The AHA July 15 commented to Sens. Sheldon Whitehouse, D-R.I., and Bill Cassidy, R-La., responding to a request for information based on the Pay PCPs Act, legislation designed to improve support and pay for primary care providers. The AHA expressed concerns that its proposed hybrid per-member-per-month and fee-for-service payment structure in the physician fee schedule for primary care could result in payment cuts, and that there may be variation in the PMPM depending on the type of provider. The bill also has language implying that there is latitude for the PMPM to not be risk-adjusted and possibly restrict what could be included in the risk adjustment, AHA said. 

The AHA voiced support for a provision in the legislation that would reduce beneficiary cost-sharing for primary care services by 50% under the hybrid payment model. The association also shared principles for Congress to consider when designing alternative payment models to make participation more attractive for potential participants.
 

Headline
The Centers for Medicare & Medicaid Services Nov. 5 published a final rule to codify the Medicare Drug Price Negotiation Program beginning in 2029. The…
Headline
The estimated average monthly premium for Medicare Part D stand-alone prescription drug plans is $51 for 2027, a 50% increase from $34 in 2026, for enrollees…
Headline
The Centers for Medicare & Medicaid Services Nov. 4 released its calendar year 2027 final rule for the physician fee schedule. As required by law, CMS will…
Headline
A coalition of healthcare organizations, including the AHA, sent a letter Oct. 27 to the Center for Medicare and Medicaid Innovation recommending changes to…
Headline
The Centers for Medicare & Medicaid Services announced that the submission period opened Oct. 16 for petitions to deny the recertification of five…
Headline
The Centers for Medicare & Medicaid Services announced that it will exercise enforcement discretion for inpatient rehabilitation facility admissions from…