AAFP advocates for Medicaid payment parity, primary care workforce support, and more in DC

Family physicians will play critical role in PHE unwinding

Why it matters:

President Biden announced that the public health emergency will end May 11. This will trigger the end of many emergency waivers and flexibilities that physicians, patients, and other stakeholders have become accustomed to. While AAFP has been expecting and preparing for the end of the PHE, we’re committed to working with federal policymakers and our members to ensure the smoothest possible transition.

What we’re working on:

AAFP wrote to President Biden urging the administration to publish a comprehensive plan for unwinding the flexibilities and waiver authorities available under the PHE, and to use its authority to minimize disruption. This includes:

• protecting equitable, affordable access to COVID-19 vaccines, treatments, and testing;
• ensuring that physician practices can purchase and stock COVID-19 vaccines once they transition to the commercial market;
• preventing Medicare telehealth coverage and payment disruptions;
• protecting patients’ access to lifesaving opioid use disorder treatment via telehealth;
• removing administrative, cost, and other barriers for individuals with long COVID seeking the health care services and federal assistance they need; and
• permanently expanding Medicare resident supervision flexibilities.

AAFP shares workforce recommendations with Senate HELP Committee

Why it matters:

Primary care is the only health care component for which an increased supply is associated with better population health and more equitable outcomes. Despite the significant role that primary care plays in our health system, primary care accounts for a mere 5% to 7% of total health care spending.

We have seen growth in the number of medical students choosing family medicine, but the increase will not be enough to meet the projected need. We will need up to 48,000 additional primary care physicians by 2034. The AAFP has long advocated for policies that target and invest in the primary care workforce to meet the diverse needs of our growing and aging population.

What we’re working on:

AAFP submitted testimony for a Feb. 16 Senate HELP Committee hearing that examined health workforce shortages and solutions to mitigate this troubling trend. AAFP’s testimony outlined several recommendations to invest in the primary care workforce, including

• strengthening and investing in federal graduate medical education programs;
• diversifying the physician workforce;
• addressing the burden of medical student debt;
• supporting physician-led, team-based care and the integration of behavioral health and primary care;
• enacting telehealth policies that extend the capacity of our health care workforce; and
• stopping anti-competitive contracting practices that harm clinicians and patients.

AAFP endorses Kids’ Access to Primary Care Act, advocates for Medicaid parity

Why it matters:

AAFP has endorsed the Kids’ Access to Primary Care Act, which would help raise Medicaid payment rates for primary care services to at least those of Medicare. We have long advocated for legislation that would fix inadequate Medicaid physician payment to ensure patients in need have equitable and timely access to needed health care services. Nationwide, Medicaid pays an average of 66% of the Medicare rate, with some states paying as little as 33%.

What we’re working on:

• AAFP endorsed Kim Schrier, Kathy Castor, and Brian Fitzpatrick’s Kids’ Access to Primary Care Act.
• In a press statement, AAFP President Dr. Tochi Iroku-Malize said, “Family physicians know how important it is for children to have timely and equitable access to primary care. The AAFP supports the Kids’ Access to Primary Care Act, which will help raise Medicaid payment rates for primary care services to Medicare levels. Increasing access to Medicaid coverage leads to better health outcomes and reduces longstanding health disparities. We urge Congress to pass this bipartisan legislation to improve access to care and ensure primary care physicians have the resources they need to treat pediatric Medicaid patients.”

AAFP champions policies to address SUD

Why it matters:

Family physicians and other primary care clinicians are on the front lines of the opioid and overdose epidemics. AAFP has long urged Congress and the administration to remove barriers for physicians prescribing medication for opioid use disorder. Among the numerous AAFP advocacy wins in the Consolidated Appropriations Act of 2023 was the elimination of the X waiver — an administrative hurdle the Academy had steadily opposed — that was worsening barriers to substance use disorder treatment. Additionally, new data continue to illustrate that primary care physicians are playing an increasing role in addressing patients’ mental health concerns.

What we’re working on:

AAFP wrote to HHS in support of proposed regulations to streamline requirements governing substance use disorder treatment confidentiality in order to facilitate care coordination.

• AAFP submitted comments to the Substance Abuse and Mental Health Services Administration supporting proposals to permanently enable opioid treatment programs to provide substance use disorder treatment via telehealth in certain circumstances and urging the Drug Enforcement Administration to make similar changes for all physicians.
• Family physician and AAFP member Dr. Marie Ramas was Sen. Maggie Hassan’s (D-N.H.) guest for the State of the Union Address. Dr. Ramas was recognized for her contributions to the health of her community and her commitment to providing medication assisted treatment to her patients in New Hampshire.
• AAFP member and family physician Dr. Blake Fagan, participated in a White House event celebrating the removal of the X-waiver for buprenorphine. The removal of the X-waiver will expand access to lifesaving medications for opioid use disorder.
• AAFP remains committed to advancing key pieces of the administration’s Unity Agenda by ensuring that primary care physicians have the resources they need to not only provide mental health care to patients but also lead effective and coordinated care teams with other mental health professionals. This includes appropriate payment, upfront funding, accessible and timely health IT updates, and a sufficient behavioral health workforce.

AAFP submits comments on Medicare Advantage prior authorization rule

Why it matters:

This proposed rule is an important first step in improving access to behavioral health services in Medicare Advantage and recognizing and reducing the administrative burdens and barriers to care imposed by prior authorization. If finalized, new prior authorization regulations would improve Medicare Advantage clinical coverage policies and reduce inappropriate care denials; however, additional reforms are needed to address the overwhelming volume of prior authorizations and ensure that patients have timely access to care.

What we’re working on:

• AAFP urged CMS to finalize proposals strengthening Medicare Advantage network adequacy requirements for behavioral health services, improving transparency of coverage criteria and medical necessity determinations, and protecting enrollees’ equitable access to basic Medicare benefits.
• AAFP also recommended that CMS strengthen the proposed rule by expanding new clinical coverage requirements to prescription drug coverage and implementing guardrails to reduce the overall volume of prior authorization requirements in Medicare Advantage.
• AAFP has repeatedly called for streamlined prior authorization to alleviate physician burden and address care delays. We will be providing comprehensive comments on a related proposal to automate prior authorization processes across payers by 2026.

AAFP’s Robert Graham Center Authors New Primary Care Scorecard

Why it matters:

AAFP’s Robert Graham Center authored the first national primary care scorecard, co-funded by the Milbank Memorial Fund and the Physicians Foundation. The scorecard finds a chronic lack of adequate support for the implementation of high-quality primary care across the United States.

This scorecard was developed in response to the challenge issued in a National Academies of Science Engineering and Medicine 2021 report calling for an annual tracking tool to measure improvements in the implementation of high-quality primary care over time.

Informed by the NASEM recommendations and an advisory committee of key stakeholders, the scorecard measures key primary care indicators over the past decade and reveals the urgent need for policies to improve a primary care infrastructure in crisis. Read the full findings here.

The Milbank Memorial Fund and the Physicians Foundation presented a virtual release of the scorecard on February 22. A link to the recording can be found here.