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This newsletter outlines key federal regulatory developments and highlights PAI’s advocacy on matters that impact physicians and patients, including renewal of the COVID-19 Public Health Emergency, CMMI’s 2020 report to Congress, the bipartisan infrastructure bill, and a report by the Better Medicare Alliance on social determinants of health.

Please visit PAI’s website for up-to-date information on PAI advocacy, research, and educational resources for physician practices. For additional information on key issues in the health policy landscape and identifying potential reforms under the Biden Administration, the 117th Congress, and in the states, please visit Healthsperien’s Resource page here.

HHS Renews COVID-19 Public Health Emergency Declaration 

On July 20, Xavier Becerra, Secretary of the Department of Health and Human Services (HHS), issued a 90-day renewal of the existing COVID-19 Public Health Emergency (PHE). The renewal is largely procedural in nature given that the Biden Administration has previously indicated they anticipate the PHE to continue through the end of 2021. The PHE was first declared on January 27, 2020, and has been subsequently renewed six times since that date. The PHE provides HHS with the ability to waive a host of existing regulations given the extraordinary circumstances physicians face. Most of these waivers terminate with the end of the PHE, though it remains to be seen which the Biden Administration will choose to continue, eliminate, or otherwise modify. Many of these decisions, such as those related to flexibilities provided for telehealth services, will require Congressional action to be extended or made permanent. A full list of 1135 waivers from the Centers for Medicare & Medicaid Services (CMS) can be found here

While CMS has finalized the extension of certain telehealth flexibilities through the end of the year in which the PHE ends (and proposed extensions until the end of CY 2023 in the 2022 Medicare Physician Fee Schedule Proposed Rule), there remains a gap in the ability to provide telemedicine services using audio-only technology and appropriate reimbursements for these services. PAI continues to advocate for physicians in private practice to be allowed to permanently use telehealth technologies to engage with their existing patients when access to facilities is limited or care can be delivered remotely. The reimbursement for this care should be equitable with face-to-face care reimbursement.

CMS Releases CMMI’s 2020 Report to Congress

On August 4, CMS published the Center for Medicare and Medicaid Innovation’s (CMMI) 2020 Report to Congress (RTC). The Innovation Center is required by statute to report to Congress on its activities, at minimum, every other year. This is the Innovation Center’s fifth RTC and covers activities from October 1, 2018, through September 30, 2020. Since the last RTC, CMMI tested, announced, or issued Notices of Proposed Rule Making for a total of 38 payment and service delivery models intended to achieve better care, improve health outcomes, and reduce expenditures for Medicare, Medicaid, and CHIP beneficiaries. Five model tests have been shown to deliver statistically significant savings:

  1. The ACO Investment Model
  2. The Home Health Value-Based Purchasing (HHVBP) Model
  3. The Maryland All-Payer (MDAPM) Model
  4. The Medicare Prior Authorization Model: Repetitive Scheduled Non-Emergent Ambulance Transport (RSNAT)
  5. The Pioneer ACO Model 

Other models such as the Comprehensive End-Stage Renal Disease (ESRD) Model and Comprehensive Care for Joint Replacement (CJR) Model did not show savings but demonstrated significant improvements in quality. CMS estimates that during the period of this report more than 27,850,000 Medicare and Medicaid beneficiaries and individuals with private insurance in multi-payer model tests have been impacted by, have received care from, or will soon be receiving care furnished by the more than 528,000 physicians and other health care providers and/or plans participating in the CMS Innovation Center’s payment and service delivery models and initiatives. 

PAI is building an alternative payment model (APM) resource guide for members who are considering joining an APM. This guide will include relevant details such as evaluating risk and understanding attribution as well as feature videos from member physicians on their experiences participating in APMs. The resources will be available free of charge on the PAI’s website. Updates will be shared in future Advocacy Updates.

Senate Releases Bill Text for Infrastructure Package

On August 1, the Senate released bill language for the bipartisan infrastructure package titled the Infrastructure Investment and Jobs Act. Although the package primarily focuses on “traditional” physical infrastructure, there are provisions in the legislation related to social determinants of health (SDOH) issues. The health care related provisions are listed below: 



On August 10, the Senate passed the bipartisan infrastructure bill by a 69-30 vote. This package now goes to the House of Representatives for their consideration. However, with the House out on August recess, many expect this legislation to be considered in the fall.

PAI will closely monitor these developments and any potential impacts on physician payment rates. PAI has consistently supported increased broadband access. Policymakers should continue to enhance funding for broadband expansion initiatives that improve the reach of telehealth and other digital health platforms within rural and underserved regions, including mobile units and technologies as well as non-real time platforms where physicians can communicate with patients.
 

Better Medicare Alliance Releases Report on Social Determinants of Health

On August 5, Better Medicare Alliance released a report highlighting innovative approaches to addressing social determinants of health for Medicare Advantage (MA) beneficiaries. Conducted by the National Opinion Research Center (NORC) at the University of Chicago on behalf of Better Medicare Alliance’s Center for Innovation in Medicare Advantage, the report found there was a dramatic increase in plan activity to address social needs within MA particularly in the areas of social isolation, transportation, housing, and food. NORC’s research also showed that barriers to further SDOH innovations remain which include technology limitations, misaligned incentives, and the disconnect between health care systems and social services.

The report proposes potential solutions to spur greater investment in SDOH, including: 



COVID has exacerbated issues of health equity and social determinants of health care. PAI is focused on addressing health equity issues for both patients and physicians, especially those in rural areas.

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