Medicare Payment Reform
Encourage your representative to sign “Dear Colleague” letter supporting Medicare payment reform
The deadline for signing onto the “Dear Colleague” letter to House leadership is July 27—contact your representative now.
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Transitioning to value-based care: Clinical data registries
The latest in a series of “Medicare basics” issue briefs providing an in-depth look at important elements of the Medicare physician payment system is now available.
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More information available about new Making Care Primary (MCP) model
The Center for Medicare & Medicaid Innovation has now posted slides and a transcript of its June 27 webinar describing the recently announced MCP alternative payment model, which will start in eight states in July 2024.
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National Update
Concerns over CMS increasing prior authorization requirements
The AMA recently urged the Centers for Medicare & Medicaid Services (CMS) not to increase prior authorization (PA) requirements in Medicare Fee-for-Service (FFS). While the AMA supports technology solutions that would modernize access to Medicare FFS PA and claims requirements, the AMA strongly objects to PA policy changes that would negatively impact both Medicare beneficiaries and physicians.
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Federal administrative simplification recommendations align with AMA comments
Recommendations from the National Committee on Vital and Health Statistics (NCVHS) to the Secretary of Health and Human Services regarding adoption of updated electronic transaction standards and new and updated operating rules completely aligned with the AMA’s written comments and hearing testimonies. The AMA’s successful advocacy with NCVHS will result in reduced administrative burdens, while also protecting practices from mandates to adopt costly, unproven new technology.
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Departments release new FAQs and report to Congress on No Surprises Act
The FAQs clarify that under the Transparency in Coverage provisions of the law, health plans are required to make price comparison information for covered facility fees available to patients through an internet-based self-service tool and in paper form, upon request. Additionally, physicians and facilities are required to provide good faith estimates to self-pay or uninsured patients in connection with facility fees.
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AMA responds to OSTP request for information on national priorities for AI
AMA comments highlighted current AMA policy on augmented intelligence and brought attention to new policy on AI oversight from the June 2023 House of Delegates meeting.
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HHS OIG issues information blocking enforcement regulation for HIEs/HINs and health IT developers
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) published a final regulation around enforcement of the 21st Century Cures Act information blocking provisions and civil monetary penalties up to $1 million per violation. In instances where physicians believe an EHR vendor is blocking information unnecessarily or using legal or financial roadblocks to prevent access to patients’ medical records, that EHR vendor may be an information blocker and subject to enforcement.
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Federal proposals would strengthen Medicaid and CHIP coverage
The AMA recently weighed in on two proposed rules from CMS that would aim to strengthen payment adequacy and expand coverage for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries.
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New modifier 25 brief
A brief on modifier 25, developed based on a referred resolution from which the Council on Medical Service developed a report that was adopted during the June 2023 Annual Meeting, is now available.
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Registration open for AMPAC Campaign School
At the 2023 AMPAC Campaign School, which will be taking place in-person on Oct. 12-15 at the AMA offices in Washington, D.C., participants will learn everything they need to know to run a successful campaign. The deadline to register is Sept. 18.
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State Update
23 medical boards make changes to support physician well-being
Nearly two dozen state medical boards have made changes to their licensing applications to help support physicians who seek care for mental health or a substance-use disorder. States have changed their licensure applications as organizations such as the Dr. Lorna Breen Heroes’ Foundation, the AMA and the Federation of State Medical Boards have pushed for officials to take a look at the questions they ask physicians seeking licensure and to eliminate or reword intrusive questions.
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How states can boost telehealth with more flexible licensure
An AMA issue brief outlines the spectrum of approaches states are adopting for telehealth licensure and provides model language for states to consider when seeking to implement licensure flexibilities.
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Judicial Update
Don’t criminalize pregnant patients with substance-use disorders
In a win for pregnant patients and their physicians, an Ohio appellate court has overturned a jury verdict that would have sent a woman to prison after she disclosed that she used illicit drugs during her pregnancy.
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