Welcome to the Accountable for Health (A4H) newsletter, including legislative and Administration updates, accountable care news, and resources.

A4H Activity

A roundup of our recent activity in Washington, DC:

  • Met with Senate Finance Committee staff as they negotiated the parameters of a health care package to accompany a government funding bill. A4H encouraged the committee to prioritize policies that would increase advanced Alternative Payment Model (APM) bonuses and mitigate the impact of cuts in the 2024 Physician Fee Schedule.
  • Engaged with Sen. Marsha Blackburn (R-TN) to help inform priorities of the Senate Medicare payment reform working group.
  • Met with Senate Budget Committee Ranking Member Chuck Grassley (R-IA) in advance of the committee’s hearing focused on expanding primary care.
  • Met with Sen. Maria Cantwell (D-WA) and Rep. Kim Schrier, M.D. (D-WA) to discuss the importance of accelerating the adoption of accountable care.
  • Specialty Care Committee met to discuss maternity care alternative payment models, with a focus on Medicaid transformation efforts and the Innovation Center’s new Transforming Maternal Health model.

Save the Date for our next Double Click on Accountable Care – May 14th, in Washington, DC. Register here, agenda to follow.

Congressional News

Next week both the House and Senate will be in session.

Legislation to fund the government and extend APM bonus advances. Following months of negotiations, the House and Senate reached an agreement on six government funding bills to avoid a partial government shutdown on March 8. The package includes funding through the end of the year for community health centers, delays Medicaid Disproportionate Share Hospital cuts through the end of the year, and reduces a 2024 physician payment cut by 1.68 percent while also extending the advanced APM incentives for one year at 1.88 percent. We are pleased to see the APM bonus included, particularly given the challenging political and legislative environment. Inclusion of the extension demonstrates an ongoing, strong bi-partisan commitment to advancing accountable care. The House passed the legislation this week and we expect Senate action on this legislation in short order. A4H looks forward to working with Congress on longer term payment reforms.

Senate Budget Committee Holds Hearing on Primary Care. During the hearing, Committee Chair Whitehouse (D-RI) announced the publication of a discussion draft intended to accelerate CMS’s efforts to support high-quality primary care and improve primary care payment. This legislation would encourage CMS to develop hybrid payments for primary care providers in Medicare. Hybrid payment approaches have been successfully deployed to save money and improve care in CMS Innovation Center models and stakeholders have called on the CMS Innovation Center to continue to build on these efforts in future models. The legislation seeks to build on these successes. A4H provided preliminary feedback from its members on the discussion draft and is in close contact with the Chairman’s staff to inform further development of these concepts.

Administration

Biden highlights health care cost and access priorities in State of the Union address. Health care was a major theme in President Biden’s address last night. The speech touted previous accomplishments and called on Congress to take additional actions to lower costs and expand access. The President highlighted Medicare’s prescription drug negotiation authority under the Inflation Reduction Act and asked Congress to expand the number of drugs eligible for negotiation and consider a $2000 out-of-pocket cap on drug benefits with private insurers.

The President also discussed record enrollment under the ACA and encouraged lawmakers to consider policies to expand options in Medicaid non-expansion states. Reproductive rights were also a major component of President Biden’s speech as he hopes to appeal to a broader base of voters in advance of the election. We expect to continue to see these themes emerge as we get closer to the election, with little in the way of legislative activity until the lame duck session after the election occurs.

CMMI Holds Webinar on the Transforming Maternal Health (TMaH) Model. The webinar provided more information on the 10-year Transforming Maternal Health (TMaH) Model’s structure, care delivery, and resources. The webinar outlined how TMaH will help state Medicaid agencies and managed care plans shift toward value-based maternal care methodologies via technical assistance, Cooperative Agreement funding, and patient experience reporting. Applications will be due in the summer of 2024, and SMAs will be selected to participate in the fall.

CMS Releases Manufacturer RFA for the Cell and Gene Therapy (CGT) Access Model. The CGT Access Model, which was announced to help rare and severe disease patients in the Medicaid population, will first focus on gene therapies for sickle cell disease. The Request for Applications (RFA) is available on the model webpage and is open to manufacturers who have a gene therapy approved or licensed by the Food and Drug Administration (FDA) for sickle cell disease.

Accountable Care Reports

Families USA Holds Webinar on Payment and Delivery Reform Agenda Items. The webinar discussed a health system transformation policy agenda developed by the American Heart Association (AHA), Families USA, National Consumers League (NCL), National Partnership for Women & Families (NPWF), and Third Way. The agenda prioritizes improving health outcomes by changing incentives to improve health, reduce inequities and prioritize high value-care delivery rather than volume. A4H continues to engage with many of these organizations through our Voices of Accountable Care convening to align priorities around improving health care delivery and addressing affordability.

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