Administration Updates

CMS: (3/16) - CMS released the request for applications for Cohort 2 of the Primary Care First (PCF) Model. Primary care practices in eligible regions are encouraged to apply. The PCF Cohort 2 will have five performance years and is scheduled to begin January 1, 2022. The deadline for practice applications is April 30, 2021, and the deadline for payer applications is May 28, 2021.

CMS: (3/16) - CMS announced updates to the CY 2022 request for applications for the Part D Payment Modernization (PDM) Model. CMS is not moving forward with the two Model design changes discussed in the January 19, 2021 CY2022 RFA: the Part D Formulary Flexibilities and removal of downside risk for CY2022. Applications are due on Friday, April 16, 2021. Applications go live March 23, 2021.

CMS: (3/15) - CMS announced it will increase the Medicare payment amount for administering the COVID-19 vaccine. The new and higher payment rate will support important actions taken by providers that are designed to increase the number of vaccines they can furnish each day. Effective on or after March 15, the national average payment rate for physicians, hospitals, pharmacies, and other immunizers will be $40 to administer each dose of the vaccine.

CMS: (3/12) - CMS issued a press release on the implementation of the American Rescue Plan Act, specifically tax credit provisions and how CMS plans to implement them. Individuals can take advantage of more generous tax subsidies starting April 1, though the provision providing additional subsidies to individuals receiving unemployment won’t be available until this summer.

White House: (3/12) - President Biden announced that in the coming weeks, the Administration will make every adult in the U.S. eligible for vaccination no later than May 1, take new steps to reopen the nation’s schools, and continue efforts to combat variants and spread of COVID-19.

CMS: (3/12) - CMS announced the final list of participants and Notice of Funding Opportunity (NOFO) for the Emergency Triage, Treat, and Transport (ET3) Model. The list of final participants include 184 public and private ambulance providers and suppliers representing 36 states. CMS also issued a Notice of Funding Opportunity (NOFO) of up to $34 million over two years for local and state governments to expand emergency and non-emergency medical triage services in locations of model participants. Information NOFU

HHS: (3/11) - HHS announced that an additional 700 HRSA-supported health centers will be invited to join the Health Center COVID-19 Vaccine Program. These health centers will have the opportunity to join the program over the next six weeks, increasing the total number of invited health center participants to 950.

HHS: (3/11) - HHS issued the seventh amendment to the declaration under the Public Readiness and Emergency Preparedness (PREP) Act for Medical Countermeasures Against COVID–19. The amendment adds additional categories of people authorized to prescribe, dispense, and administer the COVID vaccine, including dentists, EMTs, midwives, optometrists, paramedics, physician assistants, podiatrists, respiratory therapists, and veterinarians. It also authorizes medical students, nursing students, and other health care students in professions listed under the PREP Act with proper training and professional supervision to serve as vaccinators. White House Fact sheet

ASPE: (3/11) - HHS Office of the Assistant Secretary for Planning and Evaluation released a brief examining the effects of state Medicaid section 1115 demonstration policies on coverage and access to care. The brief examines policies in four major areas: 1) work requirements; 2) health behavior incentive programs; 3) health savings account-like arrangements; and 4) capped federal funding and other financing changes.

CMS: (3/11) - CMS released the 2022 request for applications for Part D plan sponsors and second year pharmaceutical manufacturer participants for the Part D Senior Savings Model. RFA

Legislative Updates

Medicare Sequester Relief Act: (3/16) - Sens. Shaheen (D-NH) and Collins (R-ME) introduced the Medicare Sequester Relief Act (S. 748), bipartisan legislation that would prevent substantial payment cuts to Medicare payments to health care providers from taking effect during the COVID-19 public health emergency.

MedPAC: (3/15) - The Medicare Payment Advisory Commission (MedPAC) released its March 2021 Report to the Congress on Medicare Payment Policy. The report includes MedPAC’s analyses of payment adequacy in traditional fee-for-service Medicare, reviews the status of Medicare Advantage and the prescription drug benefit (Part D), and reports on an option for Medicare’s coverage of telehealth services after the pandemic ends.

H.R. 1868: (3/12) - Reps. Yarmuth (D-KY), Neal (D-MA), Pallone (D-NJ), and Scott (D-GA) introduced a bill to prevent across-the-board direct spending cuts. The bill would extend the Medicare sequester moratorium, which is currently set to sunset at the end of the month, through the end of the year and would keep the cost of the American Rescue Plan Act from leading to new sequester cuts.

American Rescue Plan Act: (3/11) - President Biden signed the American Rescue Plan Act of 2021 (H.R. 1319) into law. The American Rescue Plan will provide additional relief to address the continued impact of COVID-19 on the economy, public health, state and local governments, individuals, and businesses. The House passed the legislation on March 10. HHS Fact sheet  CMS Fact sheet

Dr. Lorna Breen Health Care Provider Act: (3/8) - Rep. Wild (D-PA) and 14 bipartisan cosponsors introduced the Dr. Lorna Breen Health Care Provider Act (H.R. 1667), which would address behavioral health and well-being among health care professionals.

State Health Care Premium Reduction Act: (3/12) - Reps. Craig (D-MN) and Peters (D-CA) introduced the State Health Care Premium Reduction Act (H.R. 1878), which would amend the Patient Protection and Affordable Care Act to establish a health insurance affordability fund.

Member News

Medical Economics: (3/16) - The House is discussing a bill this week that could extend the moratorium on Medicare sequestration which prevents a two percent Medicare cut and is set to expire at the end of March, as well as prevent the PAYGO sequestration that would result from the implementation of the American Rescue Plan Act. Anders Gilberg, Senior Vice President of Government Affairs at MGMA, applauded the legislation, saying that without Congressional action medical groups will face a sequester cut that is unsustainable given the financial implications imposed on providers during the pandemic.

Medical Economics: (3/16) - Following the release of the MedPAC March 2021 Report to Congress, MGMA Senior Vice President of Government Affairs Anders Gilberg expressed disappointment with the recommendations included in the report around increases in physician services payment and the long-term effects of the pandemic. Gilberg said it was too early to assume medical practices will not continue to face financial challenges stemming from COVID in the years ahead.

California Medical Association: (3/16) - The California Medical Association (CMA) released a press release following the CMS announcement that it would increase the rate of Medicare payments for COVID vaccine administration. CMA applauds this action, as it was involved in advocacy efforts to increase payments and ensure adequate reimbursement for the administration of vaccines.

Aledade: (3/15) - On the latest episode of Aledade’s podcast, guests join to discuss the Maryland Primary Care Program (MDPCP) and how it aims to improve patients’ health by investing up-front in specific enhancements to primary care practices.

AAFP: (3/15) - Last month, CMS announced it would offer physicians participating in the Quality Payment Program’s Merit-based Incentive Payment Systems (MIPS) a data reporting reprieve for 2020 performance data. AAFP has strongly advocated for this move, stating in a previous letter to CMS that providers need to be focused on providing care for the foreseeable future given the risk COVID still presents.

Managed Healthcare Executive: (3/10) - Providers of all kinds struggled both financially and with declining patient volumes during the pandemic. This has been particularly true for primary care practices. Sean Cavanaugh, Chief Commercial Officer and Policy Officer at Aledade, said independent physicians are “small businesses without big financial reserves,” leaving many practices in dire circumstances as the pandemic continues to stretch into 2021. Cavanaugh said that the independent practices Aledade works with experienced a 30 to 40 percent immediate decline in patient visits when the pandemic began, forcing many practices to lay off staff or close.

AAFP: (3/10) - Following the passage of the American Rescue Plan Act, AAFP released a statement applauding the legislation. AAFP expressed its support of the inclusion of several of its advocacy priorities, such as providing federal funding for states to cover most of Medicaid COVID vaccine administration for one year after the public health emergency and expanding coverage to more patients.

Annals of Family Medicine: (March 2021) – Family physicians are key to the success of value-based care (VBC). AAFP is working on a project called Vision 2025: Defining the Future of Value-Based Payment, which is designed to empower AAFP members to successfully navigate the evolving value-based payment (VBP) environment and prepare them to partner with payers to help improve quality and control costs. AAFP convened an advisory group to gather feedback and lessons learned from VBP models as it moves forward with developing its next-generation primary care VBC model.

News Clips

Healthcare Dive: (3/16) - One year into the pandemic, the financial situation of independent practices is starting to improve and patient volumes are beginning to recover. Many providers that faced negative financial impacts during COVID cut unnecessary costs and lobbied for loans, which helped such practices bounce back. However, new frustrations among independent practice providers have emerged around the vaccine distribution process. Primary care providers have been left out of the vaccine rollout and have not heard back from state and local health departments about receiving vaccines.

Advisory Board: (3/16) - In this blog and episode of Radio Advisory, Advisory Board’s Ben Umansky and Natalie Trebes talk about where the health care industry stands on the path to value-based care and how COVID has affected this movement. These guests also discussed questions providers should be asking themselves about risk.

Health Payer Intelligence: (3/16) - Humana announced it will transition some of its senior primary care services into CenterWell, the newest brand of the health plan. The new brand will encompass 41 primary care facilities that were formerly Partners in Primary Care and 24 primary care centers from Family Physicians Group to make up the CenterWell Senior Primary Care beginning in April 2021. The centers will implement a coordinated care model to provide seniors with a primary care provider who is in charge of coordinating their care, putting the patient at the center and embracing whole-person health.

Fierce Healthcare: (3/15) - The House is expected to vote this week on legislation to extend the moratorium on the two percent Medicare payment cut imposed under sequestration, which is set to expire at the end of March. Provider groups are urging Congress to extend the Medicare sequester to support providers who continue to face financial difficulty as a result of the pandemic.

Revcycle Intelligence: (3/11) - Many providers have expressed frustration that the American Rescue Plan Act, which President Biden signed last week, did not include more funding for provider relief in the package. While the bill will deliver $8.5 billion in provider relief to providers in rural areas, it is less than the amounts provider groups had advocated for and could potentially trigger Medicare spending cuts as a result of implementation.

ASTHO: (3/11) - The Association of State and Territorial Health Officials (ASTHO) released a policy statement supporting alternative payment models (APMs) and value-based purchasing (VBP). In the policy statement, ASTHO lists a summary of recommendations, to include ensuring appropriate federal and state flexibility, landscapes and governance structures to enable states to develop and implement innovative APMs and VBP.

Health Payer Intelligence: (3/11) - The National Committee for Quality Assurance (NCQA) released a report with health equity recommendations for HHS and CMS. Among recommendations included enabling a digital quality measure system and strengthening Medicare value-based care plans. NCQA states that CMS should align its value-based plans around three fundamental pillars: integrity of data and performance assessment, coordination of structure and expectations across programs, and collaboration with all relevant stakeholders in designing and implementing value-based plans.

Events

March 

• March 17 - CMMI, “Webinar: Medicare Advantage Value-Based Insurance Design Model - Calendar Year 2022 VBID Hospice Benefit Component - Payment Design.” Virtual.

• March 18 - Aledade, “Real Value, Real Fast: 5 Simple Strategies to Get More From Your Transition to Value-Based Care.” Virtual.

• March 18 - Health Management Associates, “How FQHCs Can Deliver Innovative Care Under Existing and Value-Based Payment Models.” Virtual.

• March 22 - Primary Care Collaborative, “A Dangerous Disruption? The Consequences of Delayed Care During COVID-19.” Virtual.

• March 23 - MGMA, “Medicare Direct Contracting and the Accelerating Shift to Value-based Care.” Virtual.

• March 31 - Primary Care Collaborative, “Innovations in Integrating Oral Health Into Primary Care.” Virtual.

April

• April 6 - California Medical Association, “Legislative Advocacy Conference.” Virtual.
  

If you would like your event to be included in the next newsletter, please email kristen@physiciansforvalue.org.