See what the American Academy of Family Physicians (AAFP) federal advocacy team has been working on.
Public Health Emergency Unwinding
President Biden announced that the public health emergency (PHE) will end May 11, 2023, triggering the end of many emergency waivers and flexibilities that physicians, patients and other stakeholders have become accustomed to. While the 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: The 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 patient 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.
- Expanding Medicare resident supervision flexibilities permanently.
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, it 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: The AAFP submitted testimony for a February 16, 2023, Senate HELP (Health, Education, Labor and Pensions) Committee hearing that examined health workforce shortages and solutions to mitigate this troubling trend. The 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.
- Stopping anti-competitive contracting practices that harm clinicians and patients.
Kids’ Access to Primary Care Act
The 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 have equitable, 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%.
Policies Addressing Substance Use Disorders
Family physicians and other primary care clinicians are on the front lines of the opioid and overdose epidemics. The 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:
- The AAFP wrote to Health and Human Services in support of proposed regulations to streamline requirements governing substance use disorder treatment confidentiality in order to facilitate care coordination.
- The 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.
- The 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, 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.
Medicare Advantage Prior Authorization Rule
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:
- The AAFP urged the Centers for Medicare & Medicaid Services (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.
- The 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.
- The 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.
New Primary Care Scorecard
The 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.
The scorecard reveals the urgent need for policies to improve a primary care infrastructure in crisis. Read the findings.
The Milbank Memorial Fund and the Physicians Foundation presented a virtual release of the scorecard on February 22, 2023. View a recording.
For the latest policy updates impacting family medicine, follow AAFP Advocacy at @aafp_advocacy.
Post author: AAFP