Advocacy & Policy Updates

PCC Endorses Bill That Would Support Telehealth by Expanding Broadband Coverage

September 14, 2020

The PCC is among many national organizations throwing their support behind the Broadband Reform and Investment to Drive Growth in the Economy (BRIDGE) Act of 2020, introduced this summer by U.S. Senator Michael Bennet (D-Colo.), who said the bill will deploy affordable, “future-proof” broadband networks nationwide. Senator Angus King (I-Maine) also supports the legislation, along with dozens of national and state-level elected officials and organizations. 

“The coronavirus pandemic has brought into focus a 21st century reality: access to high-speed, affordable broadband is critical infrastructure that helps Americans across the nation operate their businesses, pursue their education, access telehealth, and interact with their communities,” said King. “Unfortunately, too many rural communities don’t have access to this vital tool, leaving them at risk of being left behind.”

As the regular surveys of primary care clinicians and patients conducted by the PCC and the Larry A. Green Center since March have shown, primary care pivoted to telehealth very quickly when stay-at-home orders were put into place and has depended on it as patients seek care but are not able to visit their primary care practices in person. Telehealth services are dependent on reliable internet networks, and networks moving to unserved and underserved areas will enable primary care to address health inequities, which sometimes follow the technological divides among population groups.

"As the pandemic keeps millions of families at home, it has never been more urgent to extend the benefits of affordable, high-speed broadband to every American,” said Bennet. “For years, the digital divide has prevented up to 42 million Americans—disproportionately from rural areas, low-income neighborhoods, and communities of color—from being able to fully participate in modern American life.”  

In an op-ed published today, Bennet emphasized how the pandemic has pushed Americans to rely on high-speed broadband more than ever to work, learn, and connect remotely. However, up to 42 million Americans still lack access to broadband. Bennet and King’s BRIDGE Act helps close this gap by providing $30 billion to states and $1 billion to tribal governments to deploy broadband in unserved and underserved communities nationwide and ensuring newly built networks meet minimum requirements for speed, service, and affordability. The legislation empowers communities to deploy their own broadband networks if they wish and makes them eligible for financial support. Finally, the legislation accelerates an overhaul of the Federal Communications Commission’s (FCC) broadband maps, which consistently overstate broadband access in America—especially in rural areas.

Read the full text of the bill. (also available: a section-by-section summary and a one-page summary)

Support for the BRIDGE Act from national organizations:

  • Primary Care Collaborative
  • American Library Association
  • American Psychological Association
  • Consumer Reports
  • Fiber Broadband Association
  • Institute for Local Self-Reliance
  • National Association of Realtors
  • National Farmers Union
  • National Rural Health Association
  • Public Knowledge
  • Schools, Health & Libraries Broadband Coalition

 

 

 

 

HHS extends deadline to apply for provider relief funds

September 8, 2020

Healthcare providers now have until Sept. 13 to apply for phase 2 general distribution funding through the Provider Relief Fund (PRF).

In the spring, Congress appropriated money for the PRF to help offset the pandemic’s financial strain on healthcare providers; today, tens of billions of dollars remain in the fund. The Department of Health and Human Services has granted providers an additional two weeks to apply for funding, after an earlier extended deadline in August. Politico reports that many healthcare providers, particularly those serving patients insured by Medicaid and CHIP, have been slow to apply for funding due in part to unclear and changing guidance around eligibility and reporting requirements. The reporting system for PRF recipients is now scheduled to be released Oct. 1.    

Proposed 2021 Medicare Physician Fee Schedule released

September 8, 2020

CMS released its CY2021 Medicare Physician Fee Schedule (MPFS) for comment in August. The proposed rule includes a budget neutrality adjustment to offset, in part, the increased rates for office/outpatient Evaluation and Management services set to take effect this January. The proposed adjustment reduces the Medicare conversion factor by about 10% from $36.09 in 2020 to $32.26. Primary care clinicians will see increases between 8% and 13%, though psychologists and other healthcare specialists would see cuts to their rates. Other MPFS changes include adjustments to reporting and measures for the Medicare Shared Savings Program and MIPS. PCC will work with its Executive Members to develop a comment letter on the proposed rule to meet the Oct. 5 CMS deadline for comments.

New report on capturing non-FFS spending to measure investment in primary care

September 8, 2020

Rand has issued a new report, funded by the Milbank Memorial Fund, that explores how to capture non-fee-for-service spending when measuring levels of primary care investment. Health care continues to move away from traditional claims with greater adoption of alternative payment models. The report identifies key policy decisions that must be answered in order to capture these non-FFS investments — such as risk sharing, provider incentives, HIT, and workforce expenditures — to more accurately measure and compare levels of primary care spending.

This topic will be explored further at the PCC Executive Member and State Policymaker Workshop on Dec. 2.

Congress at an impasse on new pandemic relief funding

August 31, 2020

Congress failed to reach a deal on a new round of stimulus relief before leaving for the August recess.

At the end of July, Republicans introduced a package of bills known as the Health, Economic Assistance, Liability Protection, and Schools (HEALS) Act in the Senate. The $1 trillion package proposed an additional $25 billion for the Provider Relief Fund. In mid-May, the House had passed a $3 trillion HEROES Act that proposed an additional $100 billion to help hospitals and other healthcare providers impacted by COVID. The chambers reached an impasse and are not set to return to the Capitol until September.

PCC supports targeted relief dollars for primary care and behavioral health clinicians who are critical to managing population health and who have been severely impacted by the pandemic — sustaining anticipated losses of $15 billion or more. Please advocate on Twitter and Facebook for such support by using the #saveprimarycare hashtag. 

Extension of COVID-19 Public Health Emergency (PHE)

August 3, 2020

Department of Health and Human Services Secretary Alex Azar signed an order extending the national emergency declaration by 90 days, which triggers the extension of regulatory flexibilities and payment policies that were set to expire at the end July, including:

  • a temporary increase of 6.2 percentage points in state Medicaid matching rates (FMAP)
  • requirements that insurers cover testing for COVID-19 without cost-sharing (separate guidelines released by the Trump administration clarify that insurers are not required to cover tests not deemed “medically necessary,” i.e., return-to-work testing)
  • waivers of telehealth rules related to origination sites, eligible services, and approved technologies (HIPAA)
  • Section 1135 waivers that states can request to temporarily waive provider “conditions of participation” 

Legislation is necessary if some or all of these waivers are to become permanent. The PCC favors the extension of many of the waivers above.

Medicare Physician Fee Schedule 2021 Rule Expected Soon

August 3, 2020

The PCC joined other stakeholders in 2019 in support of CMS-proposed increases for evaluation and management (E&M) codes. These codes have long been undervalued to the detriment of primary care clinicians; also, wherever they are set, they will be the baseline for value-based payments going forward.
 
Those increases are scheduled to become effective January 2021, but they are not without controversy because of the budget neutrality requirement on CMS. If budget neutrality leads CMS to reduce the conversion factor affecting all physician fee-for-service rates, there will be significant pushback from specialty physicians in particular.
 
The administration may also use the proposed 2021 Physician Fee Schedule rules to signal interest in making some telehealth rule changes that would not require legislation.  

Site-Neutral Payments Appear Poised to Go into Effect

August 3, 2020

Under the Outpatient Prospective Payment System, Medicare has paid higher rates to hospital-based physicians and departments that are located off-campus from the hospital relative to office-based physicians, distorting incentives for hospitals to acquire practices and bulk up volume at these sites of care. The Trump administration has tried to reduce these payments through rulemaking, faced court challenges by hospitals, and lost a round of litigation. In AHA v. Azar, the U.S. Court of Appeals for the District of Columbia circuit reversed a district court ruling in a unanimous decision opening the way for implementation of site-neutral payments. PCC has advocated through comment letters for site-neutral payment.

State Policy Update

August 3, 2020

Medicaid expansion is on the ballot in Missouri on August 4. This constitutional amendment follows the decision in June by a narrow majority of voters in Oklahoma to expand Medicaid. Oklahoma will expand Medicaid under the ACA effective July 2021.

No Deal Yet on Another COVID-19 Relief Bill; Expected in Early August

July 24, 2020

As of July 24, Congress and the administration had not reached an agreement on another relief package, despite looming expirations of temporary unemployment insurance benefits. More money for testing, vaccine research, distribution and use, and another $25 billion for the Provider Relief Fund are under discussion, as well as extending the deadline for providers to pay back loans from the Advance and Accelerated Payment Program. Rumored language includes extension of telehealth waivers through 2021. House Democrats are pushing their HEROES Act, which is a much larger, more comprehensive package than what Senate Republicans appear ready to consider. There is no indication yet that another package will include targeted relief for primary care, although conversations continue on that front. 
 
Despite efforts by many stakeholders to address the pernicious problem of “surprise” out-of-network bills, no fix for this problem appears likely to be included in the next package.

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