May 27, 2022: National Advocacy Update

Read the following statement from Gerald E. Harmon, MD, AMA President, on the Texas school shooting: 

“The shooting {on Tuesday} at an elementary school is horrific and sadly—and unacceptably—all too familiar in the United States. A week after Buffalo, 10 years after Sandy Hook, 23 years after Columbine; the places and cities change, but the story is the same—too-easy access to firearms, inaction on wildly popular, common-sense safety measures like background checks, and countless lives lost or changed forever.

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“As physicians, our mission is to heal and to maintain health. But too often the wounds we see in America today resemble the wounds I’ve seen in war. Each year more than 45,000 Americans die from firearm violence, and recent data from the Centers for Disease Control and Prevention indicate that firearm deaths are increasing and disparities are widening, with young people, males, and Black people experiencing the highest firearm homicide rates. More and more it is clear no place is safe—malls, schools, movie theaters, places of worship, and grocery stores have all been targeted. Firearm injuries and deaths are preventable. And while the ideal time to act and find common-sense solutions and common ground might have been years ago, the best we can do now is act today. We call on lawmakers, leaders and advocates to say enough is enough. No more Americans should die of firearm violence. No more people should lose loved ones.” 

For more information on the AMA’s policy recommendations and resources related to firearm injury and death, view the full statement.  

The AMA released new physician survey data (PDF) showing that health plans continue to stall on honoring their commitment to reform prior authorization (PA) according to the provisions of the 2018 Consensus Statement on Improving the Prior Authorization Process (PDF). The survey was fielded nearly 4 years after the publication of the Consensus Statement by the AMA, other national provider associations and insurance industry trade organizations, yet physicians report limited progress on operationalizing the agreed-upon reforms.

For example, most physicians (84% and 84%, respectively) reported that the number of PAs required for prescription medications and medical services has increased over the last 5 years, despite concurrence between both providers and health plans on the need to reduce the overall volume of PA requirements.

While insurers agreed to minimize treatment disruptions related to PA, an overwhelming majority of physicians (88%) indicated that the process interferes with continuity of care. Although health plans tout their efforts to automate PA, physicians reported the phone as the most commonly used method for completing PAs. These data highlight the need for passage of legislation to hold health plans accountable for PA reforms.

To learn more, read the survey press release and visit FixPriorAuth.org to join the AMA’s PA advocacy efforts. 

In a letter sent to CMS (PDF) Administrator Chiquita Brooks-LaSure, the AMA urges CMS to take a holistic approach to reforming PA. The letter cites a recent U.S. Department of Health and Human Services Office of Inspector General (OIG) report (PDF) that details the misapplication and misuse of Medicare coverage rules by Medicare Advantage Organizations (MAO). The AMA met with senior CMS officials immediately after the release of the OIG report, and the letter reinforced issues raised during our discussion. The letter states that “while a set of technical tools and guides are on the horizon to assist in the exchange of information between physicians and payers,” these tools “do not address the decision-making used by MAOs.”  

Examples provided in the OIG report clearly show a pattern of MAO PA decision-making that resulted in delays, denials of care and patient harm. The AMA is actively engaged with technology developers to remove physician burden resulting from PA. Yet, technology can only go so far and is currently limited to the PA data exchange process between physicians and payers. The AMA stresses that, as part of CMS’ PA reform effort, CMS must evaluate both the PA decision-making and PA processes used by MAOs. The AMA is requesting that CMS coordinate on an agency-wide campaign to reform PA.

The AMA continues to fight excessive and unnecessary PA through a multifaceted approach focused on comprehensive research, a broad range of practice resources, and reform initiatives underway at both the state and federal levels. To correct many of the problems identified in the OIG report, the AMA is urging Congress to pass the “Improving Seniors’ Timely Access to Care Act” (HR 3173; S. 3018), which would require MAOs to streamline and standardize PA processes and improve PA decision-making.

In response to significant concerns raised (PDF) by the AMA, the U.S. Department of Health and Human Services (HHS) has withdrawn (PDF) the Securing Updated and Necessary Statutory Evaluations Timely (SUNSET) final rule. The SUNSET final rule would have diverted limited HHS resources to mandated reviews of economically significant regulations and subject every regulation to expiration 10 years after passage or its last review. HHS estimated that roughly 18,000 regulations would have been subject to the SUNSET rule requirements.

The AMA raised concerns that the SUNSET rule burden would undermine HHS’ focus on the COVID-19 pandemic and would create unnecessary regulatory uncertainty. The prospect of a rule slipping through this process and simply expiring would have serious implications for insurance markets, hospitals, physicians and patients, among other affected parties.

Finally, the AMA argued that the rule appears to violate the Administrative Procedure Act, which requires that in order for a rule to be duly promulgated, it must go through notice and comment rulemaking and therefore, if HHS had wanted to sunset each of the 18,000 regulations subject to this rule, then the department must issue a proposed rule and provide the public adequate notice and opportunity to comment. The AMA greatly appreciates HHS’ consideration of these concerns and withdrawal of this flawed rule. 

On May 18, the House Energy and Commerce Committee unanimously reported out the “Restoring Hope for Mental Health and Well-Being Act of 2022.” The bill would reauthorize key programs within the Substance Abuse and Mental Health Services Administration (SAMHSA), including the Substance Use Prevention, Treatment, Recovery Block Grant, which would support mental health and substance use disorder prevention, treatment and recovery services activities and address mental health needs and prevent suicide for Fiscal Years 2023 through 2027.  

The AMA strongly supported a number of provisions in the bill including: 

• A new grant program to help with the upfront costs of participating in the Psychiatric Collaborative Care Model (CoCM) to integrate behavioral health into primary care practices 
• A provision to require nonfederal government health plans to comply with the federal mental health and substance abuse parity law 
• A grant program to help states enforce the federal parity law 
• A provision to lift the requirement that a health care practitioner must get a separate X waiver from the DEA to dispense buprenorphine for substance abuse treatment  

The package also includes the TRIUMPH for New Moms Act (“TRIUMPH”), to create a national strategy to address maternal mental health disorders, and promote the coordination and integration of maternal mental health into existing maternal, infant and mental health activities among the federal agencies.

The AMA sent a letter (PDF) opposing the inclusion of the Medication Access and Training Expansion Act (MATE Act), legislation requiring health care providers, as a condition of receiving or renewing a DEA license, to complete eight hours of training on managing patients with substance use disorders.

The AMA has long-standing policy opposing federal intrusion into physician education. The House is expected to vote on the Restoring Hope for Mental Health and Well-Being Act in June. The Senate Finance and HELP Committees are expected to have mental health and substance abuse treatment packages later this Summer. The deadline for passage of a final SAMHSA reauthorization package is Sept. 30. 

A new Policy Research Perspective (PDF) from AMA Advocacy Health Policy provides a detailed examination of the 2020 U.S. National Health Expenditures data released by CMS. In 2020, health spending increased by 9.7% to $4.1 trillion or $12,530 per capita. This spending growth rate is substantially higher than that of 2019 (4.3%). Health spending as a share of GDP was 19.7% in 2020, up from 17.6% in 2019.  

Overall, health spending in 2020 was driven by increases in government spending to manage the unprecedented COVID-19 pandemic, including both expenditures on public health activities and federal relief programs. CMS projects that, in 2021, health spending increased by 4.2% to $4.3 trillion as utilization of medical goods and services increased while government expenditures related to managing the pandemic subsided. 

The AMA joined members of the Connected Health Initiative (CHI) on a May 24 letter (PDF) to the National Artificial Intelligence Initiative office at the White House urging officials to create a standing health care subcommittee to the National Artificial Intelligence Advisory Committee (NAIAC). The NAIAC recently solicited nominations for members of the committee, yet did not select any individuals with experience in health care artificial intelligence.

Given the rapid development and deployment of augmented intelligence-based clinical tools and the lack of an AI- or digital-specific regulatory oversight structure, the AMA and CHI members feel that health care representation on national advisory committees is critical to ensuring appropriate development, use and oversight of AI-based health care tools. This representation is also critical to stated goals of the NAIAC, including ensuring appropriate deployment of AI and continued American competitiveness in this area.

The letter urges the NAIAC to consider the need for health care AI expertise on this important advisory panel and to make permanent a health care subcommittee to address issues specific to health care AI. 

The AMA joined 43 national medical specialty societies in a letter (PDF) to CMS urging the agency to work closely with physician stakeholders as it prepares a report to Congress about the Appropriate Use Criteria (AUC) Report. The AMA requests an opportunity to provide input as CMS completes the report and urges the agency to release specific program information, including the impact on small and rural practices, drill-down data about the Education and Operations Testing Period, as well as less burdensome alternatives to claims-based reporting. The AMA also expressed several concerns with the AUC Program, including an alarming lack of awareness and readiness as indicated by the 2020 claims analysis showing only 9-10% of claims would have been paid if the AUC Program had been implemented. 

The AMA has successfully advocated (PDF) for delays of the penalty phase of the AUC Program due to the COVID-19 pandemic, lack of alignment with the Quality Payment Program and complex workflow and technical challenges that plague the program. CMS has extended the AUC Education and Operations Testing Period through Jan. 1, 2023, or the Jan. 1 that follows the end of the COVID-19 public health emergency, whichever is later. Learn more about the AUC Program.   

On May 18, the House Energy and Commerce Committee unanimously passed bipartisan legislation, H.R. 7667, to reauthorize the Food and Drug Administration’s (FDA) medical product and prescription drug user fees. The bill contains several additions supported by the AMA, including provisions providing the FDA authority to require trial sponsors to file diversity action plans as part of the application process and requiring the FDA to issue additional guidance on remote clinical trials to promote more diversity and inclusion. 

The bill also includes reforms that would let the FDA require drug sponsors to start phase IV trials before granting accelerated approval and streamlining the process for the FDA removing products from the market that fail to demonstrate clinical efficacy. The House is expected to vote on the bill in June.

The Senate Health, Education, Labor and Pensions (HELP) Committee is currently considering comments to its version of the bill released as a discussion draft on May 19. It includes three major additions not included in the House bill to expand the FDA’s regulatory authority over cosmetics, dietary supplements and laboratory-developed tests. The Senate HELP Committee is expected to mark up their bill the week of June 6.   

Millions of Americans have gained coverage resulting from the Affordable Care Act (ACA) and the American Rescue Plan Act (ARPA), making progress on a long-standing policy priority of the AMA–expanding access to and choice of affordable, quality health insurance coverage. Affordable coverage options available due to the ACA—subsidized ACA marketplace coverage and the Medicaid expansion—are more critical than ever, serving as a needed safety net during the COVID-19 pandemic.  

At a time of record enrollment in ACA coverage, the AMA calls for action this year to not only maintain but build upon the coverage gains that have been achieved. Without congressional action this year, ACA improvements included in ARPA—improved premium tax credit generosity and the temporary elimination of the ACA’s “subsidy cliff”—will expire at the end of this year, causing premiums to skyrocket for millions, with the potential for affected people to either become uninsured or switch to plans with higher deductibles and cost-sharing requirements.

To ensure that there is continued momentum forward and not ground lost in efforts to cover the uninsured, 2022 and Beyond: AMA’s Plan to Cover the Uninsured (PDF) puts forward specific policy proposals targeting not only the populations who remain uninsured but also steps that can be taken to improve premium and cost-sharing affordability. 

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