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- AMA supports bipartisan House telehealth bill as congressional deadline looms
- On opioid labeling, FDA emphasizes patient-physician relationship
- AMA urges CMMI to fix WISeR model before 2026 launch
- Senate health appropriations bill protects NIH funding, improves MIPS feedback
- White House event introduces new CMS Interoperability Framework
- New ASTP/ONC final rule updates criteria for ePA and Real-Time Prescription Benefit Checks
- More articles in this issue
AMA supports bipartisan House telehealth bill as congressional deadline looms
With the Sept. 30 deadline for Congress to legislatively extend the current Medicare telehealth flexibilities quickly approaching, the AMA sent a July 30 letter (PDF) in support of H.R. 4206, the “Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2025.”
Introduced by Representatives Mike Thompson (D-CA), David Schweikert (R-AZ), Doris Matsui (D-CA), and Troy Balderson (R-OH), this legislation would permanently extend many of the key telehealth waivers initially granted during the COVID-19 public health emergency (PHE). While Congress previously passed a series of bills to extend the existing flexibilities following the conclusion of the COVID-19 public health emergency (PHE), enactment of federal legislation is the only way to permanently repeal these antiquated statutory restrictions as the Centers for Medicare & Medicaid Services (CMS) already indicated a lack of statutory authority to make this type of long-term policy change administratively.
While there is strong support to extend these flexibilities, telehealth is one of many health care issues that must be addressed prior to the start of the 2026 Fiscal Year. Congress is expected to struggle mightily on reaching consensus on a funding deal that will keep the federal government open starting on Oct. 1.
In order to receive telehealth services prior to the COVID-19 PHE, Medicare beneficiaries were statutorily required to live in a rural statistical area. Even if they satisfied the geographic restrictions, the law required Medicare patients to travel outside of the home to an acceptable “originating” medical site, such as a physician’s office or hospital, to receive virtual care. These antiquated statutory restrictions are a relic of when satellites were the only way Medicare beneficiaries could receive remote care via two-way audio-video technology. As a result, the CONNECT for Health Act would permanently remove the geographic site provision, thus ensuring that urban, suburban and rural Medicare patients can receive telehealth services. The legislation also repeals the originating site restrictions in order to allow patients to receive virtual care both within the home and anywhere they can access an acceptable telecommunications system. Finally, the legislation also permanently repeals a yet-to-be-implemented section of the Consolidated Appropriations Act, 2021, requiring Medicare patients to see a physician in-person within six months of an initial telemental health visit. While this section of the bill has been temporarily delayed by Congress as part of larger bills extending telehealth flexibilities, this provision would be permanently repealed within H.R. 4206.
The AMA was the only national medical association featured in the bipartisan press release announcing the introduction of the House legislation. “Permanently extending telehealth coverage will benefit patients and physicians far and wide, ushering in a new era of patient care,” said AMA President Bobby Mukkamala, MD. “Medicare coverage of telehealth offers better access to health care not just for rural and underserved communities; it also reduces travel time and serves as a vital tool for patients to receive seamless care with their existing physicians. We deeply appreciate Representatives Thompson, Schweikert, Balderson, and Matsui for their leadership.”
AMA sent a similar letter (PDF) to Senators Brian Schatz (D-HI) and Roger Wicker (R-MS) in support of the identical Senate companion legislation, S. 1261, on April 16. While 8 total bipartisan members of the House are already supporters of H.R. 4206, the Senate legislation has successfully amassed a filibuster proof collection of 63 bipartisan cosponsors. AMA looks forward to working with bipartisan, bicameral Congressional leaders to both ensure the existing flexibilities do not lapse as part of a potential government shutdown and push for permanent repeal of antiquated telehealth restrictions.
On opioid labeling, FDA emphasizes patient-physician relationship
The U.S. Food and Drug Administration (FDA) last week issued a new drug safety communication (PDF) on opioid labeling that emphasized the importance of physicians making individualized, informed decisions about opioid prescribing while supporting informed decision-making for patients. The guidance reflected comments provided by the AMA (PDF) emphasizing “the importance of ensuring patients have access to all FDA-approved options for pain.”
In a statement, AMA President Bobby Mukkamala, MD, noted that, “The new FDA label continues the approach laid out by CDC in its 2022 opioid prescribing guideline emphasizing the importance of individualized, shared decision-making between the patient and physician.”
The new FDA guidance also stresses that decisions whether to begin opioid therapy must be made on whether the benefits outweigh the known risks.
“We agree that—if opioid therapy is indicated—physicians should start low and go slow,” said Dr. Mukkamala.
The new labeling requirements also warn against rapid escalations and rapid discontinuation because of the need to avoid patient harm.
AMA urges CMMI to fix WISeR model before 2026 launch
The Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare & Medicaid Innovation (CMMI) developed the Wasteful and Inappropriate Service Reduction (WISeR) model to use artificial intelligence (AI) and prior authorization (PA) to curb waste, fraud and abuse. The AMA supports responsible innovation that improves value for Medicare beneficiaries, but as drafted, WISeR could delay care and add burden for physicians. With a start date targeted for Jan. 1, 2026, the AMA is pressing for changes now to ensure the model advances care without creating new barriers for patients or physicians.
On July 16, the AMA submitted detailed recommendations (PDF) to CMS and on Aug. 4, AMA CEO and Executive Vice President John Whyte, MD, MPH, and Advocacy staff met with senior CMMI leaders to outline practical fixes. The AMA’s priorities:
- Safeguard timely patient access with clear rationales, rapid appeals, and model alignment with physician-developed clinical guidelines
- Redesign payment structures to avoid perverse incentives that reward denials over appropriate approvals
- Require transparency and continuous monitoring for AI error and bias
- Standardize electronic PA and integrate it with EHR workflows to minimize burden
- Right-size the implementation timeline to ensure operational readiness
CMMI signaled openness to adjustments that protect patients and reduce physician burden.
The AMA will remain deeply engaged with CMMI to ensure WISeR meets its stated goals and that physicians are well-informed about the details of the model prior to its implementation. The AMA will also continue pushing for measurable improvements in turnaround times, denial rates, and physician workload, and for public reporting that allows course-correction throughout the model. Physicians can expect ongoing updates and advocacy as we work to make technology serve—not hinder—patient care.
Senate health appropriations bill protects NIH funding, improves MIPS feedback
Last week, the Senate Appropriations Committee passed the Fiscal Year 2026 Labor, Health and Human Services Appropriations bill by a vote of 26-3. The bill provides $197 billion in discretionary funding. Included in the bill was $48.7 billion in funding for biomedical investments through the National Institutes of Health (NIH). The AMA wrote (PDF) to Congress on July 16, 2025, to protect NIH funding against proposed cuts. The bill maintains NIH funding, as the AMA has been advocating for.
The legislation also included the following language to provide timely feedback in the Merit-Based Incentive Payment System:
Merit-Based Incentive Payment System [MIPS] Feedback Reports
The Committee urges CMS to improve timely access to MIPS feedback reports and claims data for providers, consistent with existing law. In doing so, the Committee requests an update in the fiscal year 2027 [congressional journal] on actions CMS has taken to utilize measures developed by national medical specialty societies, including qualified clinical data registries maintained by national medical specialty societies, for MIPS, MIPs Value Pathways, and alternative payment model reporting.
This language was drafted by the AMA, and the AMA worked with Senator Boozman (R-AR) to have it included in the bill. The report language urges CMS to improve timely access to MIPS feedback reports and claims data for providers, as consistent with existing law.
The Senate plans to pass the final bill in September, following the August recess, and the AMA will continue to work to ensure the language is included in a final package.
White House event introduces new CMS Interoperability Framework
On July 30, President Donald J. Trump, Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr., and CMS Administrator Mehmet Oz, MD, MBA, held an event to promote trusted, patient-centered and practical health data exchange. The effort focuses on gathering voluntary commitments to pledges from health information networks and exchanges, health systems, electronic health record (EHR) vendors, and technology platforms to implement a new CMS Interoperability Framework and become a CMS Aligned Network.
The administration’s efforts seek to enable a connected ecosystem where:
- Patients can easily access and share their health information
- Providers and care teams receive the data they need at the point of care
- Apps and digital tools deliver personalized support, anytime, anywhere
- Payers support outcomes and value-based models through appropriate data exchange
CMS created several distinct categories of stakeholders, including Health Systems and Providers. CMS developed a pledge for the stakeholders in each category. The pledge for the Health Systems and Providers category calls for stakeholders to participate in a CMS Aligned Network and work collaboratively to enable the CMS Interoperability Framework goals together where a future consists of seamless care coordination and data-sharing for the patients’ needs and patients’ health data is accessible wherever and whenever itis needed for the benefit of the patient. Examples of the early adopters in this category include Amazon, Cleveland Clinic, Intermountain Health and Providence.
New ASTP/ONC final rule updates criteria for ePA and Real-Time Prescription Benefit Checks
The Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) finalized the Health Data, Technology, and Interoperability: Electronic Prescribing, Real Time Prescription Benefit and Electronic Prior Authorization (HTI-4) Final Rule last week that adds several new certification criteria and related standards to the ONC Health IT Certification Program for electronic prior authorization (ePA), Real-Time Prescription Benefit Checks and e-prescribing. The AMA has been engaging with ASTP/ONC on these issues for quite some time.
ASTP/ONC adopted new certification criteria to support standardized, electronic capabilities and functionalities for ePA. These new rules represent a significant step forward in achieving real-time communication between physicians and payers to streamline systems toward better interoperability—and, most importantly, ensure timely patient care.
Under the new rules, physicians will be able to use their certified health IT systems to request information from payers about coverage requirements, navigate and assemble the information needed to support a PA request, submit that request directly from their systems, and monitor the status of that request. In a Sept. 2024 comment letter (PDF) on these proposed provisions, the AMA voiced strong support for updating these certification criteria and increasing the ability to meet the prior authorization application programming interface (API) requirements from the 2024 CMS Interoperability and Prior Authorization Final Rule.
The AMA also supported other proposed changes that were made final in this rule, including enabling prescriber access to prescription benefit information at the point of care. In addition, the e-prescribing certification criterion now incorporates an improved version of the National Council for Prescription Drug Programs (NCPDP) SCRIPT standard and supports functionality for ePA of prescriptions. The AMA advocated for increasing physician access to these high-value functionalities to address well-known transparency issues and administrative burdens related to drug prescribing and PA.
