Access to Rule Makers
Regulatory advocacy—After laws are passed, many of the details that will have an impact on the rheumatology community are decided in rulemaking. At the federal level, for healthcare issues, this rulemaking occurs within the U.S. Department of Health and Human Services (HHS), in particular the Centers for Medicare & Medicaid Services (CMS), as well as the U.S. Food and Drug Administration (FDA) and other HHS agencies. The ACR has a professional team on staff who directly communicates on our behalf with regulators at these agencies.
The team not only submits formal comments on proposals, such as CMS-proposed changes to the payment structure of evaluation and management (E/M) codes or Part B drug delivery and payment, but also meets with staff and top officials at HHS and its agencies, including HHS Secretary Alex M. Azar.
Last year the ACR led a campaign that successfully stopped the CMS from collapsing E/M codes, with resultant payment cuts; these cuts would have hit cognitive specialties, such as ours, particularly hard. The ACR and its partners were also successful in stopping major cuts to Part B drug reimbursements. These efforts are all driven by the corps of dedicated volunteers from our Government Affairs Committee (GAC) and Committee on Rheumatologic Care (CORC), along with others.
The opportunity to join this effort is open to any of us willing to become more involved as an ACR volunteer on these committees.
For our patients, problems abound when it comes to obtaining timely & affordable access to the rheumatologic care they need.
Access at Home
State advocacy—Of course, it is not only federal policy that has an impact on our practices and our patients’ access to care. Many issues—in particular insurance requirements or sanctions, such as step therapy and non-medical switching of prescribed treatments—are primarily handled at the state government level. Through our professional staff, the ACR monitors these activities and gets involved in issues and legislative action in all 50 states and Puerto Rico.
We provide members access to ACR resources and updates at state meetings. We also send specific alerts to members when legislation is moving in their states. Thus, on the state level, there is also great opportunity for us to make a difference, especially by contacting state legislators or governors. The ACR can also facilitate meetings for our members with their representatives in their state capitals.
Additionally, one of the best ways to make a difference is through involvement in our state or local rheumatology societies. Through the efforts of these state and local rheumatology societies, the rheumatology community is making a difference and increasing access to care in many states. So far, 22 states have passed laws that provide exemptions and other patient protections to step therapy. And there are many more such state laws in the works!