June 1, 2017: National Advocacy Update

The Senate has begun deliberations on drafting health-system reform legislation that will comport with the procedural rules associated with budget reconciliation legislation. On May 24, the Congressional Budget Office (CBO) released a revised score for the American Health Care Act (AHCA) (H.R. 1628). The CBO stated that the House-passed version of the bill would reduce the federal deficit by $119 billion over 10 years and increase the number of uninsured people relative to current law by 23 million in 2026.

Under the budget rules, the Senate health care reform legislation will be required to save at least as much as the House measure. Now that the CBO has rescored the House-passed bill, the Senate parliamentarian will begin the process of examining H.R. 1628 to determine which provisions of the bill meet the requirements of the Senate budget-reconciliation rules. The rules generally require that provisions in the bill must have a direct effect on the federal budget. It is possible that some provisions of the House-passed version of the AHCA will be stripped away during this process before the bill is considered on the Senate floor.

Separately, on May 23, the AMA sent Senate Finance Committee Chairman Orrin Hatch a letter (PDF) in response to his May 12 request for recommendations on health system reform. The letter restates the AMA's objectives for health reform legislation, such as ensuring that any proposals to replace portions of current law do not result in individuals who currently have coverage becoming uninsured. The letter makes specific suggestions to improve the health care system in the areas of tax-credit structure and health insurance affordability, stabilizing the individual market, and Medicaid.

It is not yet known when the Senate will consider its version of health care reform legislation. The AMA will continue to work with the Senate to advance proposals consistent with AMA policy and AMA health care reform objectives.

Read more at AMA Wire.

On May 18, the Senate Finance Committee voted unanimously to advance the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 (S. 870), sponsored by Chairman Hatch, R-Utah, Ranking Member Ron Wyden, D-Ore., and Sens. Isakson, R-Ga., and Warner, D-Va.

This AMA-supported legislation (PDF) would provide a clear pathway in the Medicare program toward new delivery models that are patient-centered and would improve health outcomes and value for patients with chronic conditions. S. 870 would remove barriers to care coordination, enhance the ability of beneficiaries to be a part of an accountable care organization (ACO), and extend and expand the Independence at Home Demonstration program. Further, this bill would expand Medicare telehealth coverage for patients who are suffering from acute stroke or who need dialysis, as well as Medicare Advantage plans and certain ACOs. It is unclear when this legislation will be considered in the full Senate.

On May 3, Sens. Schatz, D-Hawaii, Wicker R-Miss., Cochran, R-Miss., Warner, D-Va., Thune, R-S.D., and Cardin, D-Md., introduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017 (S. 1016). On May 19, Reps. Black, R-Tenn., and Welch, D-Vt., introduced a House companion bill, H.R. 2556. The AMA strongly supports (PDF) this legislation and worked closely with the sponsors in drafting it.

The legislation would remove antiquated restrictions in the Medicare program that prevent the delivery of clinically validated telehealth services and procedures. Increased access to telehealth and remote patient monitoring services is urgently needed to effectively address the looming demographic health demands that will be placed on the Medicare program and physicians in the near future.

The CONNECT for Health Care Act would establish a meaningful pathway to expand Medicare coverage of telemedicine and remote patient monitoring services while addressing concerns regarding the potential for increased expenditures. This legislation would expand Medicare telehealth coverage for Medicare Advantage (MA) plans, certain ACOs and patients who are suffering from acute stroke or need dialysis. Similar provisions were included in S. 810, the CHRONIC Care Act. Further, essential to promoting patient interests, the bill contains provisions that would ensure adherence to important state-based laws relevant to enforcing the oversight of medical practice laws, as well as safeguard the network adequacy of MA plans. It is unclear when this legislation might be considered in the Senate or House.

In direct response to AMA advocacy efforts and continued engagement with agency officials on the implementation of the Social Security Number Removal Initiative (SSNRI), CMS announced May 30 that it will develop and implement a look-up tool for providers and patients to obtain a beneficiary's new Medicare Beneficiary Identifier (MBI). This change will address concerns expressed (PDF) by multiple state and specialty associations about patient and physician awareness of initiative's transition to new Medicare identification cards. Physicians will need a Medicare Administrative Contractor (MAC) Portal account to access the look-up tool.

In addition to the new look-up tool, which will be available in October 2018, CMS plans to begin its patient and provider education efforts earlier than originally planned. Physicians should expect a significant outreach effort over the second half of 2017 to prepare for the start of the transition period in April 2018. CMS also plans to develop fact sheets and resources for physicians to educate patients, which it will make available on its SSNRI homepage.

• June 1, 2017: Advocacy spotlight on Physician-owned practices dip below 50 percent 
• June 1, 2017: State Advocacy Update 
• June 1, 2017: Judicial Advocacy Update