• Fighting for Family Medicine

    Fighting for Family Medicine:

    Recent AAFP Advocacy Wins



    Supporting Family Physicians During the COVID-19 Pandemic

    Family physicians have been on the front lines of the fight against COVID-19 since the start of the pandemic — and so has the Academy, pushing Congress and the administration to deliver what you need to care for your patients, keep yourself safe, and sustain your practice.

    These efforts yielded significant wins through the Families First Coronavirus Response Act; the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the American Rescue Plan Act, and other legislation. Most recently, the fiscal year 2022 omnibus spending package, which extended Medicare telehealth flexibilities for five months beyond the end of the public health emergency, delivered a win for which the AAFP had steadily called. Advances for primary care also have come through regulatory actions by the Department of Health and Human Services and the Centers for Medicare and Medicaid Services that reflected input and advocacy from the Academy, including the extension of the PHE.

    Through engagement with key congressional committees and the Biden administration, the Academy successfully advocated to increase distribution and access to COVID-19 vaccines and boosters for family medicine practices as well as access to tests, guidance on masking, and improving vaccine confidence. The Academy also successfully advocated on securing adequate payment for vaccine administration, ensuring access to the vaccines for underserved populations, and removing or pausing regulatory and other administrative burdens and policies affecting physicians.

    After the Academy and several health care partners wrote to the Biden administration asking for a stronger federal response to the pandemic, many of the measures we recommended were implemented, including the availability of free at-home COVID-19 tests and masks.

    Following AAFP advocacy, President Biden announced that the administration would require state Medicaid agencies and managed care plans to cover and pay for childhood vaccine counseling when it occurs separately from vaccine administration. The AAFP also successfully advocated to increase Medicare payment rates for COVID-19 vaccine administration.

    Thanks to the AAFP’s advocacy and robust engagement with federal officials, President Biden has repeatedly called out family physicians as trusted sources of health information to whom patients should turn for COVID-19 vaccinations and care. 

    NEXT

    The AAFP continues to work with Congress and the Biden administration to ensure that the federal COVID-19 response is adequately resourced, grounded in scientific evidence, and incorporates family physicians in COVID-19 vaccine distribution and treatment plans for children and adults. The AAFP continues to advocate for administrative relief for Provider Relief Fund reporting and to restore HRSA’s Uninsured Relief Fund to pay for COVID-19 vaccines, testing, and treatment provided to uninsured patients. 


    COVID

    Investing in Primary Care  

    Following long-term advocacy by the AAFP, CMS implemented historic Medicare payment increases for family medicine on January 1, 2021. In 2019, CMS finalized increased payment rates for outpatient evaluation and management (E/M) services, which make up the foundation of family medicine, beginning in 2021. The AAFP strongly supported these payment increases and worked to ensure that CMS implemented them as planned.

    Our efforts included both regulatory and legislative activities as Congress also weighed options to provide additional financial relief to physician practices of all specialties amid COVID-19. In addition to ensuring that the E/M improvements went into effect as planned, the AAFP secured equitable financial relief for family physicians when Congress included a 3.75% increase to all Medicare payments for 2021.

    Together, the E/M improvements and this relief will result in significant Medicare payment increases for family physicians in 2021. While the COVID-related relief is temporary, the payment increases for outpatient E/M services represent a historic step forward in appropriately valuing primary care.

    In December 2020, Congress also passed legislation freezing for two years the thresholds that physicians participating in advanced alternative payment models must meet in order to be eligible for incentive payments. The AAFP had long advocated for such a freeze to ensure that alternative payment models continue to be accessible for family physicians.

    The first performance period of the Primary Care First model began in January 2021. The model is focused on practices that provide advanced primary care and are ready to assume financial risk in exchange for reduced burden and performance bonuses. Many of the components of this model were recommended by the AAFP, and we continue to support alternative payment models that use prospective, risk-adjusted, population-based payments for primary care.

    The AAFP partnered with other physician organizations to help introduce legislation in both the House and the Senate to increase Medicaid reimbursement rates for primary care services to at least Medicare levels.

    NEXT

    The Academy will continue working with its champions in Congress to pass legislation to increase Medicare and Medicaid payments for primary care and support alternative payment models.

    Investing in Primary Care

    In 2021, the Academy secured the largest increase in primary care payments in the Medicare program when CMS implemented updated relative values for office/outpatient evaluation and management visits. The AAFP forcefully defended this overdue change and successfully fought to secure equitable short-term financial relief for all physicians negatively affected by COVID-19, in the form of a 3% increase to the Medicare conversion factor.

    Last year, the AAFP successfully advocated to extend the 3% Medicare conversion factor increase for 2022, delay Medicare sequester cuts, and postpone cuts to clinical lab payments. The 2022 Medicare physician fee schedule final rule delivered on a number of AAFP priorities: CMS nearly doubled physician payments for vaccine administration, increased the value of chronic care management services, began modernizing clinical labor pricing, and permanently covered tele-mental services for all Medicare beneficiaries after the public health emergency. The AAFP and family physicians fought back legislative attempts to undermine these wins.

    The AAFP has urged CMS and the Center for Medicare and Medicaid Innovation to expand and diversify alternative payment models available to family physicians and to prioritize model stability to attract and retain participants. In response, the administration has announced technical changes to existing models and held multiple listening sessions to inform the development of new models.

    In his State of the Union address and 2023 budget request, President Biden outlined a national mental health strategy, proposing substantial investments to support behavioral health integration with primary care and training for the behavioral health workforce to support team-based care and referrals from family physicians, all of which the AAFP has advocated.

    NEXT

    The Academy is working with its champions in Congress to increase Medicaid payments for primary care, enact sustainable Medicare physician payment updates, support alternative payment models, and support behavioral health integration into primary care. We are also partnering with CMS to continually improve the Medicare Quality Payment Program and with CMMI to implement and test new primary care alternative payment models. 


    Increasing Administrative Simplicity for Physicians

    The AAFP, as part of the Regulatory Relief Coalition, helped to reintroduce the Improving Seniors’ Timely Access to Care Act, which would streamline and standardize prior authorization in the Medicare Advantage program. Thanks to our ongoing advocacy, this bipartisan legislation is now supported by more than 280 members of Congress and 400 partner organizations.

    After persistent advocacy from the AAFP and other physician organizations, encouraging CMS to address the growing administrative burden on physicians and their practices, CMS recently established the Office of Burden Reduction and Health Informatics.

    Consistent with the AAFP’s advocacy to remove regulatory barriers to substance use disorder treatment, HHS has released new guidelines for prescribing buprenorphine that exempt certain physicians from burdensome reporting requirements.

    In line with the AAFP’s recommendation, CMS automatically applied the extreme and uncontrollable circumstances policy for performance year 2021 for individual MIPS participants and is automatically reweighting the Cost Category score to 0% for the remaining participants (reporting as a group or virtual group).

    At the AAFP’s urging, CMS delayed implementation of the Medicare Appropriate Use Criteria program penalties. The AAFP also secured language in the fiscal year 2022 HHS funding legislation requiring a report from CMS on implementation of AUC and directing the agency to consult with stakeholders. 

    CMS released updated guidance on the new Good Faith Estimate requirements that reflected the AAFP’s concerns and reduced the burden of compliance.

    In response to concerns from the AAFP and our partners regarding challenges with complying with the Provider Relief Fund reporting requirements, HHS announced it would reopen the reporting period so practices could come into compliance.

    Thanks to AAFP advocacy, CMS released new guidance clarifying that physicians cannot be compelled by insurers to receive payment from particular vendors and cannot be adversely affected by payments provided through standard transactions. This guidance may provide protections for physicians from plans that previously required the physician to receive payment through a third party that charges additional fees.

    NEXT

    The AAFP continues to advocate for Congress and CMS to address the growing burden of prior authorization and its negative effects on patients and physicians. We’re also advocating for CMS to provide relief to primary care practices in enforcement, sub-regulatory guidance, and future regulations related to the implementation of the 21st Century Cures Act and the No Surprises Act.


    Ensuring Access to Primary Care

    At the AAFP’s urging, CMS released updated guidance to states on Medicaid eligibility redeterminations, which are expected to resume after the COVID-19 public health emergency ends and federal continuous coverage requirements expire. This guidance encourages states to prioritize continuous coverage for Medicaid and CHIP enrollees and gives states additional time to complete the redeterminations. The AAFP applauded CMS’ focus on avoiding coverage losses and ensuring ongoing access to affordable care after the end of the PHE.

    The AAFP has successfully advocated for a number of regulatory changes to improve access to affordable health coverage for all. HHS recently issued a proposed rule to fix the ACA’s “family glitch,” a current policy that prevents many families from being able to access marketplace subsidies when their employer-based health coverage is unaffordable. HHS finalized proposals to roll back several harmful health insurance regulations that the AAFP opposed because they would have limited access to comprehensive, affordable health care coverage. HHS also created a new, ongoing special enrollment period for low-income individuals to join ACA plans via the marketplace and extended the annual open-enrollment period, all of which the AAFP supported. After ongoing advocacy, HHS reversed a harmful 2019 Title X regulation, which aligned with the AAFP’s longstanding commitment to supporting evidence-based family planning and other preventive health services for low-income individuals. The Department of Homeland Security released a proposed rule that would clarify for immigrants and their family members that enrolling in Medicaid, CHIP, and the Supplemental Nutrition Assistance Program would not affect their ability to receive a green card or a visa. This rule would formally reverse a harmful 2019 regulation that the AAFP strongly opposed and ultimately caused immigrants and their families to forgo needed health services.

    The Academy’s consistent support for increased access to high-value, evidence-based telehealth services after the end of the COVID-19 PHE led to permanent Medicare coverage of audio-video and audio-only tele-mental health services in beneficiaries’ homes and allowing FQHCs and RHCs to continue providing those services after the PHE.

    CMS has begun approving states to provide 12 months of continuous postpartum coverage for Medicaid and CHIP enrollees through the newly available state option established by the American Rescue Plan, which the AAFP strongly supported.

    The CDC released proposed updates to the Clinical Practice Guidelines for Prescribing Opioids, implementing changes for which the AAFP had advocated, following concerns that the 2016 guidelines were overly prescriptive and created barriers to care for patients with chronic pain.

    After the AAFP’s steadfast support for the Kids’ Access to Primary Care Act in 2020 and 2021, the Energy and Commerce Committee held a hearing on the bill in March 2021. This marked a significant step toward passing legislation that would permanently raise Medicaid payment rates for primary care services to at least Medicare levels.

    In late 2021, the House of Representatives passed the Build Back Better Act, which included many of the Academy’s priorities for improving health coverage, including closing the Medicaid expansion coverage gap, extending Medicaid postpartum coverage for 12 months, implementing 12 months of continuous eligibility for children enrolled in Medicaid and CHIP, and extending enhanced subsidies for Affordable Care Act marketplace plans. The fate of the legislation in the Senate is uncertain, but the AAFP continues to advocate for the advancement of key health provisions.

    In early 2022, Congress passed the omnibus spending package, which extends Medicare telehealth flexibilities beyond the COVID-19 PHE, temporarily eliminates barriers to tele-mental health, and extends enhanced Medicaid funding for U.S. territories, all of which the AAFP pressed for.

    NEXT

    The AAFP continues to work with Congress and the administration to expand health care coverage, improve Medicaid beneficiaries' timely access to care, and ensure coverage and appropriate payment for telehealth services after the end of the PHE. The AAFP also continues to advocate for policies to improve the uptake of behavioral health integration in primary care practices. 


    Health Equity

    The AAFP recognizes equity as a public health issue and has advocated to ensure that health care is equitable, accessible, and affordable for all Americans. The Biden administration's equity action plans to advance equity and racial justice across the federal government reflect this understanding, and President Biden’s 2023 budget included several proposals for which the AAFP had advocated. These would address racial disparities in maternal health, improve equitable access to mental health care, and remove financial barriers to evidence-based HIV and reproductive health care.

    The omnibus spending package included the Maternal Health Quality Improvement Act and the Rural MOMS Act, legislation the AAFP supported, which would make significant investments to reduce disparities in maternal health outcomes, improve access to maternal health services, and invest in robust data collection.

    After ongoing AAFP advocacy, Congress passed legislation to give the FDA regulatory authority over synthetic nicotine, closing a long-exploited loophole in the Family Smoking Prevention and Tobacco Control Act. This legislation will enable the FDA to rein in businesses that have worsened health disparities and the youth e-cigarette epidemic.

    The Center for Medicare and Medicaid Innovation recently outlined its strategy for advancing health equity, including a number of priorities for which the AAFP has advocated. The strategy includes additional investments in data collection, increasing alternative payment model participation opportunities for clinicians caring for Medicaid patients and working in community health centers, and improving risk-adjustment methodologies in current models.

    NEXT

    The Academy will continue to engage Congress and the Biden administration to advance health equity through policies and regulations that increase primary care access, improve data collection, address social determinants of health, and enhance health care quality. The AAFP provides ongoing expert recommendations to address the disparities that exist within maternal health and rural health..


    Strengthening the Workforce

    The Academy has steadily highlighted the need to align federal GME investments to meet the needs of the workforce by correcting the shortage and maldistribution of physicians and improving equitable access to high-quality care.

    In Dec. 2020, Congress passed legislation creating 1,000 new Medicare GME residency slots. The AAFP offered extensive feedback to CMS on their methodology for distributing those new slots, and the policy the agency finalized reflects our recommendations and marks an important step toward addressing physician workforce shortages and maldistribution. The rule also included important wins for rural training programs, including a technical regulatory fix that will encourage hospitals to establish new family medicine rural training sites.

    As a result of the AAFP’s persistent advocacy, in 2021 Congress extended the Teaching Health Center Graduate Medical Education program for three years and provided $330 million of additional funding. The AAFP worked with its champions in Congress to introduce the Doctors of Community Act to permanently extend the THCGME program. 

    The AAFP has ensured the continuation of the Conrad 30 Waiver Program, which allows international medical graduates practicing in underserved areas to remain in the U.S. The fiscal year 2022 omnibus spending package extended the program for another year.

    In another win for family physicians, the Lorna Breen Health Care Provider Protection Act was signed in Feb. 2022. This law provides milestone investments into behavioral health care for physicians to combat clinician burnout.

    The Biden administration extended the pause on federal student loan payment through August 2022. The AAFP has continually advocated for flexibility around medical student debt during the pandemic.

    NEXT

    The Academy will continue to work with the 117th Congress to pass legislation that increases residency training for family physicians, permanently extends the THCGME program, and invests in strategies that strengthen the family physician pipeline.


    State-level Support and Advocacy

    Against mounting challenges in the 2022 state legislative sessions, AFP state chapters have fought for family medicine and secured wins.

    • Georgia’s Mental Health Parity Act delivers sweeping reforms for behavioral health, including mental health insurance parity and loan forgiveness for primary care and psychiatric physicians, and mandates an 85% minimum medical loss ratio for Medicaid insurance plans.
    • After several years of advocacy, the Michigan Academy of Family Physicians celebrated the final passage of S.B. 247, reforming prior authorization. The law shortens the timeline for approval to seven calendar days (72 hours for urgent requests) and ensures that emergency care can be provided without prior approval.
    • The Wisconsin AFP challenged an aggressive bill from the APRN community that would have allowed independent practice. The bill passed both legislative chambers; however, following strong grassroots and chapter opposition, the governor vetoed the bill.
    • As AFP chapters continue to advocate for primary care investment, two big state wins show progress. Utah’s H.B. 210 establishes a regular, ongoing process for primary care spend measurement. And Washington’s S.B. 5589 includes the target of 12% of health spending devoted to primary care, with yearly goals for improvement toward that goal. That law also includes the affordability standard, requiring the state’s insurance commissioner to consider insurance plans’ spending and progress toward the goal when reviewing rates.

    The Center for State Policy continues to aid chapters’ advocacy efforts by providing resources, grassroots tools, legislation tracking, and policy analysis. The CSP also recently hired the consulting firm MultiState to provide analysis on select issues and provide chapters with real-time comprehensive reports on legislation affecting family medicine in their states.