- New tool to illustrate mental health and substance use coverage metrics
- H.R. 7961, the “H-1Bs for Physicians and the Healthcare Workforce Act”
- HHS Office for Civil Rights releases HIPAA Security Rule risk management video
- CMS: Expand mandatory comprehensive care for joint replacement model on a national scale
- More articles in this issue
New tool, developed in collaboration with AMA, to illustrate mental health and substance use coverage metrics
The AMA, along with The Kennedy Forum, Third Horizon, the American Psychological Foundation (APF), and Ballmer Group, collaborated to develop the Mental Health Parity Index to provide real-time commercial insurance data on mental health (MH) and substance use disorder (SUD) coverage metrics.
The AMA has long advocated for MH/SUD parity, working to ensure that insurance companies cover these services no more restrictively than they cover medical/surgical (M/S) benefits. With the issuance of an updated Mental Health Parity and Addiction Equity Act (MHPAEA) Final Rule in Sept. 2024, the AMA voiced support for multiple provisions that will increase transparency, oversight, and enforcement of prior authorization and network adequacy to prevent discriminatory coverage limitations.
For the first time, with the use of the Mental Health Parity Index, health insurance companies’ own data can be used to more accurately pinpoint where increased access to care is needed and where payment disparities exist in real time. The Index’s takeaways for the four largest commercial insurance plans indicate that 43 states show disparities in access to in-network mental health care and treatment for substance use disorders relative to physical health. In addition, patients in 7 of 10 counties face challenges finding in-network clinicians for mental health care and substance use disorder treatment compared to physical health clinicians.
Read the press release for additional information.
AMA funnels more grassroots support for H.R. 7961, the “H-1Bs for Physicians and the Healthcare Workforce Act”
The grassroots effort to urge Congress to pass H.R. 7961, the “H-1Bs for Physicians and the Healthcare Workforce Act,” continues to progress following the distribution of two letters of support. On April 13, the American Medical Association (AMA) penned a letter (PDF) to the lead bill sponsors, specifically Reps. Mike Lawler (R-NY), Sanford D. Bishop, Jr. (D-GA), Maria Elvira Salazar (R-FL), and Yvette Clarke (D-NY), in support of the legislation. In addition, the AMA joined more than 40 national medical specialty societies, patient advocacy, disease and health care advocacy organizations as cosigners of a separate coalition letter (PDF) sent to the bill sponsors on April 15 in support of H.R. 7961.
On Sept. 19, 2025, the Trump Administration issued a Presidential Proclamation requiring employers to pay a $100,000 fee for each new H-1B visa application for prospective employees not already in the United States. While the proclamation provides the Secretary of the Department of Homeland Security (DHS) with the authority to exempt certain individuals or entire professions, when it is in the national interest, no physicians or other health care workers have been granted exemptions to date.
The AMA letter of support highlights that H.R. 7961 would,
“Exempt physicians and health care workers involved in direct patient care from the $100,000 fee implemented by the Proclamation entitled, ‘Restriction on Entry of Certain Nonimmigrant Workers.’ The legislation would also prevent future fees from exceeding limits previously established by Congress following enactment of the Immigration and Nationality Act, thus ensuring greater predictability for employers looking to hire physicians and other health care workers via H-1B visas.”
The coalition letter also points out that, “The ‘H-1Bs for Physicians and the Healthcare Workforce Act’ is a narrowly tailored, commonsense solution. The bill ensures that physicians and other essential health care providers are not unnecessarily swept into a fee structure designed to address other workforce sectors.”
Following its introduction, H.R. 7961 generated strong coverage from national and health care trade media, including the New York Times, Law360 and Fierce Healthcare. The legislation has already secured 24 bipartisan cosponsors (PDF) (as of April 15) and the AMA is working diligently to introduce a Senate companion bill. The AMA commends Reps. Lawler, Bishop, Salazar, and Clarke for their bipartisan leadership.
HHS Office for Civil Rights releases HIPAA Security Rule risk management video
The Department of Health and Human Services (HHS) Office for Civil Rights (OCR) published an educational video for Health Insurance Portability and Accountability Act (HIPAA) Covered Entities and Business Associates on the HIPAA Security Rule Risk Management requirement.
All HIPAA-regulated entities must meet both risk management and risk analysis requirements to comply with the law. For risk management, entities must implement security measures sufficient to reduce risks and vulnerabilities to reasonable and appropriate levels. Risk analysis requires entities to conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information (ePHI) held by HIPAA-regulated entities. Risk analysis results should act as an input to an entity’s risk management process and help inform risk management decisions.
OCR expects that physicians and other providers will treat effective risk management and risk analysis as essential components of both HIPAA Security Rule compliance and broader cybersecurity preparedness. Risk management is a critical step not only for safeguarding ePHI, but also for defending against cyberattacks.
More information on the HIPAA Security Rule and risk management and risk analysis requirements are available online.
CMS proposes to expand mandatory comprehensive care for joint replacement model on a national scale
CMS is proposing to expand the mandatory Comprehensive Care for Joint Replacement (CJR) Model nationwide through the Fiscal Year (FY) 2027 Hospital Inpatient Prospective Payment System (IPPS) proposed rule. If finalized, the model would begin on Oct. 1. 2027 and would be the first mandatory national CMS episode-based model.
The model would hold eligible hospitals responsible for Medicare spending for lower extremity joint replacement surgery, the hospital or outpatient stay, and the first 90 days of recovery, including follow-up care such as physical therapy. With few exceptions, the episode would include all related items and services paid under Medicare Part A and Part B for eligible patients. Following the end of each performance year, actual total spending for the episode would be compared to a target price and, depending on quality and spending performance, participating hospitals would receive an additional payment from Medicare or be required to repay a portion of the episode spending. The national model would feature certain changes from the model test, including updates to payment and risk adjustment policies.
The CMS Innovation Center tested the CJR Model from April 2016 through Dec. 2024. It was originally implemented in 67 metropolitan statistical areas (MSA) and became mandatory in 34 of those MSAs in 2018. In 2021, eligible hospitals in one of the 34 required MSAs were required to participate in the 3-year extension. Unlike the test, low volume and rural hospitals would not be excluded under the new national model, but a five percent stop loss would be applied to certain hospitals including those with a high proportion of duals, “geographically rural” hospitals, Medicare-dependent, and sole community hospitals. Critical access hospitals and rural emergency hospitals would be exempt because they are not paid under the IPPS or OPPS. Hospitals participating in the Transforming Episode Accountability Model (TEAM) and those located in Maryland would also be excluded.
Comments on the IPPS proposed rule are due June 9, 2026.
