The ACR’s pediatric reimbursement resolution builds on work at last year’s Interim HOD Meeting on Resolution 817, Expanding AMA Payment Reform Work and Advocacy to Medicaid and Other Non-Medicare Payment Models for Pediatric Health Care and Specialty Populations. That resolution, supported by the ACR and passed by the HOD, has the AMA prioritizing improving Medicaid payment rates due to their critical impact on patient care and patient access to care. Additionally, it:
- Added to AMA policy new support for demonstration projects, carve outs and adjustments for pediatric patients and services provided to pediatric patients within the payment reform arena;
- Called for the AMA to work with societies on payment models and to call for related payment models to be developed by the Center for Medicare & Medicaid Innovation (CMMI);
- Will have the AMA support appropriate demonstration projects, carve outs and adjustments for pediatric patients and services provided to pediatric patients within the payment reform arena; and
- Will have the AMA support and collaborate with state and national medical specialty societies and other interested parties on the development and adoption of physician-developed alternative payment models for pediatric healthcare that address the distinct prevention and health needs of children.
Rheumatology Practice & Access to Care
The ACR’s delegation is also co-leading, with the American Society of Clinical Oncology (ASCO), four resolutions addressing issues that impact rheumatology practices and patient access to care:
- Resolution 232, Medicare Advantage Part B Drug Coverage, would have the AMA advocate with Congress, through the appropriate oversight committees, and with the Centers for Medicare & Medicaid Services (CMS) to require that Medicare Advantage (MA) plans cover physician-administered drugs and biologics in such a way that the patient out-of-pocket cost is the same as or less than the amount that a patient with traditional Medicare plus a Medigap plan would pay;
- Resolution 233, Prohibiting Mandatory White Bagging, would have the AMA urge state and federal policymakers to enact legislation to prohibit the mandatory use of white bagging;
- Resolution 234, State Prescription Drug Affordability Boards—Study, would have the AMA conduct a study to determine how upper payment limits (UPLs) established by state prescription drug affordability boards (PDABs) will impact reimbursement for physician-administered drugs and what impact state UPLs will have on patient access to care, and to report the results of this study to the AMA HOD in 2025; and
- Resolution 707, Alternative Funding Programs, would have the AMA educate employers, benefits administrators and patients on alternative funding programs (AFPs) and their negative impacts on patient access to treatment and advocate for legislative and regulatory policies that would address negative impacts of AFPs.
Additionally, with nearly 250 resolutions and reports filed for consideration at the AMA’s June HOD meeting, several topics that impact rheumatology will see extensive debate and related action by the AMA HOD. Some topics slated to be addressed include:
