The Regulatory Landscape
As the nation faces another surge in the SARS-CoV-2 pandemic, President-Elect Biden has signaled his focus on coordinating federal efforts to get the U.S. through this public health emergency and to successfully administer an approved vaccine to the population. The ACR anticipates most regulatory activity in the first six months of the year will be dedicated to pandemic response.
The Trump administration has been working on aspects of the president’s executive order on drug pricing. However, with only two months left, it is unlikely that any meaningful regulations will be finalized before the transition of power. We know the president-elect has indicated a need to address drug pricing and has voiced support for allowing Medicare to negotiate drug prices with manufacturers. This approach will likely be addressed in the legislative branch prior to any regulatory activities. The ACR team will be closely monitoring this issue.
Lastly, the calendar year 2021 Medicare Physician Fee Schedule reaffirmed the Centers for Medicare and Medicaid Services’ (CMS) finalized policy to revalue evaluation and management (E/M) codes that will yield an approximate average 16% increase in reimbursement for rheumatology, depending on the mix of services provided and where a practice is located. Specialties that face a decrease in reimbursement have undertaken significant efforts to influence legislative activity that would alter the reimbursement of E/M codes during this pandemic.
The ACR supports waiving budget neutrality to minimize the financial concerns of the procedural specialties while ensuring the much-needed improvements to E/M revaluation important to rheumatologists.
As this is being written, the E/M improvements are slated to take effect on Jan. 1. We don’t expect the Biden administration to rescind these code revaluations and look forward to working with the CMS in the new administration to ensure these improvements are made permanent to recognize the work of cognitive care specialties.
The State Landscape
The 2020 election had little impact on the balance of power in state legislatures. Republicans previously held 59 legislative chambers, while Democrats controlled just 39. Republicans added two chambers to their total and now control 61 legislative chambers, compared with the 37 now held by the Democrats. That change in party control is the smallest in state chambers since 1944. Neither a Democratic blue wave nor a Republican red wave materialized.
This unprecedented level of stability adds some predictability to the coming legislative session. We can be reasonably sure our priority legislation that failed to pass last session will be reintroduced in the coming year. Step therapy efforts in Tennessee and Massachusetts will most likely continue, along with the reintroduction of workforce legislation in Georgia and Washington. However, with COVID-19 continuing to weigh on state budgets, any legislative ask that comes with a price will be difficult to move forward.
