can also be found in a bulletin, "Options Available for Consumers with Cancelled Policies." 



When is Someone Eligible to Purchase Catastrophic Coverage?

Catastrophic plans come with higher deductibles and are geared toward younger and healthier consumers who may not anticipate needing as much health care as other consumers, yet still want protection against large medical bills in the case of an emergency (or catastrophe, hence the name). 

Consumers may not use marketplace subsidies for catastrophic plans so they are not the most cost-effective option for people who anticipate needing significant health care during the year.

In addition, only certain people are allowed to purchase catastrophic plans under the ACA:

  1. Consumers under the age of 30. This is the primary group that catastrophic plans are designed to serve.
  2. Consumers who receive a hardship exemption. To receive a hardship exemption, a consumer must demonstrate that coverage is unattainable due to financial or personal situations, such as experiencing homelessness, having filed for bankruptcy, or falling into the Medicaid coverage gap. There are 13 different categories for a hardship exemption. Consumers who receive a hardship exemption, even if they are over age 30, may buy a catastrophic plan directly from an insurer.
  3. Consumers who receive an affordability exemption. Consumers seeking an affordability exemption have to prove that the cost of insurance is greater than 8% of their household income. After receiving an affordability exemption, consumers, regardless of their age, may elect to purchase catastrophic coverage directly from an insurer.
  4. Consumers who had their plans cancelled. Consumers whose health insurance policies were cancelled may also buy catastrophic coverage. Consumers in this situation should complete the hardship exemption application and submit it, along with their cancellation policy, directly to an insurer.

For other helpful outreach and enrollment resources, please click here

For General FAQs on HRSA Health Center Outreach and Enrollment Assistance Supplemental Funding, click here

Grants & Funding Opportunities

National Health Service Corps (NHSC)
is pleased to announce that the 2014 NHSC Loan Repayment Program application cycle is now open. The application cycle will close on March 20th at 7:30 pm ET.
To help ensure that the communities with the greatest need are supported, qualified applicants working in Health Professional Shortage Area (HPSA) with the highest scores as of January 1, 2014, will be given priority. With continued service, NHSC providers may be able to pay off all of their student loans.
The Program is expected to be competitive. On average, it takes a few weeks to complete an application so please begin the process early. It is suggested that you start gathering required documentation as soon as possible.
Technical assistance webcasts and conference calls have been scheduled to address questions. Please mark your calendars for the following webcast and conference calls.
* Conference Call: Wed, February 12 at 8:00 - 9:30 p.m. ET

Clinical Excellence Grant Program

Application Deadline: February 28, 2014 
Grants of up to $50,000 to nonprofit healthcare institutions to fund clinical programs that improve infection prevention practices or outcomes.
 Mobilization for Health: National Prevention Partnership Awards Program
Application Deadline: Non-binding Letter of Intent by January 21; Application by March 3, 2014 
Supports grants of up to $500,000 for community health programs to create partnerships and implement new and innovative programs in health information and health promotion, health services, and education in the appropriate use of healthcare.  

The synopsis for this grant opportunity is detailed below, following this paragraph. This synopsis contains all of the updates to this document that have been posted as of 2/4/2014. If updates have been made to the opportunity synopsis, update information is provided below the synopsis.

If you would like to receive notifications of changes to the grant opportunity click send me change notification emails. The only thing you need to provide for this service is your email address. No other information is requested.  


Health Information Technology (HIT) Capacity Building for Monitoring and Improving Health Outcomes along the HIV Care Continuum - Capacity Building Sites (HRSA-14-057 )

02/04/2014 12:00 AM EST

Apply By: Mon, 31 Mar 2014


National Organizations for State and Local Officials (NOSLO) (HRSA-14-094 )

02/04/2014 12:00 AM EST

 Apply By: Mon, 31 Mar 2014


Affordable Care Act - Mental Health Service Expansion - Behavioral Health Integration (BHI) (HRSA-14-110 )

02/04/2014 12:00 AM EST

 Apply By: Mon, 3 Mar 2014


Affordable Care Act Patient Centered Medical Home - Facility Improvements (P-FI) Grant Program (HRSA-14-073 )

02/04/2014 12:00 AM EST

 Apply By: Fri, 14 Mar 2014


National Rural Health Policy and Community Development Program (HRSA-14-080 )

02/04/2014 12:00 AM EST

Apply By: Mon, 31 Mar 2014 


Dr. Alma S. Adams Scholarship for Outreach and Health Communications

Application Deadline: April 30, 2014
Awards scholarships to individuals who have demonstrated a commitment to community service or used the visual arts or media to convey culturally-appropriate health messages on behalf of a disadvantaged population.


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 

New HRSA opportunities for the Health Centers and quick summaries of each.

1)      PCMH Capital Improvement

HRSA has announced $35 million in grant funding to FQHCs for one-time facility remodeling/construction costs to improve patient flow and processes related to the PCMH team service delivery model.  HRSA expects to make $200 awards up to $250K for improvements.  Grants.Gov submission is due in March. Full EHB submission in April.


2)      Behavioral Health Integration

Upt to $250K for each of two years for health centers who commit to full behavioral health/primary care integration by the end of the 2nd year, demonstrate clinical improvements in depression screening and treatment, and implement the use of SBIRT as a standard process in the service delivery setting. Grants.Gov submission is due in March. Full EHB submission in April.

Clinical Quality 

What clinical quality measures will I need to report on?

Menu Objective for Eligible Professionals:  

  • Report ambulatory clinical quality measures to CMS or the States.

Menu Objective for Eligible Hospitals:  

  • Report hospital clinical quality measures to CMS or the States.  


  • For 2011, provide aggregate numerator, denominator, and exclusions through attestation.  For 2012, electronically submit the clinical quality measures.  

Eligible professionals must report on the 3 required core clinical quality measures and 3 additional clinical quality measures chosen by the professional from the menu set of 38 measures.  The quality measures that were selected for inclusion in the Final Rule all have electronic specifications and can be automatically calculated by certified EHR technology without necessitating any manual calculations.  For each objective with a percentage-based measure, the EHR can electronically record the numerator and denominator and generate a report with the numerator, denominator, and resulting percentage.  For 2011, eligible professionals will provide this information via attestation.  Descriptions and electronic measure specifications for all 44  clinical quality measures  are listed in Table 6 of the Final Rule on pages 44398-44408.

The required core set of clinical quality measures for eligible professionals are:

Hypertension: blood pressure measurement (percent of patient visits for patients 18 years and older with a diagnosis of hypertension who have been seen for at least 2 office visits, with blood pressure recorded) 

Preventive care and screening measure pair: tobacco use assessment and tobacco cessation intervention (percent of patients 18 years of age and older who were current smokers or tobacco users, who were seen by a practitioner during the measurement year, and who received advice to quit smoking or tobacco use or whose provider recommended or discussed smoking or tobacco use cessation medications, methods or strategies)

Adult weight screening and follow-up (percent of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medial record and if the most recent BMI is outside parameters, a follow-up plan is documented.)

If one or more of these required core measures are not applicable to an eligible professional (e.g., adult weight screening and follow-up is not applicable to a pediatrician), the professional reports a zero for that measure and substitutes an alternate core measure.  "Alternate core" set measures are weight assessment and counseling for children and adolescents; influenza immunization for patients 50 years old or older; and childhood immunization status.   

Eligible hospitals must report on all 15 of the eligible hospital clinical quality measures.

Health Observances This Week


National Children's Dental Health Month

Each February, the American Dental Association (ADA) sponsors National Children's Dental Health Month to raise awareness about the importance of oral health. NCDHM messages and materials have reached millions of people in communities across the country.

Developing good habits at an early age and scheduling regular dental visits helps children get a good start on a lifetime of healthy teeth and gums.

Whether you're a member of the dental team, a teacher or a parent, the ADA has free online resources that can help you with oral health presentations, ideas for the classroom and coloring and activity sheets that can be used as handouts. We also have booklets, videos and other materials available for purchase through our ADA Catalog.

Please direct all questions to

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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