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March 31, 2016

National Update

Nation's leaders call for end to stigma, increased access to treatment

On March 29, President Obama called for increased funding for treatment of substance use disorders, speaking to the leading voices in the effort to end the nation's opioid epidemic gathered in Atlanta at the National Rx Drug Abuse and Heroin Summit. "This crisis needs all hands on deck," President Obama said. "We have to think of this in a public health model."

“Concentrating on physician education [and] making sure that medication-assisted treatment programs are more widely available” are two important factors, he said. “There are steps that can be taken that will help people battle through addiction and get onto the other side, and right now, that’s under-resourced.”

The conference, which brings together nearly 2,000 policymakers, health care professionals, patient advocates, law enforcement officials and others, has become the leading national venue to bring attention to the work being done to end the nation's opioid epidemic.

In one of the conference's "vision sessions," AMA Chair-elect Patrice A. Harris, MD, called on all states to work with physicians to not only enact meaningful policies to end the national crisis "but to implement those policies to have a meaningful impact."

In her speech, Dr. Harris detailed the five key recommendations of the AMA Task Force to Reduce Opioid Abuse. "We will know that we have succeeded when we prevent new cases,” Dr. Harris said, “when a new generation of our loved ones no longer die from overdose, and when we provide treatment to all those who need it."

Read an AMA news release for more details about Dr. Harris’ session.

Sen. HELP Committee approves mental health and opioid abuse legislation

On March 16, the Senate Health, Education, Labor and Pensions (HELP) Committee approved multiple bills by voice vote to address mental health reform and the opioid abuse epidemic.

The Mental Health Reform Act (S.2680) was introduced by HELP Committee Chairman Lamar Alexander, R-Tenn., and Ranking Member Patty Murray, D-Wash., along with Sens. Bill Cassidy, MD, R-La., and Chris Murphy, D-Conn. The bill would improve coordination between federal agencies and state government mental health and substance abuse disorder programs. It would help integrate physical and mental health services and expand mental and behavioral health education and training programs.

Additionally, the bill includes initiatives that prioritize early intervention and diagnosis of mental health in children and adolescents, and address gaps in care for pregnant and parenting women.

During the mark-up, amendments were approved that would strengthen parity laws requiring insurers to offer mental health coverage equal to physical health coverage, and also to clarify federal regulations to allow patients to request partially filled prescriptions, in an effort to reduce over-prescribing and diversion. The AMA sent a letter (log in) commending the Committee's effort to address mental health reform.

The Committee also passed four bills to address the prescription opioid and heroin epidemic. These bills include:

The AMA sent a letter (log in) to the HELP Committee supporting all four of these opioid-related bills. It is possible that the mental health legislation and opioid bills will be combined and considered by the full Senate later this spring.

OCR launces second phase of HIPAA audit program

The U.S. Department of Health and Human Services Office for Civil Rights (OCR) has commenced the second phase of its HIPAA Audit Program. This phase involves the review of policies and procedures established and implemented by covered entities and their business associates to meet the requirements of HIPAA’s Privacy, Security, and Breach Notification Rules.

OCR has begun to obtain and verify contact information to identify covered entities and business associates of various types and determine which are appropriate to be included in potential auditee pools. Every covered entity and business associate is eligible for an audit.

Entities selected for an audit will be sent an email notification and will be asked to provide documents and other data in response to a document request letter. OCR expects covered entities that are the subject of an audit to submit requested information via OCR’s secure portal within 10 business days of the date on the information request.

Steps you can take now:

The AMA has created toolkits on related aspects to HIPAA, including the requirements around privacy and security.

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Issue Spotlight

“Groundbreaking effort” to prevent diabetes announced

The U.S. Department of Health and Human Services (HHS) Wednesday announced it will soon begin covering diabetes prevention programs for Medicare beneficiaries as the result of a successful demonstration project. It is the first time a preventive service model from the Center for Medicare and Medicaid Innovation (CMMI) has been expanded into the Medicare program, and the agency said the model holds promise for employers, private insurers and patients.

Success in preventing type 2 diabetes
The announcement highlights the success of a three-year demonstration project, funded by CMMI, that allowed the YMCA of the USA to deliver its Diabetes Prevention Program through local YMCAs to nearly 8,000 Medicare beneficiaries at a high risk of developing type 2 diabetes at no cost.

As part of its Improving Health Outcomes initiative, the AMA teamed up with the Y-USA and 26 physician practice pilot sites (log in) in eight states to develop tools and resources to increase physician screening, testing and referral for prediabetes.

The practices referred their patients with prediabetes to diabetes prevention programs offered by local YMCAs. Medicare beneficiaries were able to participate in this program at no cost as a result of the award from the Center for Medicare and Medicaid Innovation.

The Y-USA’s Diabetes Prevention Program is modeled after the Centers for Disease Control and Prevention (CDC) National Diabetes Prevention Program (DPP), which is a proven, evidence-based lifestyle change program. This 12-month lifestyle behavior intervention program helps patients adopt and maintain healthy lifestyles by eating healthier, increasing physical activity and losing a modest amount of weight in order to reduce their chances of developing the disease.

At a time when more than 11 million seniors have diabetes and another 26 million seniors (about one-half of all Americans over the age of 65) have prediabetes, the results of the demonstration project speak for themselves:

Research by the National Institutes of Health has shown that diabetes prevention programs can reduce the incidence of new cases of type 2 diabetes by 58 percent. The reduction in incidence increases to 71 percent for adults over the age of 60.

“This program has been shown to reduce health care costs and help prevent diabetes, and is one that Medicare, employers and private insurers can use to help 86 million Americans live healthier,” HHS Secretary Sylvia M. Burwell said in a news release. “The Affordable Care Act gave Medicare the tools to support this groundbreaking effort and to expand this program more broadly. Today’s announcement is a milestone for prevention and America’s health.”

A time for action
A study released in 2014 that used methods similar to those of the Congressional Budget Office estimated that Medicare coverage of diabetes prevention programs would reduce federal spending by $1.3 billion over a 10-year budget window. The research was conducted by Avalere Health and released by the American Diabetes Association, the Y-USA and the AMA.

The study estimated that the cumulative rate of diabetes in the Medicare population would be reduced by an estimated 37 percent after a decade, resulting in nearly 1 million fewer cases of diabetes among seniors.

Risk of developing type 2 diabetes extends to a major portion of the U.S. population beyond Medicare beneficiaries. More than 86 million adults currently are living with prediabetes, but only 10 percent of them know that they have prediabetes and are at risk of developing type 2 diabetes.

“Today’s announcement signifies an important step toward ensuring all Americans at risk for type 2 diabetes have access to the resources they need to prevent this debilitating disease,” AMA President-Elect Andrew Gurman, MD, said in a statement Wednesday. “Research shows that up to one-third of these individuals will develop type 2 diabetes within five years unless they lose weight through healthy eating and increased physical activity.”

The AMA sent a letter to the Centers for Medicare & Medicaid Services last month, calling for coverage of prediabetes screening, referrals to diabetes prevention programs and participation in diabetes prevention programs. These services recently received a Grade B from the U.S. Preventive Services Task Force.

Under the Affordable Care Act, private health plans participating in the health insurance marketplaces and the Medicaid program are required to cover preventive services that are recommended with a grade of A or B by the task force.

For patients who have insurance through private plans, the AMA is encouraging employers and health insurance companies to cover participation in diabetes prevention programs as well. The entities can use the AMA’s diabetes prevention cost-savings calculator to better understand how why they should offer this coverage, including the potential benefits for improving health outcomes while reducing health care costs.

Read more at AMA Wire®.

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State Update

National count of opioid prescriptions decreased by more than 16 million in 2015

Every state in the country saw a decrease in the number of opioid analgesics prescriptions filled in 2015 according to new data from IMS Health. This information, which reflects the activity of physicians and other health care professionals, shows that nationally there was a 6.8 percent decrease in the total number of prescriptions for opioid analgesics in 2015 (227,780,915) compared to 2014 (244,462,567). There also was a 2.9 percent decrease nationwide in 2014 compared to 2013 (251,814,805), a year when all but four states saw decreases. From 2013 to 2015 the number of opioid prescriptions filled decreased 10.6 percent.

States that saw the largest decreases in 2015 were:

The AMA and IMS Health will provide each state medical society with a more detailed view of the data. For additional questions, please contact the AMA’s Daniel Blaney-Koen or IMS Health’s Robert Hunkler.

AMA testimony in California opposes Anthem-Cigna merger

On March 29, the AMA, along with the California Medical Association, testified before the California Department of Insurance, opposing the proposed merger between Anthem and Cigna.

The testimony forcefully argued that the merger will have profound anticompetitive effects that will harm patients such as increased insurance premiums, inadequate provider networks and reductions in physician compensation that will force physicians to leave medicine and spend less time with patients, making it difficult for physicians to make practice investments necessary to maximize the quality of care they provide and participate in new payment models.

The testimony in California is just one example of how the AMA is helping state medical associations oppose the proposed mergers between Anthem-Cigna and Aetna-Humana, in addition to the AMA’s continued merger advocacy before the Department of Justice, the National Association of Attorneys General and the National Association of Insurance Commissioners.

Visit the AMA’s antitrust reform Web page for additional information.

West Virginia enacts telemedicine legislation

Bills supporting the practice of telemedicine are continuing to find success in state legislatures. Last week, West Virginia Governor Earl Ray Tomblin signed into law a wide-ranging measure, based on the AMA Telemedicine Act (log in)—a model bill, that defines the patient-physician relationship and ensures that physicians who treat West Virginia patients via telemedicine hold a license to practice medicine in the state.

The bill also defines how a physician can establish a relationship with a patient via telemedicine, stating that such a relationship cannot be established through audio-only communication, text-based communications like email or internet questionnaires or any combination thereof.

The bill also clarifies that certain modalities, like treatment based solely on an online questionnaire, do not constitute the standard of care and limits prescribing certain controlled substances through telemedicine. The AMA was proud to have supported the efforts of the West Virginia State Medical Association, which was instrumental in passage of this bill.

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Other News

Medicare revalidation deadlines approaching

All physicians who participate in Medicare must recertify the accuracy of their enrollment information with the Centers for Medicare & Medicaid (CMS). This requires revalidating all practice locations and/or current reassignments.

CMS has established due dates for all currently enrolled providers. Physicians must check their assigned due date and submit the revalidation application by this deadline. Medicare Administrative Contractors (MAC) will also send a revalidation notice two to three months prior to the revalidation due date either by email using addresses reported on prior applications, or regular mail using at least two of your reported addresses—correspondence, special payments or your primary practice address—identifying your due date.

Physicians should not submit a revalidation application if there is not a due date reflected on the file. Note that Durable Medical Equipment supplier deadlines will not be included at this time. If a due date is listed as “TBD” and you have not received an email or mailed letter from your MAC requesting you to revalidate, an application should not be submitted.

The most efficient way to submit your revalidation information is by using the Internet-based PECOS on the CMS website. PECOS allows you to review information currently on file, update and submit your revalidation via the Internet. You must either electronically sign the revalidation application; or print, sign, date and mail the paper certification statement to your MAC.

For more information visit the CMS website.

New resources available on SaveGME website

In conjunction with the recent Medical Student Advocacy and Region Conference, the AMA launched an updated version of SaveGME.org. The updates include new resources and content, including soon-to-be-released video submissions from medical students and a new call to action on Public Service Loan Forgiveness.

SaveGME.org is a concerted effort to strongly urge Congress to protect federal funding for graduate medical education.

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Upcoming Events

April 13–17: AMPAC Campaign School
Register for the 2016 AMPAC Campaign School, which is for AMA members who wish to become involved in the political process as advocates and volunteers for medicine-friendly candidates. For more information or to apply, see the online registration form or email Jim Wilson of the AMA.

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