Federal Policy Updates

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Support for AHRQ’s Primary Care Research Center

In late April, PCC issued a letter to the House and Senate leadership requesting $5 million in dedicated funding for the Agency for Healthcare Research and Quality's (AHRQ) Center for Primary Care Research in fiscal year 2022. The center was authorized by statute in 1999 but never expressly funded. PCC made the case that the research center offers to contribute important knowledge to the delivery of high-quality primary care at a time when such insights are essential to the long-term health of the nation. The new NASEM report on primary care also recommends financial support for AHRQ’s primary care research efforts. 

Changes to CMMI Primary Care Payment Models

Primary care payment models out of the Center for Medicare and Medicaid Innovation have seen a number of updates in recent weeks. Practices that joined the Comprehensive Primary Care Plus (CPC+) model in 2018 recently learned that their fifth year of the model (anticipated for 2022) would be canceled. The CPC+ program will now end for all practices on December 31, 2021.
 
Separately, application deadlines for the Primary Care First model were extended: Practices interested in joining Cohort 2 should apply by May 21; payers have until June 18. While CMMI announced the 53 organizations participating in the Global and Professional Direct Contracting Model’s first performance year (which began April 1), it also announced that it would not be opening applications for 2022 as originally planned. Previously, the Geographic Direct Contracting model had also been put on hold while under review.

CMS Updates: Brooks-LaSure Hearings, AAP Repayment, MedPAC Recommendations

Hearings began in mid-April for Chiquita Brooks-Lasure, President Biden’s pick to head CMS, along with Andrea Palm, the administration’s nominee for the number two job at HHS. While the Senate Finance Committee’s hearing for Brooks-LaSure saw little controversy, contention around the administration’s decision to revoke a Texas Medicaid 1115 Waiver has delayed the process as Sen. John Coryn (R-Texas) placed a hold on her confirmation. She is likely to be confirmed eventually.
 
Repayment of COVID-19 Accelerated and Advance Payments began on March 30, 2021. The “Better way for Providers to Repay Act (H.R. 2407) would provide a 3-month delay to recoup certain payments made under the CMS program.
 
And MedPAC approved a set of recommendations for its June report to Congress, including that CMS “implement a more harmonized portfolio of fewer alternative payment models that are designed to work together to support the strategic objectives of reducing spending and improving quality.”

COVID-19’s Continued Inequities; HHS Bolsters Community-Based Care

COVID-19 continues to take a disproportionate toll on communities of color. A recent study found that Black women are three times more likely than White men to die from COVID-19. And this month, the CDC released a pair of studies further highlighting the pandemic’s inequities, finding that Hispanic and Latino patients made up the highest proportion of hospitalized patients with COVID-19 across all four census regions. A new West Health/Gallup survey of Americans found that nearly one in five skipped health care over the last year because of cost concerns; Black adults (29%) were almost twice as likely to not afford care as compared to White adults (16%). The administration is responding, in part, by targeting funds to Community Health Centers and other locations that serve more low-income patients.
 
In early April, HHS expanded its COVID-19 vaccine program to all health centers—nearly 1,500—and Tuesday announced $1 billion for health centers to make COVID-19 related capital investments. HHS also recently announced $145 million for health center lookalikes (community-based practices that meet Health Center Program criteria but are not grantees) to respond to and mitigate the spread of COVID-19 while expanding vaccination efforts.

Public Health Emergency Extended

HHS Secretary Xavier Becerra recently renewed the country’s public health emergency that was set to expire April 21. The declaration extends the PHE another 90 days through July 21, 2021. The COVID-19-related emergency was first declared on January 27, 2020. It allows for a number of flexibilities for how and by whom health care may be delivered.
 

CDC Looks to Help Primary Care Deliver COVID Vaccines

The White House and CDC are looking to help states better incorporate primary care into their COVID-19 vaccination strategy. They have launched a three-pronged effort that includes:

  • providing states with accessible lists of enrolled medical offices that are eligible to administer the vaccine, prioritized by social vulnerability data
  • working with states to enroll more primary care clinicians to administer the vaccine
  • providing technical assistance to jurisdictions to support distribution and enrollment activities

The federal government does not plan to make any direct allocations of vaccine to primary care, apart from the existing health center program. The administration’s plan comes at a time when many primary care practices are asking to play a more active role in COVID-19 vaccination efforts but lack supply and local/state coordination. The latest Larry A. Green Center/PCC survey of primary care clinicians shows that more practices are now administering COVID-19 vaccines but still not a majority. 

FCC Opens New Round of Telehealth Funding; Telehealth Restrictions Debated

Today the FCC opens a second round of funding for its COVID-19 telehealth program. The agency will distribute at least $150 million in this round, with applications closing May 6. In 2020, the CARES Act established the FCC telehealth program to help healthcare organizations purchase equipment, IT services and devices to provide care via telehealth. A new round of funding ($250 million) was added to the program through the Consolidated Appropriates Act passed earlier this year. Telehealth remains a key topic for primary care practices—both in terms of funding and practice restrictions. The CONNECT for Health Act of 2021 (S. 2741/H.R. 4932 in the previous Congress) 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. And there is a range of perspectives—from payers to purchasers and policymakers and clinicians—on how best to approach payment for telehealth going forward.

PCC Requests Funding for Agency for Healthcare Research and Quality Center for Primary Care Research in FY 2022

The PCC sent a letter to the chair and ranking member of the U.S. Senate Labor, Health and Human Services, Education and Related Agencies Subcommittee and the chair and ranking member of the U.S. House of Representatives Labor, Health and Human Services, Education and Related Agencies Subcommittee on April 26 requesting dedicated funding for the Agency for Healthcare Research and Quality's (AHRQ) Center for Primary Care Research in fiscal year 2022. The center, authorized by statute in 1999 but never expressly funded, offers to contribute important knowledge to the delivery of high-quality primary care at a time when such insights are essential to the long-term health of the nation.

Read the letter.

 

PCC Supports New Lung Cancer Screening Recommendations

The U.S. Preventive Services Task Force (USPSTF) updated its recommendation for lung cancer screening in March, expanding the current guidelines to include individuals ages 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. This recommendation will nearly double the number of individuals eligible for screening and has the potential to save significantly more lives than the previous guidelines.

As part of their State Lung Cancer Screening Coverage Project, the American Lung Association (ALA) is working to educate stakeholders about the revised USPSTF recommendation and share information about updating insurance coverage policies to align with the new recommendation as soon as possible.

PCC has signed on to an open letter from the ALA in support of the updated USPSTF recommendation for lung cancer screening. We join other organizations in broad support for improving access to this lifesaving screening.

The PCC is connected to this initiative through its membership in the National Lung Cancer Roundtable, founded by the American Cancer Society, which is a PCC Executive Member.

Proposed Legislation Impacting Primary Care

Congress has introduced several bills impacting primary care since the start of the year. These include:

  • the Veterans Access to Direct Primary Care (H.R. 1520), introduced by Reps. Chip Roy (R-Texas-21), Madison Cawthorn (R-N.C.-11), Ted Budd (R-N.C.-13), John Curtis (R-Utah-3), and Pete Sessions (R-Texas-17), that would pilot a program providing health savings accounts to veterans, allowing them to receive care through direct primary care arrangements outside of the Veterans Administration
  • the TREAT Act, introduced by Sens. Chris Murphy (D-Conn.) and Roy Blunt (R-Mo.) and Reps. Bob Latta (R-Ohio-5) and Debbie Dingell (D-Mich.-12), provides temporary state licensing reciprocity for all licensed/certified professionals to deliver in-person and telehealth care during the COVID-19 Public Health Emergency
  • H.R. 1025, Reps. Kim Schrier (D-Wash.-8), Kathy Castor (D-Fla.-14), and Brian Fitzpatrick (R-Pa.-1), would reapply the Medicare payment rate floor to primary care services provided under Medicaid.
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