AAFP Government Affairs Update

Robert HallState Legislative Conference

Phoenix, AZOctober 28, 2016

Who We AreDirector of Government Relations

Bob Hall

Federal LobbyistsTeresa BakerAndrew AdairSonya Clay

RegulatoryRobert Bennett

Center for State PolicyShannon MoreyMilack TaliaShelby King

FamMedPac & Grassroots

Mark CribbenEric Storey

And thanks, Lorlita, Rhonda and Tia!

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What We

Deal With

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Two Americas?

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.

Lame Duck Issues and Priorities

• Chronic Care Legislation• THC Resolution• Direct Primary Care• Mental Health Reform• Regulatory Advocacy

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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.

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

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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)

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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

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)

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

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

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

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.

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AAFP 2017 Priorities• MACRA implementation, tweaks

and defense• THC reauthorization and funding• CHIP extension and funding• Medicaid expansion• Community Health Center

funding

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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

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

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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

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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

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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

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StateScape

• 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

• 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

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

Save the Dates

• Family Medicine Congressional Conference – Washington, DC– May 22-23, 2017

• State Legislative Conference – Dallas, TX– November 2-4, 2017

Questions?

Bob Hall: Rhall@aafp.org571/438-3137 (cell)