• Advocacy Wins for Family Medicine

    Advocacy Wins

    Legislative and Regulatory Progress

    Explore the Academy's critical advocacy campaigns — and crucial wins — as the battle to sustain, support and strengthen family medicine moves forward.


    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.

    New & Noteworthy

    Take an active role in shaping family medicine’s future when you come together with peers at the Family Medicine Advocacy Summit.


    Advocacy By Topic

    • Successfully urged CMS to crack down on prior authorization requirements and coverage denials by Medicare Advantage plans.
    • Successfully advocated for CMS to publish a proposed rule to broaden electronic prior authorization standards and comply with transparency requirements.
    • Encouraged CMS to finalize a rule requiring state Medicaid agencies to report on a standardized set of quality measures. 
    • Successfully urged CMS to finalize a Medicare Advantage rule streamlining prior authorization and improving access to behavioral health services.
    • Helped to reintroduce the Improving Seniors’ Timely Access to Care Act, which would streamline and standardize prior authorization in the Medicare Advantage program.
    • Encouraged CMS to establish the Office of Burden Reduction and Health Informatics.
    • Advocated 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.
    • Recommended for CMS to automatically apply the extreme and uncontrollable circumstances policy for performance year 2021 for individual MIPS participants.
    • Urged CMS to delay implementation of the Medicare Appropriate Use Criteria program penalties. 
    • 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. 
    • Expressed concerns on the Good Faith Estimate requirements, which CMS then released updated guidance on and reduced the burden of compliance.
    • Advocated for CMS to release 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.
    • Objected to the SUNSET rule, leading HHS to announce it would withdrawl the harmful rule mandating that thousands of existing health care–related regulations be reviewed or rescinded.

    Win Highlights

    • Successfully advocated for the implementation of G2211 to pay more accurately for complex, high-value office visits.
    • Testified before the Senate Finance Committee on supporting independent primary care practices amid consolidation.
    • Influenced the design of Making Care Primary, a state-based, primary care-focused alternative payment model due to launch in eight states in July 2024.
    • Testified before the House Energy and Commerce Health Subcommittee on reducing administrative burden and improving payment.
    • Supported the Strengthening Medicare for Patients and Providers Act, which would use the Medicare Economic Index to enact a positive annual update to the Medicare physician fee schedule's conversion factor.
    • Testified at a DEA public listening session to share support for permanent telehealth prescribing regulations.
    • 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.
    • 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.
    • 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.
    • 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.
    • Advocated for a national mental health strategy and substantial investments to support behavioral health integration with primary care and training to support team-based care and referrals from family physicians, which was reflected in the State of the Union address and the President's 2023 budget request.

    Win Highlights

    • Successfully advocated for the bipartisan Lower Costs, More Transparency Act, which would extend the THCGME program for seven years and increase investment.
    • Successfully called for CMS rulemaking to designate Rural Emergency Hospitals as GME training facilities able to receive GME funds and serve as Rural Track Program rotator sites.
    • 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.
    • Offered extensive feedback to CMS on their methodology for distributing new Medicare GME residency slots, and the policy the agency finalized reflects our recommendations and marks an important step toward addressing physician workforce shortages and maldistribution.
    • Advocated for Congress to extend the Teaching Health Center Graduate Medical Education program for three years and provide $330 million of additional funding.
    • 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.
    • Supported passage of the  Lorna Breen Health Care Provider Protection Act, which provides milestone investments into behavioral health care for physicians to combat clinician burnout.
    • Advocated the pause on federal student loan payment through August 2022. The AAFP has continually advocated for flexibility around medical student debt during the pandemic.

    Win Highlights

    • Helped win $42 billion in new federal funding for nationwide expansion of high-speed internet access, a social determinant of health.
    • Pushed to secure an extension of all PHE-related telehealth flexibilities for prescribing controlled substances, including buprenorphine for the treatment of opioid use disorder.
    • Successfully called for CMS to improve access to care for low-income and medically underserved consumers in federally qualified health plans by maintaining a 35% participation threshold for essential community providers.
    • Advocated for expanded patient coverage opportunities in a final rule by CMS, reducing coverage delays and increasing continuity of care for family medicine patients.
    • Urged CMS to release updated guidance on Medicaid eligibility redeterminations. This guidance encourages states to prioritize continuous coverage for Medicaid and CHIP enrollees and gives states additional time to complete the redeterminations, as the AAFP advocated.
    • Successfully advocated for a number of  regulatory changes to improve access to affordable health coverage for all.
    • Supported the Kids’ Access to Primary Care Act in 2020 and 2021, marking a significant step toward passing legislation that would permanently raise Medicaid payment rates for primary care services to at least Medicare levels.
    • Advocated for HHS to finalize proposal to roll back several harmful health insurance regulations because they would have limited access to comprehensive, affordable health care coverage.
    • Supported increased access to high-value evidence-based telehealth services after the end of the COVID-19 PHE, leading 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.
    • Supported the American Rescue Plan, which included CMS approving states to provide 12 months of continuous postpartum coverage for Medicaid and CHIP enrollees through the newly available state option.
    • Pressed for extending Medicare telehealth flexibilities beyond the COVID-19 PHE, temporarily eliminating barries to tele-mental health, and exteding enhanced Medicaid funding for U.S. territories, which were included in the 2022 omnibus bill Congress passed.

     

    Win Highlights

    • Advocated to ensure that health care is equitable, accessible, and affordable for all Americans on the belief that equity is a public health issue.
    • Supported the Maternal Health Quality Improvement Act and the Rural MOMS Act, which would make significant investments to reduce disparities in maternal health outcomes, improve access to maternal health services, and invest in robust data collection.
    • Advocated for Congress to pass legislation to give the FDA regulatory authority over synthetic nicotine, closing a long-exploited loophole in the Family Smoking Prevention and Tobacco Control Act. 
    • Advocated for the Center for Medicare and Medicaid Innovation's strategy for advancing health equity, including 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.

    Win Highlights

    • For the first time in Maryland history, the state budget includes funding for Medicaid E/M codes that will be higher than Medicare rates.
    • Thanks to the Illinois AFP’s support, the state’s 2024 budget and Medicaid omnibus legislation contains $25 million in physician rate increases.
    • Texas lawmakers heard the TAFP’s call and granted the state’s Physician Education Loan Repayment Program a 20.4% increase for the biennium budget.
    • The Florida AFP helped secure $30 million in the state budget for enhancing GME funding for residency positions.
    • The Alabama AFP helped pass a preceptor income tax for medical students who train in rural and underserved areas.

    Win Highlights

    2023 Chapter Wins Overview

    Review newly enacted policies across the state as resulting from advocacy efforts from AFP chapters.

      

       


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