Federal Policy Updates

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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.

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]

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. 

PCC's Medicare PFS Comments Stress Investment in Primary Care, Health Equity

In comments to the Centers for Medicare and Medicaid Services, PCC urged both transformative reforms and immediate steps to strengthen primary care for all communities. Noting that the COVID-19 pandemic hit hardest in those communities facing persistent inequity, PCC called out continuing underinvestment in primary care and called for “pathways to rapidly transition away from a predominantly fee-for-service system.” PCC also offered detailed comment on Medicare telehealth, tele-mental health, vaccination, and health equity policy.

Read the full PCC comment letter

New Climate Report Sparks Demand for Change in Healthcare

Following the United Nations' warning of an intensifying climate emergency in the coming decades, health experts have demanded government and industry action that will prepare medical systems for natural disasters, as well as slashing greenhouse gas emissions.

The U.N. report, issued by the Intergovernmental Panel on Climate Change (IPCC), found that temperatures on Earth have risen so much that there is no way to prevent extreme weather from getting worse in the next 30 years.

Several groups and medical societies have called on the federal government to implement policies that will reduce greenhouse gas emissions. Sixty healthcare organizations -- including the American Lung Association, the American Heart Association, and the American Psychological Association [a PCC Executive Member] -- wrote a letter to Congress today, demanding that current legislative efforts on infrastructure include a package that would cut greenhouse gas emissions in half by 2030.

House Appropriations Bills Include Primary Care Research Center Funding Win, Workforce Funding

At press time, the House of Representatives appears poised to pass H.R. 4502, the Fiscal Year 2022 Labor/HHS Appropriations bill. Report language accompanying the bill would direct $5 million, sought by the PCC, to the Center for Primary Care Research at the Agency for Health Research and Quality (AHRQ).
In April, the PCC had urged congressional appropriators to fund the center, first authorized in 1999 but never actually funded.
The House bill also includes investments in Health Resource and Services Administration health workforce programs. This House Appropriations Committee Bill Summary includes highlights from the bill.
The debate over next year’s appropriations now moves to the Senate, where the Appropriations Committee plans to begin mark-ups the week of Aug. 2.

Bipartisan Momentum Grows for Behavioral Health, Social Determinants, and Vaccine Policy Changes

As debate over big-ticket infrastructure and budget reconciliation bills unfolds, the Senate Finance and House Energy and Commerce Committees are charting more bipartisan paths on behavioral health, social determinants of health, and vaccine access priorities.
At a June 15 hearing, Senate Finance Committee Chairman Ron Wyden (D-Oregon), Ranking Member Crapo (R-Idaho), and committee members of both parties signaled interest in crafting mental health legislation, potentially incorporating expansions of telemental health and the Certified Community Behavioral Health Clinic (CCBHC) Demonstration. Additional primary care-behavioral health integration policy changes and investments may be on the table in this developing conversation.
In the House, the Energy and Commerce Committee advanced several individual bills on July 21, including measures addressing vaccine policy as well as Medicare and Medicaid initiatives to address social determinants of health.

Medicare Part B Proposed Rule Updates Reimbursement, Extends Some Telehealth Authorities

On July 13, CMS released its annual Medicare Part B Physician Fee Schedule proposed rule.
Among other provisions, CMS proposes to:

  • Update reimbursement for Medicare Part B fee schedule services
  • Maintain certain telehealth services on the list of covered Medicare services to Dec. 31, 2023, so that there is a glide path to evaluate whether the services should be permanently added to the telehealth list.
  • Reimburse for audio-only telemental health services, provided an in-person service is is provided within six months
  • Take steps to expand participation in the Medicare Diabetes Prevention Program Expanded Model by reducing the benefit’s duration from two years to one (aligning the program with Centers for Disease Control and Prevention program design) and reworking the program’s benefit structure
  • Refine Medicare’s Quality Payment Program, proposing an increased performance threshold for incentive payment under Merit-based Incentive Payment System and outlining the first seven MIPS Value Pathway (MVP) measure sets.
  • Notably, despite the above steps that were proposed by CMS, certain broader waivers of geographic telehealth requirements will expire with termination of the current Public Health Emergency. Additional congressional action will be required.

CMS’ Notice of Proposed Rule Making (NPRM) also requested comment on vaccine administration payment and health equity data collection.
A draft PCC comment letter will be circulated to Executive Members for feedback in advance of CMS’ Sept. 13 deadline.
CMS resources:

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