Federal Policy Updates

For state specific policy head to State Policy Updates


PCC endorses the Primary and Virtual Care Affordability Act (H.R.5541)

Legislative Update

 

  • Sens. Todd Young (R-Indiana) and Debbie Stabenow (D-Michigan) introduced the bipartisan Social Determinants Accelerator Act, a PCC-supported Senate companion bill to the Social Determinants Accelerator Act of 2021 (H.R.2503) initially introduced in the House.
  • On Oct. 8, the American Psychological Association (APA) submitted comments to the bipartisan social determinants of health (SDOH) caucus, highlighting the behavioral health elements faced by children and families, undocumented immigrants, and individuals without broadband access, and expressing the need for more uniform collection of SDOH data. In addition, the APA requests that CMS establish a new “G code” to better capture the utilization of SDOH specific services. The APA also endorses H.R. 2503.
  • The bipartisan Primary and Virtual Care Affordability Act (H.R. 5541) was recently introduced by Reps. Bradley Schneider (D-Illinois) and Brad Wenstrup (R-Ohio). It would allow high-deductible health plans with associated Health Savings Accounts to waive the deductible for telehealth and primary care services through the end of 2023.
  • PCC joined the Coalition to Improve Diagnosis, adding its signature to a letter to Senate leadership on the Appropriations Committee requesting increased funding to the Agency for Healthcare Research and Quality (AHRQ) for patient safety and diagnostic safety and quality.

Other Policy Updates

 

  • American Academy of Pediatrics released a new study that found that over 140,000 children experienced the death of a parent or grandparent caregiver during the COVID-19 pandemic and the risk of losing a caregiver was much higher for children of racial and ethnic minorities.
  • Health plans are taking on a larger role in addressing the social drivers of health to achieve health equity. In a report published in September, the Anthem Public Policy Institute explored the affordable housing crisis in California, with a focus on patients experiencing homelessness. The report discusses how Medicaid managed care plans can partner with states to provide resources for individuals experiencing homelessness. Additionally, Humana recently invested $25 million as part of a broad population health campaign to support affordable housing initiatives. PCC board member Dr. Nwando Olayiwola, Chief Health Equity Officer at Humana, said, “Humana is committed to addressing structural and root cause barriers to good health outside of the clinical setting, such as access to healthy food, transportation, social connections and stable housing, to help eliminate unjust differences in health.”
  • In a new paper titled “Health Care for Our Nation's Veterans: A Policy Paper From the American College of Physicians,” the American College of Physicians (ACP) advocates for the patient-centered medical home model for primary care delivery in the Veterans Health Administration by sustaining and strengthening the Patient-Aligned Care Team (PACT) model.
  • On Oct. 7, the National Partnership for Women and Families along with over 50 other reproductive justice and Black policy leaders signed a letter to democratic congressional leadership urging them to commit to extending postpartum Medicaid coverage to 12 months and include other equity-focused provisions found in the Black Maternal Health Momnibus Act of 2021 (H.R. 959) in the reconciliation process.
  • On Oct. 13, a number of PCC Executive Members (including American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, Catalyst Health Network, and One Medical) signed on to a letter to executive leadership at the White House and HHS to include primary care physician practices in the ongoing COVID-19 vaccine rollout.
  • A partnership among Covered California (California’s ACA marketplace), California Public Employees’ Retirement System (CalPERS) and PCC Executive Member Purchaser Business Group on Health (PBGH) will launch a pilot program beginning in 2022 to test practice-level measurement using 11 advanced primary care measures developed by the California Quality Collaborative

Primary Care and COVID-19 Vaccines

At the time of this writing, the processes of approving COVID-19 booster shots for eligible populations and initial doses for children between the ages of 5 and 11 have moved forward.
 
In anticipation of the authorization of the COVID-19 vaccine for children 5 to 11, the White House released on Oct. 20 a plan to ensure a timely and equitable distribution of the child doses. Primary care will play a substantial role in the distribution from the onset, with the White House planning to engage over 25,000 pediatric and primary care practices in vaccine administration. This includes providing appropriate training and working with states to increase the number of practices enrolled to administer the vaccine.
 
The American Academy of Pediatrics and others in primary care are eager to play a greater role in vaccine administration. This is coming at a time when vaccine hesitancy continues and as primary care is seen as the most trusted source of COVID-19 information. Now the federal government needs to compensate primary care clinicians for vaccine counseling, along with continued support for vaccine administration. 

Reconciliation: Extended ACA Subsidies and Medicaid Expansion Against Growing Medicare Benefits

Congress has turned its attention to a budget reconciliation package (H.R. 5376, Build Back Better Act).  After tough intra-party negotiations, Democrats are now contemplating legislation with between $1.5 and $2.0 trillion. The pressure to limit the bill’s expenditures may pit congressional Democrats against each other over health-related provisions, such as expanding Medicaid to low-income adults in all states, extending American Rescue Plan Act marketplace subsidies, and expanding Medicare benefits to include vision, dental, and hearing. Although these issues may be addressed, health care is not the focus of the bill.
 
During PCC’s Oct. 19 Policy and Advocacy meeting, Jennifer Bell from Chamber Hill Strategies provided insight on the status of the reconciliation bill as it relates to health provisions. Bell expects activity to likely center around strengthening the Affordable Care Act and expanding Medicaid coverage. There are also several critical healthcare provisions that are not included in the current reconciliation negotiations, including telehealth.
 
Democrats feel there is an opportunity to make significant progress and feel tremendous pressure to deliver on campaign promises with this reconciliation package. However, debates have grown as Democrats consider cutting funding for Medicare Advantage to pay for portions of the bill. Additionally, according to Bell, there is a real possibility that the package could fail as deadlines rapidly approach and a lack of trust and sense of urgency stall necessary action on expiring provisions, which include surface transportation funding, the debt ceiling, and the child tax credit.

CMS Innovation Center Update

Last week, the CMS Innovation Center released a refreshed strategic vision for the agency that hopes to achieve equitable outcomes through high-quality, affordable and person-centered care. In the document, the Innovation Center identifies and reflects on lessons learned from the previous decade of work, lays out broad objectives, and defines measures of progress to guide the work of the agency over the next decade.

The strategic objectives include:

  1. Drive Accountable Care
  2. Advance Health Equity
  3. Support Innovations
  4. Address Affordability
  5. Partner to Achieve System Transformation. 

In a public statement on the new strategy, PCC’s President and CEO, Ann Greiner, praised CMS leaders for “a bold vision and strategy for how to continue transforming the U.S. health system through innovation and a focus on equity" while noting “strong investments in comprehensive, whole-person primary care [are] crucial to its success.”

PCC's Statement on new CMS Innovation Center Strategy

WASHINGTON, Oct. 20, 2021—Following is a statement by Ann Greiner, president and CEO of the PCC, on the release today of The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMS Innovation Center/CMMI) “Driving Health System Transformation – A Strategy for the CMS Innovation Center’s Second Decade.”

"CMS Administrator Chiquita Brooks-LaSure, Deputy Administrator and Center for Medicare & Medicaid Innovation (CMMI) Director Elizabeth Fowler and the CMMI team have laid out a bold vision and strategy for how to continue transforming the U.S. health system through innovation and a focus on equity, and strong investments in comprehensive, whole-person primary care are crucial to its success.
 
"By 2030, CMS calls for most Medicare and Medicaid beneficiaries to be in longitudinal, accountable-care relationships, which are foundational to primary care. CMS envisions new advanced primary care models for 2023 and beyond as well as further support for smaller and independent practices to foster transformation.
 
"Centering health equity, the CMS Strategy Refresh insists that the benefits of innovation reach underserved and rural communities that have often been left out in the past. 
 
"The Primary Care Collaborative looks forward to working with CMS/CMMI on the concrete steps to realize this exciting vision."

# # #

Ann Greiner, Primary Care Collaborative president and CEO, is available for further comment and interviews. To arrange an interview, contact:
Stephen Padre
Communications Manager, Primary Care Collaborative
[email protected]
202-417-3911

PCC joins letter to Senate Appropriations Commitees urging funding of AHRQ work to improve diagnostic safety and quality

The PCC and some of its Executive Members joined many other healthcare-related organizations in a Sept. 30 letter as part of the Coalition to Improve Diagnosis, an initiative of the Society to Improve Diagnosis in Medicine, to leaders of the U.S. Senate Appropriations Committee/Subcommitee. The letter from the organizations asked the leaders, as they develop the fiscal year 2022 Labor, Health and Human Services, Education, and Related Agencies Appropriations bill, to include a dedicated increase in funding for the Agency for Healthcare Research and Quality’s (AHRQ) patient safety portfolio specifically to expand and accelerate the agency’s work to improve diagnostic safety and quality. The letter urged the Appropriations Committees to allocate at least $8 million in additional, dedicated funds for FY22 for these activities, matching the House-passed amount.

The letter goes on to state that AHRQ is poised to help the Coalition to Improve Diagnosis improve diagnostic safety and quality through a research and quality-improvement pipeline modeled on the agency’s highly successful efforts to combat Healthcare Associated Infections (HAI). The Senate matching the House's passage of an increase of $8 million in dedicated funding for diagnosis improvement efforts in the FY22 Appropriation would be an important step toward a robust portfolio of work that will put life-saving tools and practices into the hands of healthcare systems, clinicians, and patients, the letter states.

Read the full letter

Primary Care Priorities Included in Infrastructure, Reconciliation Bills; Timing and Outcome is Uncertain

At the time of writing, the fate of the U.S. House of Representatives’ reconciliation package is uncertain. The timing and outcome of a promised House vote on the Senate-passed bipartisan infrastructure bill, the Infrastructure Investment and Jobs Act (IIJA), also remains unclear. Together, the bills could have significant impacts for the under-resourced primary care delivery system. 

Primary Care Provisions in the Reconciliation and Infrastructure Bills 

The reconciliation bill, the Build Back Better Act, includes investments that could shape the future of primary care, with a clear focus on communities facing health inequities. Provisions include: 

  • $10 billion in funding for Community Health Center capital projects 

  • Workforce investments including $6 billion in funding for Teaching Health Center Graduate Medical Education and $1.3 billion for nursing education and loan repayment 

  • A new Medicare dental benefit, inclusive of preventive, minor and major dental care as well as dentures, scheduled for 2028 

The IIJA includes $65 billion to expand broadband access and increase affordability of broadband services for low-income families – improvements with the potential to increase access to digitally-enabled primary care. 

Although the bipartisan IIJA has passed the Senate, the larger reconciliation bill has yet to see Senate mark-up or floor action – where changes to both detailed provisions and overall size of the package are possible. The ultimate fate of its primary care-relevant provisions hinges on unanimous support of the legislation across all 50 members of the Senate’s Democratic majority. 

Medicaid Pay Parity, Medicare Telehealth Await Future Legislative Vehicles 

Two other top PCC policy aims - Medicaid primary care pay parity and Medicare telehealth reforms - remain largely unaddressed by the infrastructure and reconciliation bills. PCC proudly supports the Kids Access to Primary Care Act and the CONNECT for Health Act. Working with its Executive Members, PCC will be pressing Congress for action on these issues. 

Behavioral Health Integration Legislation Possible this Congress 

Exacerbated by the pandemic and associated economic disruptions, the prevalence of substance use disorders and mental health disorders is growing, particularly in communities of color. The Senate Finance Committee is moving toward a legislative package during this congress. Meanwhile, House legislators have introduced a variety of bills that may move independently or as part of an evolving bipartisan CURES 2.0 package

PCC’s Behavioral Health Integration Workgroup is developing federal policy recommendations to advance behavioral health integration in federal payment models. Workgroup meetings occur bimonthly and are open to all PCC Executive Members. To ensure your organization is represented, please contact PCC’s Policy Director, Larry McNeely, at [email protected].  

COVID-19 Vaccination Campaign Update

On Sept. 24, the Centers for Disease Control and Prevention (CDC) authorized COVID-19 vaccine booster shots for recipients of the Pfizer COVID-19 vaccines at least six months following their shot. The CDC recommendations open a third booster shot to individuals age 65 and older, adults at risk of serious illness due to underlying conditions, and adults at higher risk due to their job or institutional setting.   

In the weeks and months ahead, FDA and CDC are expected to act on vaccination of 5-11 year olds and consider Moderna and Johnson and Johnson vaccine boosters. 

Since the launch of the vaccination campaign, PCC has called for greater recognition and support for primary care’s fundamental role in expanding vaccination and increasing vaccine acceptance. PCC has continued to engage with the administration, including both administrative agencies and the Executive Office of the President. Most recently, PCC’s Medicare fee schedule comments urged CMS to increase vaccination and counseling reimbursement for COVID-19 and other diseases. 

Go to top