San Francisco Community Clinic Consortium Issues Public Comment on HHS Proposed Rule

WASHINGTON, Dec. 16 -- Deena Lahn, vice president for policy and external affairs at the San Francisco Community Clinic Consortium, California, has issued a public comment on the Department of Health and Human Services proposed rule entitled "Securing Updated and Necessary Statutory Evaluations Timely". The comment was written on Dec. 4, 2020, and posted on Dec. 8, 2020:

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The San Francisco Community Clinic Consortium (SFCCC)is made up of 11 community health centers that serves over 112,000 patients a year. We provide primary care to the most vulnerable populations in San Francisco, and are the recipient of Health Center Program funds, which allows us to provide high quality primary care to patients regardless of their ability to pay.

We appreciate the opportunity to provide comments on the Department of Health and Human Services (HHS) proposed rule, "Securing Updated and Necessary Statutory Evaluations Timely" (hereinafter referred to as the "Regulations Rule").

Comment on the Proposed Regulations Rule

SFCCC generally strongly supports government accountability, including efforts to ensure that regulations governing the Health Center Program (HCP) remain current. However, the blanket nature of the proposed regulations rule could adversely impact critical operations, including the ability to provide health care to the most vulnerable populations. Regulations play an important role in forming and establishing the framework for HHS safety net programs such as the HCP.

With the majority of our health center patients earning annual incomes at or below 200% of the Federal Poverty Guidelines, reliability and stability of operations are critical for ensuring that our vulnerable populations retain access to the services on which they rely and that are crucial to their health and welfare. In this pandemic, we have played a special role in testing, screening, and treating COVID -19 patients, and expect to play a vital role in vaccine distribution as well. We can not accept a Regulations Rule that could potentially de-stabilize critical programs such as the Health Center Program and payor programs such as Medicaid, Medicare, and Children's Health Insurance Programs. 13 million Californians rely on the Medicaid program, and it is a principal source of health center revenues. Just as consistency of operations is critical for the health of our patients, revenue stability is essential for maintaining the strength of health center organizations. A strong regulatory framework provides all stakeholders - including states, provider organizations, managed care plans, patients - with both the clarity and constancy they need to operate on a day-to-day basis and the key guidance necessary to understand their various rights and obligations.

The majority of health centers would be considered "small entities" as it pertains to this Rule. While SFCCC welcomes thoughtful efforts to modernize and streamline the various regulatory approaches under which health centers operate and are reimbursed in order to minimize the economic and administrative burdens that adversely impact health centers' ability to serve their patient, the process proposed by HHS to achieve the goals is unworkable.

As crafted, HHS estimates that the proposed rule would cost nearly $26 million dollars over ten (10) years and necessitate ninety (90) full-time staff positions to undertake the required reviews. Within the first two (2) years, HHS estimates the need to assess at least 12,400 regulations that are more than ten (10) years old. Given these estimates, it is highly likely the Regulations Rule would adversely affect HHS's ability to focus on the administration of current programs while carefully determining which regulations need modification or amendment. We are concerned that the unnecessary tight timelines could result in important regulations being arbitrarily rescinded because there is not enough time for a thoughtful review. Regulations that do not complete the complicated and time-consuming review process would summarily expire, potentially leaving large holes in the regulatory framework that is critical for implementing important HHS programs and policies such as the HCP. Health Centers and most importantly, the patients they serve, need increasing resources, stability, and rationality to best operate with limited resources. An arbitrary rushed review will not serve these purposes.

In addition, we strongly object to the truncated 30-day comment period, which provides insufficient time to fully consider this complex proposal that has potentially far-reaching consequences.

Finally, given the importance of the Regulations Rule and the dire consequences if agencies fail to complete required reviews on a timely basis, SFCCC opposes the Regulations Rule until a detailed analysis of the potential consequences can be conducted, and urges HHS to withdraw it immediately.

Conclusion

Given the truncated 30-day comment period, SFCCC opposes the Regulations Rule until a detailed analysis of the potential consequences can be conducted and urges HHS to withdraw it immediately. Alternatively, if HHS decides to proceed with the promulgation of the Regulations Rule, SFCCC urges HHS to: (i) extend the two- (2) year review period for existing regulations to a period not less than five (5) years, and (ii) build in safeguards to ensure that regulations critical to the operation of safety net providers such as health centers will not automatically rescind due to the failure of HHS or one of its agencies to complete a timely review. For purposes of the latter, SFCCC requests urges HHS to issue a second notice requesting appropriate stakeholder input.

We appreciate the opportunity to provide comment on this proposed rule. Should you have any questions about our comments, please feel free to contact Deena Lahn at [email protected] or 415 355-2762.

Deena Lahn

Vice President, Policy and External Affairs

San Francisco Community Clinic Consortium

2720 Taylor Street, Suite 430

San Francisco, CA 94133

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The proposed rule can be viewed at: https://www.regulations.gov/document?D=HHS-OS-2020-0012-0001

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