Federal Policy Updates

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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.

CMS Payment Model Updates & Deadlines

The Centers for Medicare and Medicaid Services (CMS) recently released the Request for Applications for the second cohort of Primary Care First (PCF), which is open to all practices in the 26 regions, not just those in the Comprehensive Primary Care Plus (CPC+) program ending this year. Practices should apply by April 30 and payers by May 28. The Seriously Ill Population component of the PCF model is currently under review. The Geographic Direct Contracting Model known as “Geo” is also on hold while being reviewed. CMS announced that ACOs should submit a Notice of Intent to Apply (NOIA) by June 7 at 12 p.m. ET in order to apply for a January 1, 2022, start date for the Medicare Shared Savings Program.

Reimbursement for COVID-19 Vaccine Administration Nearly Doubled

On March 15, CMS announced that it was increasing the Medicare payment for administering COVID-19 vaccines to an average of $40 per dose, up from the previous averages of $28.39 for single-dose vaccines; and $16.94 (1st dose), then $28.39 (2nd dose) for two-dose vaccines. (The exact payment rate depends on the type of entity furnishing the service and geographic adjustments.) And the American Rescue Plan mandated that the federal government now fully cover COVID-19 shots for Medicaid and CHIP beneficiaries. Patients continue to receive COVID-19 vaccines for free—regardless of health coverage type/status—with no applicable copayment, coinsurance or deductible.

Health Disparities and COVID

The Department for Health and Human Services recently released a new issue brief describing health disparities by race and ethnicity during the COVID-19 pandemic, with findings showing disparities in testing, infections and hospitalizations. COVID-associated death rates were considerably higher among American Indian/Alaska Native, Black and Hispanic persons compared to White persons. Mid-month, the Biden administration announced that it was investing $250 million to encourage COVID-19 vaccination among underserved populations. And an analysis by the Kaiser Family Foundation found that community health centers were successfully reaching people of color in their early vaccination efforts.

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.

Latest COVID Relief Package’s Implications for Primary Care

The latest COVID-relief bill passed by Congress, the American Rescue Plan Act of 2021, includes a range of economic and public health support measures, many of which have implications for patients and primary care practices. The package significantly expands access to health coverage through substantial subsidies for Affordable Care Act plans, as well as COBRA subsidies for the unemployed, and funding to incentivize Medicaid expansion in the 12 states that have not yet pursued it. The act also includes $7.6 billion to expand the public health workforce and $800 million for the National Health Service Corps, along with funding for teaching health centers. The relief package allocated $10 billion for rural health care providers to pay for unexpected expenses related to the pandemic. It also recognizes the toll of the pandemic on the mental health of Americans and included policies and funding to address their needs, including $40 million to HRSA to specifically address the mental health needs of healthcare professionals. No additional funds were allocated to the Provider Relief Fund, apart from targeted money for rural hospitals, and the loan terms of the Medicare Advanced Payment program were not relaxed.

ACA Open Enrollment Extended, Medicaid Work Requirements

The most recent COVID-19-related stimulus package included substantial subsidies for healthcare coverage (see above). It builds on the several healthcare-related executive orders Pres. Biden signed within his first weeks office, including one on Strengthening Medicaid and the Affordable Care Act. The Department of Health and Human Services announced a special enrollment period for uninsured and underinsured individuals to access coverage through the Federal Marketplace between February 15 and May 15, along with $50 million for an outreach campaign. Just last week, the administration announced it would extend the open enrollment period by three more months, allowing more Americans time to sign up for health coverage using the subsidies included in the American Rescue Plan passed by Congress earlier in March. The executive order also called for the immediate review of agency actions under President Trump, with the Biden administration recently notifying states that it is withdrawing approvals for Medicaid work requirements.

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