How you can help: Watch for call-to-action alerts for sending letters to CMS to support the complex add-on code and maintain valuation of cognitive specialties.
The win: The Pediatric Subspecialty Loan Repayment Programs (PSLRP) was authorized by the CARES Act legislation; however, it is not yet funded. The Resident Physician Shortage Reduction Act (HR 1763/S. 348) made progress, with 240 cosponsors.
Context: Pediatric rheumatology fellowship slots are filled around 50% of the time, while adult rheumatology fellowship slots must turn away applicants. The final COVID package of 2020 repealed the cap on Medicare support for graduate medical education (GME) instituted by the Balanced Budget Act of 1997 and added 1,000 new Medicare-funded GME full-time equivalent residency positions, beginning in fiscal year 2023. The PSLRP legislation addresses the pediatric workforce shortage by providing funds for loan forgiveness when certain metrics are met.
How you can help: Watch for calls for sending letters to Congress encouraging support of these policies.
Telehealth: Parity & Access
The win: The CMS and commercial insurance companies increased reimbursement for telehealth visits to match those of in-person visits during the public health emergency (PHE). Many states followed suit and increased telehealth reimbursement in Medicaid and some state-regulated health plans.
Context: Prior to 2020, telehealth was a novelty practiced by few providers. As in-person visits plummeted during the PHE, providers quickly learned and implemented procedures to treat patients virtually. Prior to the pandemic, reimbursements were quite low for telehealth, despite acuity and providers’ cognitive efforts. The CMS, followed by commercial insurers, increased the reimbursement for telehealth to match in-person visits for audio-visual and, later, audio-only visits. The CMS recognizes that telehealth is here to stay when this PHE is over. They have begun to add additional services to the list of covered services for telehealth for post-pandemic treatment.
How you can help: Watch for calls to action for sending letters to Congress or the administration to continue to expand telehealth flexibilities and ensure appropriate reimbursement. Also, watch for state action alerts to send letters to state legislators and executive office officials.
Utilization Management & Reimbursement: Step Therapy, Prior Authorization & DXA Scans
The wins: For step therapy, H.R. 2279 has 157 bipartisan co-sponsors and the companion Senate bill, S. 2546, has 18 bipartisan co-sponsors. For prior authorization, H.R. 3107 has 280 bipartisan co-sponsors. For DXA reimbursement, H.R. 2693 and the companion bill S. 283 have bipartisan support.