Federal Policy Updates

For state specific policy head to State Policy Updates


Looking Ahead as Public Health Emergency Winds Down

As discussion continues about how to extend the enhanced subsidies in the American Rescue Plan, which will expire at the end of 2022, there are calls for improving affordability of both premiums and out-of-pocket costs in marketplace plans. Lowering out-of-pocket costs by making Gold-level plans affordable could improve access to primary care, particularly for lower-income enrollees.
 
Many temporary COVID-19-related Medicare payment and other waivers are tied to the duration of the national Public Health Emergency (PHE). The American Rescue Plan (ARP) included temporary funding and other temporary policy changes that have significant implications for the primary care community. The table below lists and tracks some important expiration dates.
 

FEDERAL PROGRAM/PROVISION

EXPIRATION DATE

Public Health Emergency (PHE) declaration from Secretary of Health and Human Services

Renewed 4/21/21 for 90 days; expected to be renewed through CY 2021

Provisions of $1.9 trillion American Rescue Plan

Medicaid state option for 12 months postpartum

5 years beginning April 2022

Enhanced FMAP (85%) for optional state community mobile crisis intervention services

5 years beginning April 2022

Two year 5% FMAP incentive (on all Medicaid populations) for states that have not yet expanded Medicaid (on top of 6.2% FMAP if during PHE)

2 years after state enactment

COVID-19 vaccine coverage for Medicaid/CHIP 100% match; state option for uninsured coverage

End of first quarter after 12 months after end of PHE

Temporary expansion of ACA marketplace APTCs

Expire at end of CY 2022

$8.5 billion for new fund for rural providers to cover losses due to COVID-19

Funds available until expended (providers must apply)

$9.1 billion for public health workforce-related grants; $100 million for Medical Reserve Corps; $800 million National Health Service Corps; $200 million Nurse Corps; $330 million for Teaching Health Centers GME (THCGME) programs

FY 2021; available until expended;

All programs extended through FY 2023

Community Health Center funding of $7.6 billion

End of FY 2022

$1.5 billion for Community Mental Health Block Grants; $1.5 billion for Prevention and Treatment of Substance Abuse Grants

FY 2021; expended by 9/30/25

Consolidated Appropriations Act, 2021

Medicare 2% sequestration suspended through 3/31/21; Congress extended again in April 2021

Expires end of CY 2021

Medicare PAY-GO cuts of 4% to be triggered by ARP deficit spending unless Congress acts

Congress must act by 9/30/21

One-time 3.75% ($3 billion) bump in Medicare physician fees to mitigate offsets in 2021 Physician Fee Schedule

CY 2021

Postponed complex E&M codes for Medicare billing

Until 1/1/2024

Federal Policy Developments Related to Primary Care

Department of Health and Human Services
 
The Health Resources and Services Administration (HRSA) announced $125 million in workforce grants to support 14 nonprofit private and public organizations’ efforts toward underserved communities to “engage in locally tailored efforts to build vaccine confidence and bolster COVID-19 vaccinations.” These grants were authorized in the American Rescue Plan.
 
Centers for Medicare and Medicaid Services
 
CMS added 2019 Quality Payment Program performance information to the Doctors and Clinicians section of Medicare Care Compare and the Provider Data Catalog. More information.
 
Center for Medicare and Medicaid Innovation
 
Elizabeth Fowler, Deputy Administrator and Director of CMMI, has been engaged in a listening tour of stakeholders as part of a review of CMMI models and a new strategic focus. She has mentioned the importance of primary care in several public forums and has included the PCC in her stakeholder outreach. She has also spoken of the importance of incorporating health equity as a formal goal of alternative payment models.
 
MedPAC
 
In chapter two of its June report, MedPAC recommends that the Secretary of Health and Human Services “harmonize” and reduce its portfolio of alternative payment models and ensure they work together to support the strategic objectives of reducing spending and improving quality. This recommendation suggests that primary care stakeholders should evaluate the potential of all CMMI and CMS models to drive investment in and transformation of primary care.

Updates on Federal Legislation Related to Primary Care

Telehealth
 
Bills related to telehealth continue to be introduced in both houses of Congress. The Alliance for Connected Care has a comprehensive list of bills and summaries.
 
Expansion of Teaching Health Centers
 
Noting that “we need more primary care physicians—that was true before this pandemic and its truer than ever now,” Senate HELP Committee Chair Patty Murray (D-Wash.) joined House Energy and Commerce Chair Frank Pallone (D-N.J.) in introducing new legislation to permanently authorize and expand the Teaching Health Centers Graduate Medical Education program. The bill, the Doctors of Community Act, would expand funding to support 100 new programs and 1,600 new residency slots, which would be filled primarily by residents in primary care.
 
E&C Hearing: Empowered by Data: Legislation to Advance Equity and Public Health
 
On June 24, the House Energy & Commerce Committee held a hearing on strategies for digitizing the nation’s public health data systems, insuring interoperability and collection of meaningful, actionable data to support addressing social determinants of health and health equity. Committee members have introduced a series of bills to address these goals. Funding an interoperable public health data system is foundational to successful models of comprehensive primary care.

States Codify Telehealth Payment Parity

As states are ending state-level public health emergencies that temporarily added new telehealth payment coverage in Medicaid and other state-funded or -regulated programs and payers, many states are codifying telehealth payment parity for telehealth on a permanent basis. Manatt has a helpful tracker.

Coalescing Around the NASEM Report, Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care

The PCC is working with its members and other leaders in primary care to build unity and momentum for the bold changes the recent NASEM report calls for, particularly those related to payment reform. The report is an opportunity to shift the priorities of our healthcare system and improve the health of communities. The PCC is engaging our community in ongoing conversations to ensure our policy and advocacy agenda leverages this historic opportunity.

Watch the recording of PCC’s May webinar about the report.

Affordable Care Act Celebrates a Good June

In early June, the Department of Health and Human Services announced that a record 31 million Americans were enrolled in coverage related to the Affordable Care Act as of February 2021, demonstrating its role as a lifeline for people facing economic and health hardships during the COVID-19 pandemic. Enhanced premium tax credits included in the American Rescue Plan enacted in March 2021 and available during an extended special enrollment period have reduced average monthly premiums by over 40% for returning consumers. Later in June, the U.S. Supreme Court upheld the ACA for the third time and dismissed a challenge brought by Texas and 17 other states on grounds that they were not harmed and therefore lacked standing. The challengers had argued that the entire law was invalid after Congress reduced to zero the ACA’s penalty for failing to enroll in minimum essential coverage in 2017.

New House and Senate bill aims to tackle primary care doctor shortage

Congress is considering new legislation aimed at boosting funding for medical education with a goal of tackling a shortage of primary care doctors in underserved areas.

The Doctors of Community (DOC) Act introduced in the House of Representatives Tuesday and expected to be released in the Senate next week would permanently authorize the Teaching Health Center Graduate Medical Education program that aims to train primary care medical and dental doctors. The legislation would increase annual funding for more than $500 million per year from 2024 through 2033.

The goal of the legislation is to fund an additional 100 new medical education programs across the country and create roughly 1,600 new resident and physician slots, a major expansion of the program.

CMS Updates

New CMS Administrator Confirmed

On May 25, Chiquita Brooks-LaSure was confirmed as the next Administrator of the Centers for Medicare & Medicaid Services. She is the first Black woman to fill the role. Her confirmation process had been delayed following controversy over the administration’s decision to revoke a Texas Medicaid 1115 Waiver, but ultimately went forward with 50 Democrats and 5 Republicans voting to confirm her.

 
CMS’s Next Gen Model Ending

The Centers for Medicare & Medicaid Services announced the week of May 24 that the Next Generation ACO model will end on December 31, without an additional year extension. However, Next Gen ACOs will be given the opportunity to apply for the Global and Professional Direct Contracting model. (Next year’s Direct Contracting model will not re-open to any other entities.) According to PCC Executive Member NAACOS, the Next Gen program saved Medicare $1.4 billion in 2019 after accounting for shared savings/losses and discounts paid to CMS.

COVID-19’s Outsized Impact on the Uninsured; Federal Programs to Reimburse for Their Care

The pandemic is having an outsized impact on Americans without health insurance. According to a report by Families USA, approximately one out of every three COVID-19 deaths nationally are linked to health insurance gaps. The federal government has committed $4.8 billion from the American Rescue Plan to reimburse practices for COVID-19 tests and treatment administered to uninsured patients, regardless of immigration status (“HRSA COVID-19 Uninsured Program”).
 
Separately, a new program—“The COVID-19 Coverage Assistance Fund”—covers the costs of vaccinating patients who are un- or under-insured. Clinicians must provide the COVID-19 vaccine to individuals regardless of their coverage status and without patient out-of-pocket costs. Some in Congress are also concerned about the costs of COVID-19-related care for patients with insurance, particularly those with high deductibles. At the end of April, ten members of Congress sent a letter to Anthem, CVS/Aetna, and United Health encouraging them to continue waiving patient cost-sharing for COVID-treatment, which some insurers have rolled back in recent months.

Congress Considers Telehealth

Congress continues to weigh how telehealth should be treated after the public health emergency ends. In late April, the House Ways and Means Health Subcommittee held a hearing on the path forward for telehealth. Witnesses included Sinsi Hernández-Cancio of the National Partnership for Women and Families, a PCC Executive Member, whose testimony called for the implementation of telehealth that reduces and does not exacerbate longstanding health inequities.
 
Several telehealth-related bills have been introduced in both the House and Senate. The CONNECT for Health Act of 2021 proposes permanently lifting or expanding geographic and site-based restrictions, permanently allowing for waivers during public health emergencies and requiring studies on the impact of telehealth on utilization and care. PCC and several of its members have signed on to the legislation, which has 56 co-sponsors and over 160 supporting organizations.
 
Other bills include the Permanency for Audio-Only Telehealth Act, re-introduced in the House, that would allow Medicare to permanently cover audio-only visits, and the Telehealth Improvement for Kids’ Essential Services, introduced in the Senate earlier this week, that looks to expand telehealth access for enrollees in Medicaid and CHIP. 

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