- National advocacy makes it safer for more than 3.35 million physicians & other healthcare professionals to seek care
- AMA urges administration to implement broader medical frailty exemption, reasonable use of self-attestation for Medicaid work requirements
- Medicare Data-Driven Performance Payment System Act of 2026 (H.R. 8622) makes key MIPS reforms
- AMA review documents compliance failures in prior authorization public reporting, urges CMS to strengthen implementation
- NO FAKES Act protects physicians from nonconsensual use of digital replicas
- CMS: Medicare Plan Finder enhancements for CY 2027, reflecting reforms the AMA has long championed
- More articles in this issue
National advocacy makes it safer for more than 3.35 million physicians and other healthcare professionals to seek care
The ALL IN: Wellbeing First for Healthcare coalition, led by the Dr. Lorna Breen Heroes’ Foundation (LBF), announced this week that more than 3.35 million health workers now practice in states or systems that no longer include stigmatizing and intrusive mental health or substance use disorder questions on their licensing and credentialing applications.
As of May 15, there now are 74 licensure boards (including 44 state medical boards) and 3,392 hospitals, health systems, urgent care centers and other care facilities that have made changes consistent with recommendations from the AMA, LBF and national partners such as the Federation of State Medical Boards, Federation of State Physician Health Programs, and the American Osteopathic Association, National Association of Medical Staff Services, The Joint Commission, and many others.
“During Mental Health Awareness Month, it is encouraging to see more states, hospitals and care facilities taking steps to better support the mental health of physicians and healthcare workers,” said AMA President Bobby Mukkamala, MD. “Every licensing board, hospital or health system that makes these updates represents meaningful progress. Health systems are seeing the value of creating a culture where people feel safe asking for help, whether they are struggling with mental health challenges or a substance use disorder, and more workers are using the support services available to them. That kind of progress is long overdue in healthcare.”
"The 3.35 million health workers who now have a safer path to mental healthcare are the heart of this movement—they are our friends, family, and colleagues who no longer have to choose between their jobs and their health," said Corey Feist, co-founder and CEO of the Dr. Lorna Breen Heroes’ Foundation. "As we recognize Mental Health Awareness Month, we are reminded that our healthcare workforce deserves the same grace they give their patients every day. It’s heartening to see that grace translated into real-world progress, with half a million health workers now protected at the credentialing level as more hospitals and care facilities champion mental healthcare and privacy."
In another positive sign of the reach of this effort, MinuteClinic became the first national retail medical clinic to be verified as having credentialing applications consistent with AMA and LBF recommendations.
To review the full list of licensing boards, hospitals, health systems and others who have been verified as having licensing/credentialing applications consistent with AMA and LBF recommendations, please visit the LBF website.
AMA urges administration to implement broader medical frailty exemption, reasonable use of self-attestation for Medicaid work requirements
The AMA has been actively engaged with the Centers for Medicare & Medicaid Services (CMS) on the implementation of Medicaid community engagement requirements (“work requirements”) established under Public Law 119-21. In March, the AMA sent a letter (PDF) to the Center for Medicaid and CHIP Services (CMCS) outlining our priorities, which include a comprehensive and flexible “medical frailty” exemption and allowing states to accept self-attestation to verify when individuals are eligible for this or other exemptions. In the weeks that followed, the AMA had productive discussions with CMCS leadership and shared more details on the AMA's perspective. Based on these interactions, the AMA was optimistic that many of our proposed safeguards would be incorporated into CMS’s upcoming interim final rule on Medicaid work requirements, which is due on June 1.
However, on May 20, the AMA learned of reports that other parts of the Trump administration are pressuring CMS to adopt a narrower definition of medical frailty and prohibit self-attestation—contrary to what has been communicated to the AMA, states and other stakeholders over the past few months. In response, the AMA wrote (PDF) to CMS Administrator Mehmet Oz, MD, MBA, on May 21, emphasizing the need for a broader exemption for medically frail individuals and reasonable use of self-attestation to verify eligibility, and expressing concerns about eligible patients losing coverage and added burdens on physicians if the rule did not include these provisions. The AMA remains committed to advocating on this critical issue.
Medicare Data-Driven Performance Payment System Act of 2026 (H.R. 8622) makes key MIPS reforms
The AMA provided a letter of support (PDF) to the bipartisan lead sponsors of H.R. 8622, the Medicare Physician Data-Driven Performance Payment System (DPPS) Act, specifically Reps. Mariannette Miller-Meeks, MD (R-IA), and Herb Conaway, MD (D-NJ), on May 22.
While the Merit-based Incentive Payment System (MIPS) has been riddled with problems for more than a decade, the two principal issues reported by physicians are the win-lose “tournament” model and the lack of timely access to data during a performance year. Too often the data from the CMS indicates that a majority of solo, small and rural physicians are penalized up to 9%. As stated in the letter penned by AMA CEO John Whyte, MD, MPH, “Nearly 50 percent of solo eligible clinicians, 29 percent of small practices, and 18 percent of rural practices received a MIPS penalty in 2023, the most recent year for which these data are available.” These steep payment reductions ultimately fund corresponding payment increases awarded to larger, better resourced practices that have the time and resources to more successfully participate in the MIPS program.
The inability of CMS to provide any meaningful, useful data during a twelve-month performance period makes it increasingly difficult for physicians to make any real-time improvements.
To combat these frustrating realities, Reps. Miller-Meeks and Conaway introduced H.R. 8622 on April 30. This bipartisan legislation would:
Freeze the MIPS performance threshold at 75 points for at least three years.
Eliminate the MIPS win-lose “tournament style” payment adjustments to ensure physicians are no longer subjected to steep penalties.
In lieu of penalties, link physicians’ MIPS performance to a portion of their annual payment update (e.g., either the existing 0.25% under MACRA or the percentage increase in the Medicare Economic Index (MEI), should it be enacted in a separate bill).
Mandate that CMS fulfills its statutory obligations under MACRA to share data on a quarterly basis with the MIPS performance year, so physicians can leverage this data to implement changes that would improve patient care and use resources more efficiently.
Failure by CMS to provide MIPS physicians with three quarters worth of data during the performance year results in physicians receiving the highest possible payment update.
The AMA will continue to lobby bipartisan members of the House of Representatives to cosponsor this legislation. AMA members are also encouraged to contact their Members of Congress to urge them to lend their support to this crucial Medicare payment bill.
AMA review documents compliance failures in prior authorization public reporting, urges CMS to strengthen implementation
On May 22, the AMA sent a letter (PDF) to CMS Administrator Mehmet Oz, MD, MBA, documenting widespread deficiencies in how Medicare Advantage (MA) plans implemented the prior authorization (PA) public reporting requirements established under the 2024 Interoperability and Prior Authorization Final Rule (CMS-0057-F). The letter summarizes the AMA’s review of 15 MA contracts offered in Miami-Dade County following the March 31, 2026, reporting deadline and offers recommendations to help ensure the rule delivers the transparency, comparability and oversight CMS intended.
The AMA’s review found widespread deficiencies in the usability, accuracy and accessibility of payer disclosures. Many plans technically posted PA information but placed it where beneficiaries and physicians could not reasonably find it, including provider portals, legal and compliance subpages, and PDFs reachable only after five or more navigational steps from a plan’s homepage. Reported metrics contained errors, omissions and internal inconsistencies, while lists of services requiring PA ranged from 832-page undifferentiated billing-code compilations to descriptions so generic they provided little insight into whether a specific item or service required PA. Several plans also prominently displayed approval rates calculated by excluding entire categories of PA activity covered by CMS-0057-F, contrary to the rule’s reporting requirements.
The AMA’s letter recommends targeted implementation refinements to strengthen the usability, accuracy and discoverability of PA disclosures. These include:
Linking directly from Medicare Plan Finder to each plan’s PA metrics and service lists
Establishing a uniform public website location for disclosures
Prohibiting plans from carving out categories of care from PA metrics
Requiring standardized templates for PA metrics and service lists so disclosures are more readable and comparable across plans
The AMA seeks to ensure CMS-0057-F achieves its core purpose: enabling beneficiaries to evaluate PA practices when selecting coverage, helping physicians identify PA requirements before care is delayed, and giving CMS the data needed to oversee MA plan compliance.
These recommendations are especially timely as CMS prepares to finalize CMS-0062-P, which would extend the PA reporting framework to drugs. The AMA’s forthcoming comments on CMS-0062-P will reiterate key recommendations from the CMS-0057-F implementation letter and urge CMS to establish clearer standards before payers replicate the same reporting problems in drug PA disclosures.
NO FAKES Act protects physicians from nonconsensual use of digital replicas
The AMA has endorsed bipartisan, bicameral legislation to protect the voice and visual likenesses of individuals and creators from the proliferation of digital replicas created without their consent. The Nurture Originals, Foster Art, and Keep Entertainment Safe (NO FAKES) Act (S. 1367/H.R. 2794) was introduced by Sens Blackburn (R-TN) and Coons (D-DE), and Reps. Salazar (R-FL), and Dean (D-PA). The bill is broad enough to cover physician-specific concerns, and addresses nonconsensual use of digital replicas by:
Holding individuals or companies liable if they distribute an unauthorized digital replica of an individual’s voice or visual likeness
Holding platforms liable for hosting an unauthorized digital replica if the platform has knowledge of the fact that the replica was not authorized by the individual depicted
Excluding certain digital replicas from coverage based on recognized First Amendment protections
Preempting future state laws regulating digital replicas
The revised version of the NO FAKES Act, S. 4591:
Adds a counter-notice procedure to better protect Americans’ free speech rights
Provides an exemption for libraries, archives, and research institutions to ensure that the study of digital replicas is not inhibited
Makes technical fixes to ensure that the bill works as designed for streaming music platforms
The AMA supports both versions of the bill and issued a letter of support (PDF) for the previous version. AMA CEO John Whyte, MD, MPH, was quoted in support of the revised version included in the May 20 press release announcing reintroduction of the bill.
CMS outlines Medicare Plan Finder enhancements for CY 2027, reflecting reforms the AMA has long championed
On May 15, CMS announced multiple enhancements to Medicare Plan Finder (MPF) that implement reforms the AMA has championed through sustained regulatory advocacy. Among the biggest wins, CMS will populate MPF with MA provider directory data submitted by plans and validated by CMS—a reform the AMA has pressed through comments urging the Agency to integrate provider directory data into MPF and through support for Senate legislation requiring accurate MA directories. By allowing beneficiaries to confirm their physicians’ network participation before enrolling, these changes will begin to address the care disruptions that occur when patients discover after enrollment that their trusted physicians are out of network, forcing them to switch plans or find a new provider.
CMS also announced MPF enhancements that will give beneficiaries clearer information about benefits and plan stability before choosing coverage. The “More Extra Benefits” section will include more detailed information on nutritional benefits, telemonitoring, in-home safety assessments, medical nutrition therapy, and additional smoking cessation counseling, including cost sharing and authorization requirements. CMS will also alert mid-year shoppers when an MA organization intends to terminate or non-renew its contract at the end of the year.
The AMA commends CMS for making these changes, which align with long-standing AMA recommendations to expand MPF beyond premiums and benefit design to include the network, supplemental benefit and prior authorization information (PDF) that determines whether a plan will meet a beneficiary’s needs.
