The 2024 Medicare physician fee schedule final rule included several important victories for family medicine.

• The G2211 add-on code, which more accurately pays for the complexities of primary care, is up and running, following our push to get it over the finish line.
  
• So is new payment code G0136, for administering a social determinants of health risk assessment — in line with our advocacy.
  
• There also are new codes for community health integration services to address SDOH needs that are barriers to diagnosis or treatment, and for principal illness navigation services to help patients with serious, high-risk illnesses.  
  

There’s more.

As the Academy urged, a requirement for states to provide one-year continuous coverage for children enrolled in Medicaid or CHIP (called for in the Consolidated Appropriations Act of 2023) went into effect on Jan. 1. We continue to push for the expansion of continuous coverage requirements to other beneficiaries.

Our advocacy has also come to fruition in several Medicare provisions enacted in the Inflation Reduction Act of 2023 and newly in force:

• no prescription coinsurance or co-payments for Medicare patients in the catastrophic phase of the prescription drug benefit,
  
• Part D premium stabilization through 2029, and
  
• expanded financial help with prescription drug cost-sharing and premiums for Part D patients.
  

Academy members also will, as of this month, see additional Medicare payment for at-home administration of all Part B–covered vaccines for patients with certain conditions and/or limitations.

Latest AAFP Administrative Simplification Wins

The start of the year has also kicked off new regulations governing Medicare Advantage prior authorization, including new guardrails ensuring that

• prior authorizations stay valid as long as medically necessary,
• plans provide a minimum 90-day transition period when a beneficiary switches to a new plan,  
• plans defer to traditional Medicare coverage for medical necessity determinations or use criteria that are based on current publicly available evidence,; and
• each plan establishes a utilization management committee charged with annual policy reviews that include prior authorization.

Again, there’s more.

Just days ago, HHS' Office of the National Coordinator for Health Information issued a final rule on EHRs that positively reflects the Academy’s guidance following the rule’s proposal.

A big win we see here includes the final rule’s establishment of first-of-its-kind transparency requirements for certain artificial intelligence components and predictive algorithms built into certified health IT. The AAFP strongly supported these new requirements, which will help physicians and other clinical users assess algorithms for fairness, appropriateness, validity, effectiveness and safety.

Likewise, the rule includes a new “Third Party Seeking Modification Use” exception for the Information Blocking Rule the Academy has long cautioned was problematic. This change, as we called for, will increase the amount of data available to be used and exchanged for patient care — promoting equity, reducing disparities and supporting public health data interoperability. 

That rule goes into effect Mar. 11.

Latest Congressional Advocacy

As I told you last month, Congress set itself a Jan. 19 deadline to finalize the federal budget. As I write this, it’s possible that lawmakers will pass another continuing resolution to keep the government running as negotiations proceed. Regardless of the when, we told House and Senate leaders this month, the AAFP’s what remains the same: Family physicians’ payment and workforce priorities must be addressed.

Our Jan. 5 letter repeated the Academy’s call for

• financial relief from the Medicare physician fee schedule’s 3.4% clinician payment cut (without interfering with the G2211 implementation that’s already underway);
  
• extension of the physician work Geographic Cost Practice Index floor of 1.0 and the advanced alternative payment model incentive payment;
  
• policy mandating Medicare payment parity of Part B drug administration across care settings;
  
• reauthorization and increased funding for the Teaching Health Centers Graduate Medical Education program, Community Health Centers and the National Health Service Corps;
  
• extension of the Conrad 30 Waiver program (which allows international medical graduates to remain in the United States to care for patients in underserved communities); and
  
• enactment of a minor technical fix to ensure that trained family physicians can continue to include substance use disorder treatment in the care they deliver to their patients.
  

Punching out the AAFP’s list of time-sensitive legislative priorities, the letter said, would ensure that patients have access to high-quality, affordable primary care.

Three Presidents to D.C.

The AAFP’s top physician leaders will be in Washington Jan. 23 and 24 to meet with members of Congress and CMS leadership to advocate in person on behalf of Academy members. Board Chair Tochi Iroku-Malize, M.D., M.P.H., M.B.A., FAAFP; President Steven Furr, M.D., FAAFP; and President-elect Jennifer Brull, M.D., FAAFP; will push for reauthorization of the THCGME program, Medicare physician payment reform (again, without altering G2211 now that it’s in effect) and policy ensuring that family physicians can continue to provide necessary substance use disorder care. Watch AAFP News for updates after the visit.

One More Thing

Registration has opened for our 2024 Family Medicine Advocacy Summit, May 19-21 in Washington, D.C. This is our biggest in-person advocacy event of the year, where AAFP members join colleagues in their chapters for face-to-face conversations with members of Congress about the Academy’s top legislative priorities. I’m excited to see you there.