April 5, 2024: National Advocacy Update

With the substantial impact of the Change Healthcare cyberattack on physician practices, the AMA’s advocacy work continues at all levels of government and across the payer community to find workable solutions that allow practices to maintain financial stability while providing timely patient care. The AMA has pushed for significant regulatory flexibilities, including advance payments for physician practices from all payers.

On March 25, the Department of Health and Human Services (HHS) provided resources (PDF) to help those that have been experiencing disrupted billing and claims operations because of the cyberattack. The HHS resources highlight how the Biden-Harris administration has made advance and accelerated payments available to providers and hospitals through Medicare, as well as how it is urging UnitedHealth Group and private health care plans health to do the same. In addition, the administration is providing flexibility for state Medicaid programs to offer interim payments to fee-for-service providers.

As part of the administration’s efforts, HHS compiled information, resources and tools (PDF) from health plans and payers for providers in need of assistance, including how to connect with payers regarding impacts of the cyberattack, links to resources payers have set up (including guides to connect to alternate data clearinghouse services), and information on advanced payments.

The AMA will continue its work to support physician practices and patients. Look to the AMA for additional information and visit the AMA’s Change Healthcare cyber outage webpage for updates and new materials.

The Department of Homeland Security’s (DHS) Cybersecurity and Infrastructure Security Agency (CISA) published a Proposed Regulation with sector-based criteria for entities that own or operate certain types of facilities or entities that perform certain functions to report information on cybersecurity incidents that impact them. Within the Health Care and Public Health Sector, reporting criteria are proposed for large hospitals, critical access hospitals, manufacturers of essential medicines, and manufacturers of Class II and III medical devices. Comments on this proposed regulation will be due in early June.

Seen as a major step to bolstering America’s cybersecurity, CISA was required to develop these criteria by the Cyber Incident Reporting for Critical Infrastructure Act of 2022 (CIRCIA). The primary purpose of CIRCIA is to help preserve national security, economic security, and public health and safety. The idea behind CIRCIA is that implementation of this law will improve CISA’s ability to use cybersecurity incident and ransomware payment information reported to the agency to identify patterns in real-time, fill critical information gaps, rapidly deploy resources to help entities that are suffering from cyberattacks and inform others who would be potentially affected. When information about cyber incidents is shared quickly, CIRCIA helps CISA use this information to render assistance and provide warning to prevent other organizations from falling victim to a similar incident.

The Dr. Lorna Breen Health Care Provider Reauthorization Act passed without any no votes out of the House Energy and Commerce Committee on March 20. The bill, which was introduced on Jan. 30, seamlessly sailed through the House Energy and Commerce Committee, passing with a vote of 48-0. The legislation would continue the already ongoing work established in the Dr. Lorna Breen Health Care Provider Act, which was signed into law on March 18, 2022. The law has already provided $100 million in funding for mental health care for physicians and other care providers across the country. The bill now moves to full consideration by the House of Representatives. The AMA supports this legislation and hopes to see it pass the House of Representative expeditiously.

Additionally, the Senate passed the “Health Workforce Well-Being Day of Awareness” resolution on March 20. Introduced by Senators Tim Kaine (D-VA) and Roger Marshall, MD (R-KS), the resolution, which was supported by the AMA, recognizes the seriousness of widespread health care worker burnout in the United States, and the need to strengthen health workforce well-being.

Learn more about the AMA’s campaign on wellness.

On March 28, the AMA released a statement on behalf of AMA President Jesse M. Ehrenfeld, MD, MPH, commending the administration for releasing final rules that are expected to advance consumer protections and expand access to affordable health care coverage. “Together, these actions will strengthen patient protections and close coverage gaps, helping millions of Americans gain or keep coverage and access care,” said Dr. Ehrenfeld.

One final rule, released March 28, would close loopholes and impose new transparency requirements to help customers better distinguish between comprehensive coverage and short-term limited duration insurance (SDLDI), which are not held to the same standards that govern other ACA Marketplace and employer-sponsored plans. The AMA previously indicated support (PDF) for the changes, which are expected to promote consumer transparency, expand consumer protections, save patients money and stabilize markets.

A second final rule (PDF) released March 27 implements changes aiming to remove administrative barriers and simplify the process to enroll in or renew Medicaid or Children’s Health Insurance Program (CHIP) coverage with the goal of preventing eligible individuals from experiencing coverage gaps. In particular, the rule aims to address coverage gaps that disproportionately impact historically minoritized and underserved populations, including children, the elderly and individuals living with disabilities. The rule comes on the heels of the latest Medicaid enrollment numbers from December 2023, which reflect a decrease of more than 8.7 million individuals, or more than 9% of all Medicaid/CHIP enrollees, since March 2023, the final month that the Medicaid continuous coverage condition was in effect. In comments (PDF) responding to the proposed rule, the AMA welcomed the now-finalized changes, which are expected to eliminate enrollment barriers and help individuals transition to new forms of coverage. In the statement, the AMA also praised the Centers for Medicare & Medicaid Services (CMS) for separately extending a special enrollment period for individuals to transition to Marketplace coverage from July 31 to Nov. 30, 2024.

More recently, on April 2, CMS finalized another rule making it easier for low-income individuals to enroll in Marketplace coverage, expanding consumer protections, and setting distance standards for in-network appointments and network adequacy standards for the time. The AMA supported these changes in comments to the agency in January.

On April 1, CMS finalized the Calendar Year (CY) 2025 Rate Announcement for the Medicare Advantage (MA) and Medicare Part D Prescription Drug (Part D) Programs. Overall, MA payments are expected to increase on average by 3.7%, or over $16 billion, from 2024 to 2025. In comments (PDF) to the agency, the AMA raised strong concerns over the growing discrepancy between the nearly 4% increase in MA rates for 2025 and the repeated cuts in Medicare physician payment rates. Among other changes, the rule also finalized a number of changes to the MA and Part D Star Ratings program.

The White House Office of Management and Budget (OMB) published a set of revisions to Statistical Policy Directive No. 15 (Directive No. 15): Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity (PDF). The updated standards released by OMB are the first since 1997 and closely follow an Interagency Technical Working Group’s evidence-based recommendations. The key revisions include changes to questions used to collect information on race and ethnicity, such as:

• Using one combined question for race and ethnicity, and encouraging respondents to select as many options as apply to how they identify
• Adding Middle Eastern or North African as a new minimum category
• Requiring the collection of additional detail beyond the minimum required race and ethnicity categories for most situations, to ensure further disaggregation in the collection, tabulation and presentation of data when useful and appropriate

The updated standards also include several additional updates to definitions, terminology and guidance to agencies on the collection and presentation of data.

One of the primary goals of Directive No. 15 is to ensure consistent and comparable race and ethnicity data across the federal government. To help meet that goal, the standards instruct federal agencies to begin updating their surveys and administrative forms as quickly as possible, submit an Agency Action Plan for complete compliance within 18 months, and finish bringing all data collections and programs into compliance with the updated standards within five years. However, many programs will be able to adopt the updated standards much sooner—the Office of the U.S. Chief Statistician will direct its efforts to help agencies collect and release data under these updated standards as quickly as possible.

On March 13, the AMA and over 40 other members of the Graduate Medical Education (GME) Advocacy Coalition sent a letter (PDF) of support for the Substance Use Disorder Workforce Act of 2024. This bipartisan legislation—introduced by Reps. Brad Schneider (D-IL), David Valadao (R-CA), Annie Kuster (D-NH), Mike Carey (R-OH) and Mike Kelly (R-PA)—would provide 1,000 additional Medicare-supported GME positions over five years in hospitals that have, or are in the process of establishing, accredited residency programs in addiction medicine, addiction psychiatry or pain medicine.

This bill will help address the nation’s drug overdose and death epidemic by training more physicians to meet the needs of patients across the country who require treatment for substance use disorder. The AMA supported this bill last Congress, and sent an individual letter (PDF) supporting this legislation this Congress on Feb. 1.

CMS has released a letter to teaching hospitals and medical schools regarding a guidance reiterating teaching hospital requirements for informed consent from patients as it relates to medical professionals performing sensitive examinations, particularly on patients under anesthesia. When CMS released the letter and guidance, officials said they had received reports that some teaching hospitals allowed medical students to perform sensitive examinations, including pelvic, breast, prostrate or rectal examinations while patients were under anesthesia. This is an educational effort for teaching hospitals and physicians of current informed consent requirements as well as making patients aware of their rights.

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