Government Affairs Update - Bob Hall
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Government Affairs Update - Bob Hall
- 1. AAFP Government Affairs Update Robert Hall State Legislative Conference Phoenix, AZ October 28, 2016
- 2. Who We Are Director of Government Relations Bob Hall Federal Lobbyists Teresa Baker Andrew Adair Sonya Clay Regulatory Robert Bennett Center for State Policy Shannon Morey Milack Talia Shelby King FamMedPac & Grassroots Mark Cribben Eric Storey And thanks, Lorlita, Rhonda and Tia!
- 4. Two Americas? 4 CRFB estimates that current policies would lead to $42.9 trillion in debt held by the public in 2036, compared to $42.4 trillion under Clinton and $58.8 trillion under Trump.
- 5. Lame Duck Issues and Priorities • Chronic Care Legislation • THC Resolution • Direct Primary Care • Mental Health Reform • Regulatory Advocacy
- 6. Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2016 • Legislation – Expands Independence at Home Demo - AAFP supports permanency. – Opens payment for telemedicine in select instances. AAFP supports payment for telemedicine but is skeptical of doing it piecemeal. – Allows more Medicare beneficiaries to sign up for ACOs (prospective attribution) rather than be passively assigned (retrospective attribution). AAFP supports prospective attribution. – Expands testing of value-based insurance design in Medicare Advantage (this theoretically would drive more patients toward high-value lower-cost services like PC). Unclear • HHS/CMS recommended action – Scale up of the Diabetes Prevention Program - AAFP supports. – Add a new code for complex chronic care management. AAFP supports. – Behavioral health integration. AAFP supports. – Create a one-time visit code for Alzheimer’s. Unclear. 6
- 7. Other Telehealth Items • CONNECT for Health Act (S. 2484) – Gives CMS authority to temporarily remove certain payment barriers within Medicare Part B (e.g. requirement that patient must be in a clinic in a health shortage area to receive services) • NDAA TRICARE – Threatens to pre-empt state law providing that the care occurs where the patient is located – AAFP has opposed this change
- 8. Teaching Health Centers • $230 million, 5-year initiative created by the Affordable Care Act of 2010 • Trains primary care residents and dentists in community-based settings • MACRA provided $60 million FY 2016 funds and an additional $60 million FY 2017 funds to support residency training in Teaching Health Centers • Teaching Health Center GME funding pays for direct and indirect medical education expenses for training residents in new or expanding community-based primary care residency programs • Clinical training sites include federally qualified health centers (FQHCs) and FQHC Look-Alikes, community mental health centers, rural health clinics, Indian Health Service or Tribal clinics, and Title X clinics (family planning clinics) 8
- 9. Teaching Health Centers • Astonishing results • Using Resolution of support (H.Res. 899) to educate the Hill about Teaching Health Centers in members’ districts • Also approaching appropriations strategy 9
- 10. Direct Primary Care • Two problems – Patients with Health Savings Accounts (HSAs) lack access to DPC. – Traditional Medicare beneficiaries lack access to DPC. • Primary Care Enhancement Act (H.R. 6015) – Reps. Paulsen, Blumenauer – Allows patients with HSAs to become DPC patients – Those with HSAs may use their HSA dollars to pay for the DPC monthly fees. – House companion to S. 1989 (Cassidy, Cantwell)
- 11. Mental Health Reform • Key message: Primary care physicians play an important role in providing mental health care for patients • AAFP’s Priorities – Support primary care and mental health integration – Allow same-day billing for physical and mental health services – Strengthen mental health parity – Provide adequate funding to improve access for all – Do not cut primary care work force funding • Status: Lame Duck Priority
- 12. Mental Health Reform • Helping Families in Mental Health Crisis Act (H.R. 2646): Reps. Tim Murphy (R-PA) and Eddie Bernice Johnson (D-TX) • Mental Health Reform Act (S. 2680) – Sens. Bill Cassidy (R-LA) and Chris Murphy (D-CT) • Major reforms – Reform of HHS programs targeting the seriously mental ill – National public education campaign to combat stigma – Same day-same location billing for physical and mental health services – Mental health and primary care integration prioritized in state block grant program – Technical assistance grants for primary care and mental health integration – Pediatric telehealth services grants – Mental health insurance parity reports to Congress – New regulations to clarify HIPAA requirements
- 13. Regulatory Advocacy • MACRA – Final rule released October 14, 2016 • VA APRN – VA reviewed, sent to OMB September 28, 2016 • MPFS – CMS reviewed, sent to OMB October 18, 2016 • Confidentiality of Substance Use Disorder Patient Records – CMS Reviewed, sent to OMB October 27, 2016
- 14. MPFS 2017 – today? • Proposed changes in draft rule projected to result in ~$900 million in additional funding to primary care physicians. • AAFP Comment to Draft Rule – Support proposal to pay separately for complex chronic care management services. – Express concern about Appropriate Use Criteria (AUC) requirements - urged delay – Support revisions to telemedicine policies that break down barriers use of telemedicine services – Support CMS for identifying and reviewing potentially misvalued codes – Support CMS in its efforts to adjust work relative value units. – Fully supported the expansion of the Medicare Diabetes Prevention Program.
- 15. AAFP 2017 Priorities • MACRA implementation, tweaks and defense • THC reauthorization and funding • CHIP extension and funding • Medicaid expansion • Community Health Center funding 15
- 16. 2017 - Wither Obamacare? • Between 2014 and 2015, the uninsured rate decreased in 47 states and the District of Columbia • Three states — North Dakota, South Dakota and Wyoming — did not experience a statistically significant change • Medicaid expansion and CHIP 16
- 17. Appropriations Priorities • AHRQ - Choosing Wisely and supports Primary Care Research Networks provides for research on practice transformation in health care system reform, and patient safety • HRSA Title VII, Section 747 Primary Care Training and Enhancement • HRSA Family Planning Title X • Zika Prevention and Research • National All Schedules Prescription Electronic Reporting (NASPER) grants to support state Prescription Drug Monitoring Programs • CMS program administration and innovation funding • CDC Tobacco Prevention
- 18. Center for State Policy Issue Areas • Shannon Morey, JD – Manager – Medicaid – Children’s Health Insurance Program – Health Insurance Marketplaces – Prescription Drug Pricing – Biologics – Public Health Issues – Scope of Practice • Milack Talia, JD – Senior Policy Analyst – Antitrust – Consolidation – Direct Primary Care – Network Design and Adequacy – Professional Liability Insurance • Shelby King, MPA – Legislative and Policy Strategist – Graduate Medical Education – Prescription Drug Abuse – Student Loan and Education Financing 18
- 19. Center for State Policy Scope of Work • AAFP Congress of Delegates Initiatives • Chapter Advocacy Casework – State Legislative Conference – Chapter Advocacy Days • Model Legislation Library • Policy Analysis • State Legislative Tracking 19
- 20. Resources Available to Chapters • New Issue Backgrounders: – Health Insurance Marketplaces – Medicaid Expansion – Scope of Practice – Nurse Practitioners – Telemedicine – Trends in Tobacco Legislation – Vaccine Exemptions • Model Legislation Library • SpeakOuts • State Legislative Tracking Report – coming December 2016 20
- 21. StateScape 21 • StateScape is the new AAFP legislative tracking service • This resource will be integrated into our website in the coming weeks • If your chapter is interested in receiving email reports on introduced legislation please contact Shelby King
- 22. • As issue experts and constituents, your elected officials want to hear directly from you. • Reaching them has never been easier. • Lobby Days and Hill Visits • Emails and letters • Phone calls • Social Media Please Act - Grassroots Impact
- 23. Unite ● Organize ● Engage Join the Family Physician Action Network Visit www.aafp.com/grassroots to join Access Network-only content Coordinate with other family physicians Lead Social Media campaigns Engage in Congressional office visits Gain recognition at AAFP conferences and lobby days Work With Other Family Physicians to Cut Through The Noise
- 24. Save the Dates • Family Medicine Congressional Conference – Washington, DC – May 22-23, 2017 • State Legislative Conference – Dallas, TX – November 2-4, 2017
Notes de l'éditeur
- In July the Center for State Policy was announced. Since then, Milack Talia has joined the division and following you will see a list of each of their issue portfolios. The Center will enable the AAFP to better serve our members chapters through expanded policy analysis and content development. The Center will continue to be the primary source of information for chapters seeking analysis of health policy issues and advocacy related resources. In addition, the Center will engage in proactive policy analysis and resource development on key issues impacting family medicine and the health care system.
- The Center for State Policy is tasked with :
- The Center for State Policy has been working to develop resources that will help our chapters while advocating on family medicine Currently there are six backgrounders online and many more in the works, if you have any suggestions for backgrounders you would like to see, please share this with our staff The Model Legislation Library is up and has model legislation for direct primary care, Medicaid/Medicare parity, telemedicine, etc. If you have a piece of legislation that would be a good model for states, please send this to Shannon Chapters can also use the AAFP Speak Out subscription to create letter templates on specific advocacy issues that allows constitutent members to submit letters to their state officials. This is a really simple process, all you have to do is complete the online form on the chapter webpage and it will send this to Shelby The State Legislative Tracking Report is a resource that can be used to research and connect with other chapters who had similar legislative issues. The Center hopes that this resource will allow colleagues to connect on best practices, sharing of resources, discuss challenges, and work to establish a win for family medicine. The 2015 report is up on the chapter webpage and the 2016 report will be out in early December
- StateScape is a new legislative monitoring service that allows the Center to receive updates on state legislation. If your chapter is interested in receiving email reports on introduced legislation in your states please contact Shelby. This resource will also be integrated into our website in the coming weeks allowing members to view what legislation is trending across the country. FYI- This is an example, there are more than 6 bills on prescription drug abuse out there.
- “The number one thing I get asked about Grassroots is, ‘Does it really matter?’ Well, according to a recent CMF study, some of the best ways to move the needle on an issue is to hear directly from you, the constituents. In fact, you can notice that the top 5 or 6 ways to impact policy are constituent driven rather than direct lobbying. The only problem is getting lost in the noise, and the best way of ensuring you are hear is by coordinating together and moving with one solid push. ”
- “That is why we are launching the Family Physician Action Network. Here you can get insider updates on what is happening in Washington, work with other family physicians to reach your elected officials, and engage when and where you like. In this grassroots community we will provide you with the tools and training to make a meaningful impact in health policy.”