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Special Edition: May 29, 2020

Issue Spotlight

Updated CDC serology testing guidelines follow AMA's recommendations

The Centers for Disease Control and Prevention (CDC) recently updated its guidelines on serology (antibody) testing, bringing them in line with the AMA's recently issued guidelines on the same. For the past several weeks, the AMA has been in touch with various arms of the administration, including the CDC, to discuss and express concerns surrounding current serology testing. In the update the CDC notes ongoing concerns about poor performance among many serology tests currently available on the market. Specifically, the CDC notes concerns about the significant possibility for false positive results. Like the AMA, the CDC further recommends that serology tests not be used as the basis for making policy, returning to work or for decisions about housing/congregating groups of people. In addition, the U.S. Food and Drug Administration (FDA) has provided updated information about FDA-authorized serology tests, including information about performance of those tests.

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National Update

Telehealth coverage for ERISA plans is needed

The AMA sent a letter to Representatives Schrier, Roe, Morelle and Van Drew in addition to Senator Smith expressing strong support for H.R. 6644, "The Health Care at Home Act." Currently physician practices are working hard to quickly establish the ability to decrease patients' risk of exposure to COVID-19 by providing care to patients through virtual means. However, the ability to access needed care through telemedicine remains limited for many patients, which is why legislative approval for health plans regulated by ERISA is needed to ensure coverage of telehealth services. Telehealth services have never been more vital, and are especially important for the elderly, individuals with chronic conditions and patients with mental health needs.

While some health plans have taken voluntary steps to increase access to telehealth services, overall access remains limited and there is a lack of uniformity among plans governed by ERISA. This leaves physicians and other health care providers unsure of whom, and under what conditions, they are permitted to provide medical services via telehealth. This has led to a disruption in continuity of care and created additional anxiety and confusion for patients during an already stressful time.

Similar to the guidelines provided by Medicare, the AMA is advocating that telehealth coverage is expanded to ERISA plans. As outlined in H.R. 6644, this coverage should include requiring that services provided via telehealth be reimbursed at the same rate as in-person services, allowing for the use of expanded modalities for the provision of telehealth to include telephone visits and common audio-video technology, as well as enabling physicians to offer telehealth services to new and established patients. These changes will make it possible for ERISA plan patients to access the care they need without having to increase their risk of exposure by traveling to their physician's office or a hospital.

CMS announces savings on insulin for patients with diabetes

The AMA has been concerned for several years about the cost of insulin for patients with diabetes. Physicians have reported that their patients are rationing their insulin therapy due to its cost or being forced to try and make less-effective alternatives work. Patients with Medicare are particularly vulnerable, as they are often on numerous medications and at increased risk for diabetes-related complications. 

In response to these concerns, this week the Centers for Medicare & Medicaid Services (CMS) announced implementation in 2021 of a new Medicare Part D model, called the Part D Senior Savings Model, that will significantly reduce patients' out-of-pocket costs for insulin. Participating Part D prescription drug plans will provide Medicare patients access to a broad set of insulins at a maximum $35 copay for a month's supply. Under the regular Medicare Part D program, patient cost-sharing amounts change over time as they move through different phases of the Part D benefit. The new model will not only reduce out-of-pocket costs but will also make them more stable and predictable. One-third of Medicare beneficiaries have diabetes, and more than 3.3 million patients with Medicare rely on insulin to manage their condition. 

Family separation causes irreparable harm and should be ceased immediately

In response to recent reports of family separation at the border, the AMA, along with other medical organizations, sent a sign-on letter to the U.S. Department of Homeland Security (DHS) and U.S. Immigration and Customs Enforcement urging the administration to halt family separation, which is known to be irreparably detrimental and traumatic.

Recent reports indicate that the administration is forcing immigrating families at the border to choose between either remaining indefinitely detained with their children or relinquishing custody of them and being separated. This policy ignores the overwhelming evidence of harm from separating children from their parents as well as being detained.

A judge has recently ruled that Immigration and Customs Enforcement has not implemented sufficient measures to ensure that children and families in its detention centers are protected against COVID-19. Families in these centers are unable to practice social distancing and often lack frequent access to hand washing and cleaning supplies. Prior to COVID-19 physicians visiting family detention centers reported seeing sick children in need of urgent medical care. These facilities are not appropriate places for families, especially now.

The AMA spoke out strongly against the Zero Tolerance policy before, and watched in dismay as DHS carried it out, separating thousands of children from their parents. This failed policy harmed countless children and families and was implemented despite overwhelming evidence of harm to child health and development. The AMA is urging the administration to immediately abandon any policy that seeks to separate parents from their children and to put an end to family detention.

HHS must address funding distribution to native communities to fight COVID-19

A letter was sent to U.S. Department of Health and Human Services (HHS) Secretary Alex Azar urging his agency to address the dire situation that American Indians and Alaskan Natives are facing when it comes to confronting the COVID-19 pandemic. The AMA is very concerned that promised federal funding to native populations has either been very slow to be released or has not reached many tribal nations at all. Such assistance is vitally important to ensure that the tribes have the resources to mount a full response to the virus.

The Paycheck Protection Program and Health Care Enhancement Act included $11 billion for COVID-19 testing for states, localities, territories, tribes, tribal organizations, urban Indian health organizations or health service providers to tribes, of which not less than $750 million is to be allocated to tribes and tribal organizations. Such funding will provide critical support to develop, purchase, administer, process and analyze COVID-19 tests, conduct surveillance, trace contacts and related activities. However, there has been a delay in the distribution of these funds and so the AMA is urging that HHS rapidly address distribution of testing funding, Indian Health Service funding and provider relief funding to tribal hot spots and in rural areas.

Infection control resources are needed for physician practices to safely reopen

As physician practices across the country begin to reopen and see patients in person again, the threat of COVID-19 still looms, and therefore it is essential that physicians and their staff institute proper infection control procedures in their practices. Personal protective equipment (PPE) and other critical infection control supplies have been directed towards COVID-19 hotspots and to facilities treating COVID-19 patients, but as non-hospital physicians return to work and reopen practices, the need for these supplies is rapidly expanding to these other care sites.

The AMA sent a letter urging the administration to provide additional assistance to these non-hospital physicians in securing PPE, disinfectants and sanitizers. This assistance may include providing points-of-contact within each state or locality that can provide guidance to physicians as to where to secure these items, listings of legitimate manufacturers or suppliers that may be able to supply physician practices, or dedicating additional federal infection control resources to help supply these providers. The sustainability of the physician practices that are beginning to reopen is critical to not only addressing the pandemic but the future health of the nation. Adequate infection control resources for those practices is essential in minimizing risks to physicians, patients and staff.

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State Update

New research highlights need to remove barriers for patients with opioid use disorder

States need to continue efforts to remove prior authorization for treatment of opioid use disorder as well as better enforce network adequacy standards for addiction and mental illness, according to two new studies from the Legal Action Center and Center on Addiction.

The Spotlight on Legislation Limiting the Use of Prior Authorization for Substance Use Disorder Services and Medications examines state statutory standards that limit the use of prior authorization in both public and private insurance.  According to the study, "as of April 20, 2020, 21 states and the District of Columbia have enacted laws that limit public and/or private insurers from imposing prior authorization requirements on a SUD service or medication. Since 2019 alone, 15 jurisdictions enacted such laws." The AMA, in partnership with state and specialty societies, has supported many of those laws through AMA model legislation and direct advocacy.

In the Spotlight on Network Adequacy Standards for Substance Use Disorder and Mental Health Services, the organizations describe  the federal and state regulatory framework for defining and monitoring network adequacy for public and private health plans and offers recommendations to improve and enforce network adequacy standards.

Many of these recommendations align with those in the AMA-Manatt Health national policy roadmap, released last fall. Among its recommendations, the AMA called for policymakers to ensure adequate networks that allow for timely access to addiction medicine physicians and other health care professionals; this includes payment reforms, collaborative care models, and other efforts to bolster and support the nation's opioid use disorder treatment workforce.

View other recent research on the nation's opioid epidemic.

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Upcoming Events

How are physician practices working to address mental health care needs?

June 1-8: In a time when physical distancing and isolation are necessary responses to COVID 19, health care clinicians are rightfully concerned about their personal mental health as well as that of their colleagues, family members and patients. Join an online discussion and engage with expert panelists, learn and share best practices, and discuss how COVID-19 has affected behavioral health within your practice for you and your patients. The discussion runs June 1 – June 8.

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