Sept. 26, 2025: National Advocacy Update

ACIP further narrows vaccine recommendations

The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) advanced new recommendations for use of COVID-19 and Measles, Mumps, Rubella, and Varicella (MMRV) vaccines in both children and adults while delaying a vote regarding recommendations for Hepatitis B vaccines in newborns.

The Committee, which met Sept. 18 and 19, will no longer recommend that all adults receive the COVID-19 vaccine and has instead approved a recommendation that COVID-19 vaccination in all individuals be determined by individual decision making and consultation with an individual’s health care provider. The new recommendation includes those with one or more risk factors for severe COVID-19.

In addition to new recommendations for COVID-19 immunization, ACIP members also moved to recommend against the combined MMRV vaccine, recommending instead that children under age 3 receive immunization for varicella separate from measles, mumps, and rubella (MMR). Concerns over a slight risk of febrile seizures following MMRV immunizations in young children drove this recommendation. The committee also voted to recommend testing pregnant women for Hepatitis B prior to childbirth but did not vote on a specific recommendation for Hepatitis B immunization for newborns. 

While the ACIP recommendations have not yet been accepted or rejected by the CDC Director or Secretary of Health and Human Services (HHS), they have caused significant uncertainty among physicians and patients. A patchwork of state policies tied to ACIP recommendations has triggered widespread confusion regarding potential prescription requirements for vaccines, including COVID-19, leaving many patients without clear pathways for access. Additionally, the Food and Drug Administration’s (FDA’s) failure to authorize the 2025-2026 COVID-19 vaccines for healthy adults and children under 65 raises additional questions about their availability for those populations.  

The AMA has strongly advocated for maintaining access to vaccines and has opposed efforts by HHS and its agencies to limit vaccine access and availability. The AMA’s efforts have reached the FDA, CDC, and Congress and have consistently called for evidence-based decision making, maximum transparency, and opportunity for public input into any action impacting vaccine access. 

AMA advocacy helps secure extended enrollment flexibility for Medicare patients

Following AMA calls for greater accuracy in the Medicare Plan Finder, the Centers for Medicare & Medicaid Services (CMS) has extended enrollment flexibility for patients impacted by incorrect provider data. This allows patients to switch plans in 2026 and strengthens transparency in Medicare enrollment. 

• Affected individuals can move to another Medicare Advantage plan or return to Original Medicare.
• Applies to beneficiaries who used Plan Finder and discovered network errors within three months of enrollment.
• Patients must call 1-800-MEDICARE to confirm eligibility and request changes.
• CMS’ decision builds on AMA-supported improvements to Plan Finder functionality. 

Physicians should remind patients to verify provider networks and use 1-800-MEDICARE if corrections are needed. The AMA will keep pressing CMS to ensure Plan Finder accuracy and reduce enrollment errors.

Telehealth flexibilities set to expire on Sept. 30

On Sept. 25, the AMA sent a letter of endorsement for the Telehealth Modernization Act (TMA) (S. 2079 and H.R.5081) introduced by Sens. Tim Scott (R-SC) and Brian Schatz (D-HI) in the Senate (PDF) and Reps. Buddy Carter (R-GA) and Debbie Dingell (D-MI) in the House (PDF). This important bill would continue the telehealth flexibilities granted during the pandemic, extending telehealth access for Medicare beneficiaries through fiscal year 2027. The telehealth flexibilities are set to expire on Sept. 30, 2025. The TMA would ensure that seniors, particularly those living in rural and underserved communities, continue to have access to virtual care. In particular, the TMA would: 

• Remove geographic and originating site restrictions to allow patients to access telehealth services from any location. 

• Protect access to telehealth for patients in rural communities by allowing audio-only telehealth services for those without internet access or smart devices. 

• Expand the use of telehealth by additional physicians and non-physician practitioners approved by the Secretary of the Department of Health and Human Services (HHS). 

• Waive the requirement that patients be seen in person within six months of receiving telehealth services for mental or behavioral health. 

• Allow patients to participate in virtual diabetes prevention programs as part of the Medicare Diabetes Prevention Program Expanded Model. 

• Allow patients to receive cardiopulmonary rehabilitation services at home. 

• Require HHS to share best practices for improving telehealth services for non-English speakers. 

• Extend the use of telehealth to meet face-to-face requirements for hospice care and home dialysis. 

• Extend the Acute Hospital Care at Home Program to allow patients to receive acute-level care at home. 

The AMA supports all the aims of this important legislation, which works hand-in-hand with the CONNECT for Health Act (S. 1261/H.R. 4206) introduced by Sen. Schatz (D-HI) and Rep. Mike Thompson (D-CA), which would also continue the telehealth flexibilities granted during the pandemic.  The AMA has endorsed both bills and looks forward to working the bill sponsors to see this critical legislation enacted this Congress. Along those lines, the AMA has also supported a bipartisan House Dear Colleague circulated by Reps. Mike Thompson (D-CA), Troy Balderson (R-OH), and Doris Matsui (D-CA) to House leadership urging that the current telehealth flexibilities be extended and to prioritize the inclusion of permanent changes to telehealth policies the AMA supports. The sign-on deadline is Sept. 26, and the AMA is actively lobbying this letter which currently has 16 bipartisan cosigners.  

Impact of potential government funding shutdown on Medicare telehealth

The AMA has long called for Congress to enact legislation that would: (1) permanently allow Medicare patients in every geographic area, not just patients in rural areas, to receive telehealth services by waiving the geographic restrictions in current law; and (2) permanently allow Medicare patients to receive telehealth services in their homes instead of having to go to a medical facility to receive telehealth from a distant site. To date, however, Congress has passed legislation that only temporarily waives these requirements. Most recently, in March 2025 Congress extended these telehealth flexibilities for a six-month period that ends Sept. 30, 2025. 

Physicians who provide telehealth services to Medicare patients should be aware that if Congress is not able to pass legislation before Oct. 1, 2025, that extends government funding, then the current Medicare telehealth flexibilities will lapse for care to all patients except those being treated for mental health or substance use disorders. This means that telehealth services would be limited to rural areas as they were before the COVID public health emergency and that patients would not be able to receive telehealth services in their homes. In addition, the ability to provide audio-only services to Medicare patients would lapse, as would the Acute Hospital Care at Home program. 

In past government shutdowns, whenever Congress passed legislation to reopen the government, it made the funding and policies retroactive to the effective date of the shutdown. Physician practices may want to consider adjusting their patient schedules for telehealth services, however, as neither the likelihood nor the duration of a shutdown are known. 

Bipartisan AMA-supported prior authorization reform bill introduced in the U.S. House

A new bipartisan piece of legislation was introduced in the House of Representatives on Sept. 23 to reform prior authorization processes affecting pharmaceuticals prescribed for Medicare Advantage (MA) patients afflicted with autoimmune diseases and blood disorders. Representatives Julie Johnson (D-TX) and Mike Kennedy, MD (R-UT) worked together to introduce H.R. 5467, the Patient Access to Autoimmune Treatments (PAAT) Act. 

This bill, which was supported by the AMA in a Sept. 19 letter (PDF), marks the first time these two freshman members of the House of Representatives joined forces to reform utilization management techniques focused on prescriptions associated with autoimmune and blood disorders, including but not limited to hemophilia and Von Willebrand disease. More specifically, should a MA prescription drug plan cover a particular product, the bill limits reviews for all pharmaceuticals used to treat autoimmune and blood disorders to once within a 12-month period, thus eliminating the threat of mid-plan year reviews. The legislation does include common-sense, narrow exceptions to the limitations on prior authorization reviews, including pharmaceuticals prescribed for less than a year; benzodiazepine, barbiturates, or carisoprodol; or drugs that have a FDA-mandated Risk Evaluation and Mitigation Strategy (REMS). 

A joint press release from Reps. Johnson and Kennedy included a quote from AMA President, Bobby Mukkamala, MD: 

“Reforming prior authorization in Medicare Advantage is essential to protecting timely  access to high-quality care and reducing the administrative burdens that contribute to  physician burnout. Alarmingly, the American Medical Association found that more than one  in four physicians report prior authorization has led to a serious adverse event for a patient  in their care. Patients living with chronic autoimmune and blood disorders are especially  vulnerable to the delays and denials associated with frivolous prior authorization  requirements. America’s physicians applaud Reps. Julie Johnson and Mike Kennedy, M.D.,  for championing this bipartisan, common-sense legislation to put patients before  paperwork." 

The AMA looks forward to working with Reps. Johnson and Kennedy to add additional bipartisan cosponsors and, hopefully, advancing this legislation through the U.S. House of Representatives before the conclusion of the 119th Congress. 

Reauthorization for bipartisan SUPPORT Act to be signed into law 

On Sept. 18, the U.S. Senate unanimously passed the SUPPORT for Patients and Communities Reauthorization Act, sending the legislation to the President to be signed in to law. The bill renews programs that lapsed in 2023, including those that support substance use disorder (SUD) treatment and postpartum women. The legislation, H.R. 2483, initially passed the House of Representatives in June of this year. The unanimous consent passage of the bill in the Senate shows broad bipartisan support of the legislation, and it is anticipated to be signed into law by the President.  

The AMA previously expressed support (PDF) for the bill while it was under consideration in the House and looks forward to it being signed into law and working with the administration to continue to eliminate unnecessary barriers to SUD patient care, evidence-based pain care, and other measures to help end the nation’s overdose epidemic.  

AMA report: Physician participation in alternative payment and delivery models

A new report (PDF) by the AMA examines the recent trends in participation in care delivery models as well as the use of fee-for-service (FFS) and alternative payment models (APMs). In addition, it describes how participation in care delivery models varies across practice characteristics. 

The analysis finds that: 

• Participation in ACOs has grown over the past decade, with more than half of physicians (53.5%) reporting that their practice participated in at least one ACO type (commercial, Medicare, or Medicaid) in 2024. Still, although long term participation was up, there was evidence of a stagnation in trend between 2022 to 2024.
• Participation in ACOs and medical homes was higher among physicians in practices with primary care physicians (PCPs), multi-specialty practices, and hospital-owned practices than among physicians in practices without PCPs, solo practices, and physician-owned practices, respectively.
• FFS remained the most prominent payment method as in prior years, with 82.8% of physicians reporting that their practice received at least some payment from this method in 2024.
• The use of APMs has also become more prevalent, as 62.4% of physicians were in practices that received at least some payment from one of the four APMs asked about in the survey (capitation, bundled payments, pay-for-performance, and shared savings), up from 59.0% in 2014.
• In 2024, for every $100 in practice revenue received, $32.30 was from APMs (with the remainder from FFS), up from just $28.10 in 2014. 

The rise in ACO participation highlights how more providers are embracing patient-centered, coordinated care designed to improve quality of care while controlling costs. It signals some shifts toward value-based care, as evidenced by a gradual move away from complete dependence on FFS and toward greater use of APMs. Nonetheless, FFS remains a significant and stable source of revenue partly because many APMs are “built off” FFS payments. 

AMA offers resources to MedPAC on prior authorization, consolidation

On Sept. 19, the AMA wrote (PDF) to the Medicare Payment Advisory Commission (MedPAC) regarding prior authorization (PA) and consolidation, two topics discussed during its September 2025 meeting. Specifically, the AMA shared its 2024 AMA PA physician survey (PDF), which lends credence to concerns raised by the Commissioners about the negative impact of PA on patients and physicians. For instance, an overwhelming majority (93%) of physicians surveyed reported that PA delays patient care, with 82% stating that the process can lead to treatment abandonment and 94% linking it to negative patient clinical outcomes. In addition, the AMA shared two reports focused on competition in the pharmacy benefit manager (PBM) (PDF) and health insurance markets (PDF) as MedPAC discussed consolidation across health care sectors as part of its Medicare payment context chapter. The AMA appreciates MedPAC’s consideration of these resources and will continue to closely monitor developments at its next meeting in October. 

Bipartisan bill to reauthorize medical student education program introduced

House Appropriations Committee Chairman Tom Cole (R-OK) and Rep. Dina Titus (D-NV) introduced H.R. 5428, the Medical Student Education Authorization Act, which authorizes up to $75 million in annual appropriations through 2028 to support the education of medical students and encourage them to serve in a Tribal, rural, or medically underserved community as primary care physicians after completing residency training. The legislation gives priority to accredited public institutions in states with at least two “Indian Tribes or Tribal organizations.” 

According to AMA President Bobby Mukkamala, MD, “There is a critical shortage of physicians in rural America, where limited access to care continues to drive poorer health outcomes. The Medical Student Education Authorization Act is a smart, bipartisan investment in the future of our nation's critical health care workforce—one that would expand the pipeline of primary care providers serving tribal, rural, and medically underserved communities.”  

The AMA looks forward to working with the sponsors to advance this legislation and ultimately advocate for its full funding. 

AMA joins with 120+ organizations to protect EPA’s endangerment finding

The AMA joined over 120 medical societies and health organizations to submit public comment (PDF) on an Environmental Protection Agency (EPA) Proposed Rule that rescinds the 2009 Greenhouse Gas Endangerment Finding. The letter describes how rescinding the endangerment finding contradicts the overwhelming scientific consensus on climate change, disregards the near-daily health impacts Americans are already experiencing, and places our nation on a dangerous path towards greater illness, suffering, and environmental and economic harm.  

Without the endangerment finding, the EPA would lack clear statutory authority under the Clean Air Act to regulate emissions from new motor vehicles and new motor vehicle engines. Revoking it would strip the federal government of its strongest legal tool to limit carbon pollution from vehicles and power plants. 

In August, AMA Trustee Ilse R. Levin, DO, MPH & TM, testified on behalf of the AMA (PDF) at an EPA Public Hearing on its efforts to rescind the 2009 Greenhouse Gas Endangerment Finding and urged the agency to reconsider its position and maintain the endangerment finding as well as greenhouse gas emission standards for vehicles. In addition, Dr. Levin discussed the AMA’s declaration in 2022 proclaiming climate change a public health crisis and strong support for efforts to reduce U.S. greenhouse gas emissions. 

More articles in this issue

• Sept. 26, 2025: Advocacy Update spotlight on removal of stigmatizing questions on applications
• Sept. 26, 2025: Judicial Advocacy Update