Policy Levers for Primary Care: May 2024 Update

Federal policy initiatives remain an important lever in the movement to support high value primary care, which is why it’s important to stay current with ongoing legislation and Elation’s advocacy efforts. A number of acts currently under Congressional review will impact the way primary care delivers care, the way patients access care, and how patients and clinicians can jointly afford the highest quality care possible. 

Here are a few of the newest policy efforts to know:

HR 2829 - Chronic Care Management Improvement Act

We support HR 2829, which removes the patient cost-sharing burden from reimbursement for the care coordination activities related to management of chronic conditions. This act is a step toward dismantling financial barriers that prevent patients from receiving care aimed at preventing complications from chronic disease.

HR 7681 - Primary Care and Virtual Care Affordability Act

We support HR 7681, which extends pandemic telehealth coverage for another two years and makes primary care services a covered benefit pre-deductible in high deductible plans without an HSA and covered under the HSA for plans with one. This act is crucial to ensure access to primary care for those with financial barriers, and for flexible access to care, especially for individuals that are unable to access care locally due to transportation concerns or lack of local providers.

HR 3836 - Medicaid Primary Care Enhancement Act

We support HR 3636, which has passed the House and has now moved to the Senate. This act clarifies that states can work with CMS to provide Medicaid beneficiaries great access to primary care using direct primary care (DPC). This expanded access to DPC uses an advanced payment model (APM), instead of fee-for-service, which helps center personal relationships with a primary care doctor at a reasonable cost and helps diversify the options Americans have when seeking high-quality, patient-centric care.

S.628 - Primary Care Enhancement Act (HSAs) 

We support S.628, an IRS code which would allow a medical expense tax deduction for DPC service arrangements and provides that participation in DPC arrangements can be paid out of health savings accounts (HSAs). This code would help make direct primary care more flexible and affordable for Americans.

S.2556 - Improving CARE for Youth Act

We support S.2556. S.2556 eliminates reimbursement restrictions on primary care and behavioral health services delivered on the same day for children in Medicaid/CHIP. Medicaid and CHIP cover more than 80 million Americans, including a disproportionate percentage of rural individuals, low-income seniors, people with disabilities, and people of color. This will expand access to mental health services for youth by removing the barrier of billing restrictions and supporting better coordination of care.

The Pay PCPs Act 

We support the Pay PCPs Act, newly introduced legislation which aims to enhance primary care delivery for seniors by aligning financial incentives with comprehensive and continuous patient care, ultimately improving health outcomes for Medicare beneficiaries. This bill would task the Centers for Medicare & Medicaid Services (CMS) with reforming primary care payments by establishing a hybrid payment model to reward primary care providers who provide the best care to their patients and reward patients with better health outcomes.  The act introduces a combination of prospective, per-member-per-month payments and traditional fee-for-service payments. This change is intended to provide more predictable and flexible revenues for primary care practices, enabling them to offer comprehensive and continuous care, particularly to those with chronic conditions and complex needs.

Both individually and collectively, these acts will help address the barriers that prevent patients from accessing, benefitting from, and affording necessary care. We’re proud to stand alongside the Primary Care Collaborative (PCC) and many others to support legislation that advances primary care. To get involved in policy advocacy, visit PCC and the affiliated Better Health Now campaign, which offer information and tools to help you be a more active participant in the future of primary care.