Advocacy Update

Aug. 25, 2023: National Advocacy Update


Recently, AMA President Jesse M. Ehrenfeld, MD, MPH, met with Shereef Elnahal, MD, the U.S. Under Secretary of Veterans Affairs for Health. The meeting focused on the AMA’s concerns surrounding the Department of Veterans Affairs’ (VA) Federal Supremacy Project. As a reminder, the VA launched the Federal Supremacy Project following publication of the “Authority of VA Professionals to Practice Health Care” Interim Final Rule in Nov. 2020.

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The VA has invoked the Supremacy Clause so that it can develop National Standards of Practice (NSP) for 51 health care occupations unfettered by state scope of practice and medical licensure laws, potentially enabling some health care occupations to practice independent of physician supervision. Due to AMA advocacy, the VA agreed to stagger publication of draft NSPs in the Federal Register with a 60-day comment period and 13 draft NSPs have already been published in the Federal Register.

As a result of Dr. Ehrenfeld’s meeting with Dr. Elnahal, the VA is hosting a series of five virtual listening sessions on NSPs. The purpose of these listening sessions, the first of which is scheduled for Thursday, Aug. 24, is to offer individuals an opportunity to share their research, input and comments on variance between state licenses and scopes of practices for health care occupations, and their recommendations on what should be included in the NSP (excludes occupations that have already had proposed NSPs published in the Federal Register). The five listening sessions will be held for the next five weeks on Thursdays from 2–4:30 p.m. Eastern, and focus on a preset list of occupations grouped by service type. Find out more details about the Listening Sessions. Immediately after the VA announced the listening sessions, the AMA notified the specialty societies.   

On Aug. 8, the AMA submitted a comment letter (PDF) to the Federal Trade Commission (FTC) on the Health Breach Notification (HBN) Rule. The FTC is proposing to revise the HBN Rule to help ensure that health-related data remains protected once it is outside the scope of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, shore up consumer confidence, and rein in unauthorized disclosures by entities entrusted with individuals’ health information. 

The AMA supported much of what FTC proposed, including the specific exclusion from the rule’s scope of entities that are subject to HIPAA—since there is the potential for burdensome, competing notice obligations under the HBN Rule and the HIPAA statutory regime. The letter also endorses broadening the existing definition of “personal health record identifiable health information” to diminish confusion in the health care community regarding what protections apply to this information when it is generated or inferred entirely outside of a health care setting. In addition, the AMA appreciated the work of FTC to authorize expanded use of electronic notices to inform individuals of breaches and unauthorized disclosures and how individuals should have options about how they choose to be informed of a breach.  

The AMA did raise the point in its letter that the new proposed definition of “health care provider” in the rule that explicitly excludes HIPAA covered entities from its scope will cause needless confusion. The letter recommended that the FTC delete the unhelpful, unnecessary, and potentially harmful definition of health care provider. 

CMS is seeking applicants by Aug. 30, 2023, for a new EPCS Program Prescriber User Group to provide input on educational materials and the usability of the prescriber portal for the CMS EPCS Program. Applicants for this voluntary group are expected to commit approximately 10 hours divided over a 12-month period. CMS EPCS program requirements apply to all controlled substance prescriptions filled under Part D plans (including Medicare Advantage). For the user group, they are seeking applicants who represent various specialties, practice locations (e.g., urban and rural) and prescribing patterns. Physicians as well as their representatives such as office administrators are encouraged to apply. Interested parties need to submit an application through this form or by contacting the EPCS Service Center by Aug. 30, 2023, at 8:00 p.m. Eastern.

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