Oct. 13, 2016

National Update

Congress provides funding for public health emergencies

After months of back and forth between Congress and the White House, President Obama on Sept. 29 signed the “Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2017, and Zika Response and Preparedness Act,” (H.R. 5325).

The legislation serves primarily to provide continuing appropriations for the federal government through Dec. 9. By that time, a lame-duck Congress will be required to pass additional continuing appropriations or an Omnibus spending bill to prevent a government shutdown.

The legislation also provides a vehicle for supplemental funding to meet the threat of the Zika virus, an issue that has been hotly debated since the funding was originally requested last February. The final bill provides $933 million for the support of vector control, technical assistance for states, international response activities, vaccine and diagnostic development, public health emergency preparedness and other Zika response activities.

The bill contains a modest amount of initial funding for several programs authorized under the recently enacted Comprehensive Addiction and Recovery Act (CARA). Despite this, considerable additional funding will be required to be enacted by the lame duck Congress if CARA is to provide assistance to states and localities struggling with the crisis of opioid misuse and addiction.

Physician-Focused Payment Models Committee seeks input

At a recent meeting, the committee charged with soliciting proposals from specialty societies and other stakeholders for physician-focused alternative payment models (APM) under the Medicare Access and CHIP Reauthorization Act (MACRA) outlined the types of proposals it will be seeking and the process it will use to review them.

Representatives of the AMA and several specialty societies that have been designing APMs outlined their ideas to the committee members and discussed challenging issues such as risk adjustment, attribution of costs and access to data analysis. The committee has now posted documents for public comment.

The AMA recently submitted comments to the Centers for Medicare and Medicaid Services (CMS), recommending a number of modifications to its proposals for new mandatory episode bundled payment models that could potentially count as APMs under MACRA.

Cloud computing guidance issued by OCR

The U.S. Department of Health and Human Services Office of Civil Rights (OCR), which enforces compliance with the Health Insurance Portability and Accountability Act (HIPAA), recently released guidance intended to assist cloud service providers and their customers—including physicians–in understanding their obligations under HIPAA.

Physicians currently using or contemplating using a cloud service provider to store or transmit protected health information should review this guidance and the accompanying FAQs to evaluate whether they and their cloud service providers are in compliance with HIPAA.

OCR shares sample language access plan with AMA members

As noted in a prior edition of Advocacy Update, covered physicians are encouraged to develop and implement a language access plan to comply with the U.S. Department of Health and Human Services Office of Civil Rights’ (OCR) final rule implementing Section 1557 of the Affordable Care Act.

The OCR said that it is considering creating a template to assist covered entities in designing a language access plan, but, in the meantime, has shared HHS’ language access plan with the AMA as an example of what such a plan might entail. The agency noted that the plan is an example for guidance and that physicians do not need to follow it exactly.

OCR also stated that it is working on additional guidance to assist physicians with determining what is a “significant publication” under Section 1557. The AMA will disseminate this guidance when it is published.

Guidance issued on physician office lab reporting requirements

The Centers for Medicare and Medicaid Services (CMS) recently released new information to assist physician office-based laboratories with a new reporting requirement mandated by the Protecting Access to Medicare Act (PAMA).

Under PAMA, physician office-based laboratories meeting certain revenue thresholds will be required to report private-payer pricing data for testing paid on the Clinical Laboratory Fee Schedule.

CMS also released a reporting template that must be used by labs that choose to report electronically, as well as further guidance on which labs are required to report and what information must be provided.

Labs that are required to report must do so between Jan. 1 and March 31. The data required to be reported is data that was collected from Jan.1 to June 30 of this year. The AMA urges all physician office-based laboratories to carefully review the new requirements to determine if they must report. More information is available on the AMA website and the CMS website.

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Issue Spotlight

Preparing for upcoming Medicare changes? Tools to help your practice

The Centers for Medicare and Medicaid Services (CMS) is slated to release its Medicare Access and CHIP Reauthorization Act (MACRA) final rule by Nov. 1. While the program does not affect Medicare payments until 2019, physicians need to prepare for the changes now. To help physicians prepare for this historic change, the AMA has been developing a collection of valuable online tools and resources to help your practice prepare.

The new AMA Payment Model Evaluator helps you determine how MACRA will impact your practice. After answering questions and following the steps—which should take ten minutes or less—you’ll receive a brief assessment as well as relevant educational and actionable resources to help you navigate the new regulations.

Once you’ve filled out the online assessment in the Payment Model Evaluator, you will receive guidance as to which payment model might best fit your practice under proposed rules, so that you can begin to assess the impact.

The aim of the new tool is to ease the transition to MACRA. You’ve heard all about the Merit-Based Incentive Payment System (MIPS) and alternative payment models (APM), but now is the time to see how they may fit the characteristics of your own practice.

The tool holds MACRA education resources including:

An important aspect of the Payment Model Evaluator is that it will be updated to reflect future regulatory changes.

Also, the tool is free to both physicians and practice administrators. To create a personalized assessment, all you need is an AMA account—also free—to sign in and you can access the tool and other available educational resources on Medicare payment reform.

Other tools and resources to prep for Medicare changes
The AMA STEPS Forward™ collection of practice improvement strategies has grown to 42 modules including a variety of educational modules to help your practice implement team-based care, electronic health records, value-based care, team documentation, and many others in collaboration with the Transforming Clinical Practices Initiative.

Accurate reporting on quality metrics will be critical under the new Medicare payment system, and new resources in the STEPS Forward collection provide a high-level understanding of the quality programs and show you ways to maximize your preparedness for quality reporting.

Read more at AMA Wire®.

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State Update

Arizona approved to make changes to Medicaid expansion program

Arizona last month received federal approval to implement changes to its Medicaid expansion program, including requiring some beneficiaries to contribute up to two percent of household income into health savings accounts and a healthy behaviors incentive component.

The state had been negotiating the terms of the wavier, called the “Choice, Accountability, Responsibility, and Engagement (CARE) program,” since submitting the proposal in September 2015.

The federal government rejected some of Arizona’s controversial proposals, including monthly contributions for beneficiaries with incomes below the poverty line, a six-month lockout period for nonpayment of monthly premium contributions, a work requirement, fees for missed appointments and a five-year time limit on coverage.

The Centers for Medicare and Medicaid Services (CMS) said the rejected provisions could undermine access to care and do not support the objectives of the Medicaid program. The agreed to portions of the waiver proposal were approved in conjunction with granting a five-year extension of the Arizona Health Care Cost Containment System (AHCCCS), the state’s longstanding Medicaid managed care program.

Last month, CMS also denied a waiver proposal from Ohio that would have required all "newly eligible" adult Medicaid enrollees, as well as some low-income parents, foster care youth and beneficiaries with breast and cervical cancer to pay monthly fees into health savings accounts. In its denial, CMS cited concerns that the monthly financial obligation would undermine access to coverage and affordability of care.

For more information on state Medicaid activity, contact Annalia Michelman of the AMA.

New national educational resources available on opioid epidemic

New educational resources from the Prescribers Clinical Support System for Opioid Therapies (PCSS-O) address key issues surrounding the treatment of chronic pain and stigma.

The modules, Concurrent Management of Chronic Pain and Addiction and Follow-up Q and A Webinar: The Role of Shame in Opioid Use Disorders, are from the American Academy of Pain Medicine and the American Academy of Addiction Psychiatry, both members of the AMA Task Force to Reduce Opioid Abuse. The AMA is a member of the PCSS-O Steering Committee.

The Partnership for Drug-Free Kids also recently launched a new national educational campaign, “Search and Rescue,” with resources for physicians and other prescribers of controlled substances. The new Partnership effort, supported by the U.S. Food and Drug Administration, urges increased use of prescription drug monitoring programs, enhanced education and training and additional resources created by Centers for Disease Control and Prevention and others to support increased awareness of overdose prevention and treatment resources.

The new campaign highlights many of the resources also available through the Task Force, as well as videos and other tools.

Georgetown research shows network quality rarely regulated

A recent issue brief from the Georgetown Health Policy Institute found that little attention is being paid to narrow networks by regulators, and quality is rarely a factor in their design despite frequent claims otherwise—for example, narrow networks being labeled as “high-quality” networks.

The AMA funded the research in an effort to better understand narrow network design, efforts—or lack thereof–of regulators to regulate narrow networks specifically, and the interest of stakeholders in ensuring the quality of narrow networks. 

In its own analysis, the AMA drafted a discussion piece (log in) that suggests that special attention should be paid to narrow networks by regulators to prevent these networks from becoming inferior products and to ensure that patients who purchase these products have access to quality care.

The AMA plans to incorporate Georgetown’s findings into its ongoing work to improve network adequacy and the regulations of provider networks.

Contact Emily Carroll or Daniel Blaney-Koen of the AMA with any questions.

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Judicial Update

Court case tests New York City sodium warnings rule

The New York City Department of Health and Mental Hygiene (NYC DOHMH) recently adopted a rule requiring larger restaurant chains to post icons on their menus warning patrons of dishes that contain more than the US government’s daily limit for sodium. The National Restaurant Association (NRA) sued to block the rule and lost, but it now seeks to reverse the state supreme court’s decision. Besides the millions of vulnerable New Yorkers who are in need of the warnings, the case has implications for medical and public health organizations nationwide.

What happened in New York
The NYC DOHMH adopted the rule in response to a crisis of hypertension in the city. More than one in four adults in New York City has been told by a health professional that he or she has hypertension, meaning there are almost two million New Yorkers for whom a reduction in sodium consumption is crucial for improved health and a longer life.

Warnings about sodium consumption are also critical for the city’s residents who are at high risk, including African-Americans, people age 51 and older and those with high blood pressure, diabetes or kidney disease, who together make up more than half of the city’s population.

At stake in National Restaurant Association v. New York City Department of Health and Mental Health, currently before the New York Supreme Court’s Appellate Division, is whether the rule is an appropriate response to a public health problem, how the First Amendment applies to required science-based warnings, what constitutes arbitrary and capricious actions by health agencies and when local law may be preempted by the federal Nutrition Education and Labeling Act.

The NRA lost initially in the trial court and again in seeking a preliminary injunction pending appeal.

Local and national importance
In the past several months, the U.S. Department of Agriculture (USDA) and the U.S. Department of Health & Human Services have released the final Dietary Guidelines for Americans for 2015–2020, which recommend that adults consume less than 2,300 milligrams (mg) of sodium per day. Research from the USDA indicates that mean daily sodium consumption for adults is nearly 3,600 mg.

“Notwithstanding the NRA’s attempt to sow doubt and uncertainty about the contribution of sodium consumption to hypertension, there is clear scientific consensus regarding the link,” said the Litigation Center of the AMA and State Medical Societies in an amicus brief defending the rule. “The requirement that chain restaurants post a warning statement and a symbol indicating that a single menu item exceeds the recommended total daily sodium limit is a moderate and reasonable response to a severe public health threat.”

Read more at AMA Wire.

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Other News

New podcast series: “Inside Medicare’s new payment system”

To help physician practices transition to the new quality payment program under the Medicare Access and CHIP Reauthorization Act (MACRA), the AMA launched a new podcast series produced by ReachMD. “Inside Medicare’s new payment system,” delves into key aspects of MACRA and provides helpful tips on what physicians can do now to prepare, featuring interviews with industry experts and physician leaders.

Each of the eight podcasts can be downloaded or listened to through the ReachMD website. The latest programs include:

Read the press release and visit the AMA’s MACRA website for additional information.

Preview 2015 quality measures on Physician Compare

The Centers for Medicare and Medicaid Services (CMS) will be publicly reporting a subset of 2015 Physician Quality Reporting System (PQRS) measures and Consumer Assessment of Healthcare Providers and Systems (CAHPS) for PQRS measures on Physician Compare.

Starting October 12, CMS is facilitating a 30-day preview period for select quality measures through the PQRS portal—Provider Quality Information Portal . This preview period provides an opportunity for group practices and individual eligible professionals to review their measures before they are publicly reported on Physician Compare.

To learn more about which measures will be publically reported and how to preview your measures, visit the Physician Compare Initiative page . Group practices and EPs will need an enterprise identity management account (EIDM)  to preview their Physician Compare report.

If you have any questions about Physician Compare, public reporting or the 2015 quality measure preview period, please email CMS contractor Westat.

Fresh look at the Small Business Health Options Program

The Small Business Health Options Program (SHOP) Marketplace offers health insurance options that could help small physician practices struggling to cut costs while maintaining competitive benefits packages for their employees. Physician practices with 50 or fewer full-time equivalent (FTE) employees can apply for a SHOP plan online beginning Nov. 15.

The SHOP Marketplace includes four insurance options—Bronze, Silver, Gold or Platinum—that enable small business owners to control their health care benefits costs. SHOP tax credits could further reduce costs for eligible practices—the tax credit is worth up to 50 percent of your contribution toward your employees' premium costs (up to 35 percent for tax-exempt employers). To qualify for the tax credit, the following must apply:

Access SHOP Marketplace how-to guides, fact sheets, tools, and other resources for employers on the SHOP website, or call (800) 706-7893 to speak to a SHOP representative.

VA offers military culture training for community physicians

The Department of Veterans Affairs (VA) is providing a number of accredited training resources at no cost to all Veteran care physicians and other community providers. Learn more by accessing the following course titles:

These four modules are delivered via VHA TRAIN, a new service to share valuable Veteran-focused continuing medical education at no cost to physicians and other community providers.

Visit the AMA’s Supporting Veteran Health web page for information about how non-VA providers can delivery care to veterans through the Veterans Choice Program.

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