Advocacy & Policy Updates

Growing Number of Emergency Medicaid Waivers

March 31, 2020

The president’s national emergency declaration on March 13 authorized states to apply for 1135 waivers granting time-limited flexibilities to respond to the crisis. As of Friday, 34 states had been granted Medicaid waivers that offer a range of flexibilities such as the abilities to enroll out-of-state or new providers more quickly and to temporarily suspend prior authorization requirements. See the latest list of state waivers on Medicaid’s website.

Stimulus Packages Passed to Respond to COVID-19

March 31, 2020

Congress has passed three stimulus packages to respond to the clinical and economic toll of the pandemic. The first package (“Phase 1”), passed March 4, provided billions of dollars to federal agencies to combat the virus’s spread and additional funds to ramp up testing. Phase 2 passed ten days later; it covered emergency provisions spanning food aid, paid sick leave, free COVID-19 testing for the uninsured, and unemployment insurance. Cost-sharing for visits relating to testing was waived for Medicare Part B, Medicare Advantage, Tricare, Medicaid/CHIP, Veterans, and Indian Health Service. The bill also included a temporary 6.2 percentage point increase to states’ federal medical assistance percentage (the federal portion paid to Medicaid) for coverage of testing for the duration of the public health emergency. Phase 3—a $2 trillion package—passed the house on Friday. PCC is advocating that the direct relief allocated to states, ranging from $1.25 to $10 billion, be used, in part, to help sustain and strengthen primary care practices as they continue to serve as front-line responders.

MIPS Short-Term Reporting Relief

March 31, 2020

CMS has adjusted reporting requirements for the Quality Payment Program (QPP) in light of the COVID-19 situation. The 2019 Merit-based Incentive Payment System (MIPS) data submission has been extended from March 31 to April 30, 2020. Participating clinicians who do not submit data by April 30 will qualify for the “automatic extreme and uncontrollable circumstances policy” and receive a neutral payment adjustment for the 2021 payment year. CMS implemented the policy to provide relief to clinicians who are actively responding to COVID-19. PCC commends CMS on the policy and is urging the waiver to be extended into 2020.

PCC Comment Letter: Protect CMMI’S Ability to Advance Value-Based Models

March 31, 2020

In March, PCC issued a comment letter to Congress that expresses opposition to H.R. 5741 and calls to protect CMMI’s ability to advance value-based payment models for beneficiaries. While the “Strengthening Innovation in Medicare & Medicaid Act” was framed as a way to increase accountability for the Center for Medicare & Medicaid Innovation (CMMI), PCC is concerned that the legislation will impede the Innovation Center’s ability to agilely test and scale payment models. The letter asserts that the bill weakens CMMI's autonomy, introduces opportunities to politicize payment models, and adds unnecessary administrative burden.

PCC Comment Letter: Protect Final Physician Fee Schedule

March 31, 2020

A PCC comment letter called on Congress to protect the final 2020 Medicare Physician Fee Schedule (PFS), which includes much-needed re-valuations for primary care. PCC believes the policy changes issued by CMS are well-justified by evidence, reflect current practice patterns, and are fiscally prudent. The final fee schedule includes higher values for E/M office visits and a visit complexity add-on payment starting in 2021; both help to re-align an unbalanced health care system that today better compensates “downstream” acute and specialty care over “upstream” prevention and chronic disease management.

PCC Opposes H.R. 5741; Calls to Protect CMMI’s Ability to Advance Value-Based Models for Medicare Beneficiaries

March 6, 2020

On March 6, 2020, PCC submitted a letter to members of Congress to express opposition to HR 5741 "Strengthening Innovation in Medicare and Medicaid Act." This proposed legislation risks weakening CMMI's leadership role and autonomy. HR 5741 has the potential to politicize CMMI models with the introduction of congressional approval. It would also restrict model parameters and create unneccessary administrative burden that would effectively hinder CMMI's ability to flexibly deploy and adapt models to meet beneficiary needs.

Connecticut Primary Care Spending Target

January 22, 2020

On January 22, 2020, Governor Lamont of CT signed into law Executive Order No .5, which directs OHS to monitor healthcare spending across payers, set annual benchmarck for 2021 through 2025. It also requires that the benchmarks should account for primary care spending and have targets within each year to increase primary care spending to 10% of total healthcare spending by 2025.

Physician Fee Schedule Comment Letter

September 30, 2019

On Friday, September 27, 2019, PCPCC submitted formal comments regarding the physician fee schedule. Specifically, PCPCC commented on the evaluation and management (E/M) codes, Medicare coverage for opioid use disorder, physician supervision for physician assistants, care management services, payment bundles, and and updates to the Quality Payment Program. While PCPCC was pleased with many of the updates in the proposed rule, there were some concerns, including the risk that removing the accreditation organizations for Patient-Centered Medical Home for performance improvement under MIPs could dilute standards for PCMH.

Physician Fee Schedule Letter

September 6, 2019

On Thursday, September 5, the PCPCC submitted a letter of comments to CMS regarding support of some of the changes made in the proposed 2020 physician fee schedule such as the changes to E/M codes. More detailed, formal comments will be submitted to the Federal Register later in the month. Read the letter here.

Primary Care First Letter to CMMI

August 6, 2019

On Friday, August 2, the PCPCC sumbitted a letter of comments and concerns to CMMI regarding some facets of the new Primary Care First Model. These included suggestions around the risk groups, performance incentives, and quality measures. Learn more and read the letter here.

Go to top