The National Association of Community Health Centers (NACHC) has expressed strong support for both the House and Senate-passed versions of health care reform legislation. NACHC outlines six recommendations that focus on priority provisions for community health centers, where differences exist between the two versions of the legislation. It is NACHC's recommendation that the final bill:

1. Protect Health Centers from Underpayment by Exchange Plans
Senate legislation (Section 10104(b)) ensures that health centers would not lose revenue when treating newly insured patients gaining coverage through the new health insurance exchanges established by the bill.
NACHC recommends the Conferees include Section 10104(b) of the Senate bill in the final legislation.

2. Grow the Federal Investment in Primary Care, Prevention and Public Health
Both the House and Senate legislation contain provisions that would ensure that access to care grows in health reform, as well as increased insurance coverage. Both bills require that the discretionary base funding for these programs be protected.
NACHC recommends that the Conferees include the highest possible guaranteed funding levels for the Health Centers program, the National Health Service Corps, and other critical public health and prevention programs in the final legislation.

3. Provide for Appropriate, Predictable Medicare Reimbursement to Health Centers
Senate legislation (Section 5502) updates Medicare reimbursement systems for health centers. It eliminates the current, outdated cap and replaces it with a new funding mechanism based on costs. The Senate version, unfortunately, moves health centers backward toward a fee-for-service payment methodology. Both House and Senate bills contain similar provisions that update the list of eligible preventive services under Medicare for health centers.
NACHC recommends that the Conferees include a modified version of Section 4105(o) of the Senate bill, which includes the service update, in the final legislation.

4. Ensure Full Participation by Safety-Net Providers in Exchange Plans.
Both House and Senate legislation include provisions that require plans offered through an exchange to include all 340B eligible entities; only the House includes a provision recognizing "generally applicable payment rates" for such providers. This would complement the payment protection in Priority #1 and ensure that as uninsured patients gain coverage, the plans covering them will not exclude those low-income communities and individuals most in need of access to care.
NACHC recommend that the Conferees include Section 304(b)(7) of the House bill in the final legislation.

5. Fund the Training of Medical Residents in Community-based Settings.
House legislation creates a new grant authority under the Public Health Service Act for the development and operation of community-based residency training programs (Section 2214) which would increase the number of residents training in primary care, and the number completing that training in community-based settings like health centers. Senate legislation also creates two separate grant programs for the development and operation of teaching health centers. A priority for funding health center-based residency programs is flexibility. Health centers also support the role of AHECs in providing assistance to community-based residency programs.
NACHC recommends that the Conferees include Section 2214 of the House bill in the final legislation with the addition of language from the Senate recognizing the role of AHECs.

6. Outline an inclusive Process for the Redefining of Medically Underserved Populaions (MUPs) and Health Professional Shortage Areas (HPSAs).
Senate legislation establishes a process of "negotiated rulemaking" (Section 5602) to determine criteria and methodology for defining these important measurements which will effect location of future health centers, priority in National Health Service Corps placements, and a number of federal policy decisions.
NACHC recommends that the Conferees include section 5602 of the Senate bill, with modified dates, in the final legislation.