April 19, 2024: National Advocacy Update

As the second session of the 118th Congress heats up, the AMA has submitted a number of statements for the record in response to a variety of hearings held in both the U.S. House of Representatives and Senate. First, the AMA submitted comments (PDF) on March 26 in follow-up to a March 12 House Ways and Means Committee hearing entitled, “Enhancing Access to Care at Home in Rural and Underserved Communities.”

In addition, the AMA submitted comments (PDF) to the House Energy and Commerce Committee in response to an April 10 hearing entitled, “Legislative Proposals to Support Patient Access to Telehealth Services,” which explored many of the same themes covered in the Ways and Means hearing. Finally, the AMA provided the Senate Finance Committee with detailed written remarks (PDF) to coincide with an important April 11 bipartisan hearing entitled, “Bolstering Chronic Care through Medicare Physician Payment.”

AMA’s comments (PDF) to the House Ways and Means Committee focused on telehealth, reducing administrative burdens to physicians and key tenets of Medicare payment reform. In particular, the statement for the hearing record pushed federal lawmakers to support H.R. 4189/S. 2016, the CONNECT for Health Act, and H.R. 7623, the Telehealth Modernization Act (TMA). The CONNECT for Health Act and the TMA are both bipartisan bills that, among other things, permanently repeal the Medicare telehealth geographic and originating site restrictions, while the TMA goes one step further by continuing audio-only telehealth flexibilities beyond Dec. 31, 2024. AMA also cautioned Committee members about establishing unnecessary telehealth guardrails, such as in-person visit requirements or practice audits, and actively opposed H.R. 1746, the Preventing Medicare Telefraud Act. The statement for the hearing record also presses committee members to expeditiously pass legislation to extend the current Acute Hospital Care at Home (AHCaH) policy for at least an additional five years, as well as support H.R. 6487, the No Fees for EFTs Act, which would prevent health plans from charging physicians’ fees in the range of two to five percent to receive payment via electronic fund transfers. Finally, the statement to the Ways and Means Committee outlined AMA’s strong support for H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which provides physicians with an annual inflationary update in Medicare tied to the Medicare Economic Index, H.R. 6371, the Provider Reimbursement Stability Act, which reforms budget neutrality requirements in the Medicare Physician Fee Schedule, and the need to overhaul the Merit-based Incentive Payment System (MIPS).

Many of these same themes were covered in the AMA statement (PDF) to the House Energy and Commerce Committee that corresponded with the April 10 telehealth hearing.

Finally, comments (PDF) to the Senate Finance Committee echoed the strong need for Medicare payment reform and continued telehealth flexibilities. The statement also raises awareness about AMA’s efforts to better combat chronic diseases via elimination of patient cost-sharing requirements in Chronic Care Management (CCM) codes, passage of H.R. 766/S. 114, the Dr. Michael C. Burgess Preventive Health Savings Act, and continuing the Hospital-at-Home program. Finance Committee Members are also encouraged to pass H.R. 7856/S.4094, the PREVENT Diabetes Act, which makes the Medicare Diabetes Prevention Program permanent and expands its coverage to include virtual diabetes prevention platforms.

The AMA appreciates Congress exploring this variety of important health care topics and looks forward to working with members of the House and Senate to bring these various policies to reality in the 118th Congress.

On April 11, the AMA released (PDF) a new set of concrete steps that the administration and Congress can take to improve maternal health outcomes in the United States.

To bolster federal and state efforts and provide recommendations to advance maternal health, the AMA has worked collaboratively over the last year with a variety of members of the Federation of Medicine, including relevant specialty societies, state medical associations and physicians from rural areas.

More women in the U.S. die from pregnancy-related complications than in any other developed country. According to the Centers for Disease Control and Prevention, about 1,205 pregnancy-related deaths occurred in 2021, and 80% of these deaths were preventable. Major disparities in maternal mortality exist, with Black women being three to four times more likely than non-Hispanic white women to die due to pregnancy-related complications and American Indian or Alaska Native women being more than twice as likely as non-Hispanic white women to die due to pregnancy-related complications. As such, the AMA believes the federal government should take concrete actions to reduce and prevent the rising rates of maternal mortality and serious or near-fatal maternal morbidity.

The AMA recommends that the following actions be implemented to address the leading causes of maternal mortality and morbidity:

• Promote telehealth and home monitoring during pregnancy and the postpartum period and address barriers to providing remote patient care. Hypertensive disorders of pregnancy are one of the leading causes of pregnancy-related deaths that occur in the first six weeks after delivery. The AMA encourages the administration to help ensure comprehensive Medicaid coverage of virtual maternal health care services.
• Expand the Maternal Health and Obstetrics Pathway and ensure that additional maternal health pathways can be created for rural and urban training for OBGYNs, maternal-fetal medicine specialists, family physicians, and other physicians who are likely to provide maternal care.
• Provide the financial resources necessary to implement the practices recommended by the Alliance for Innovation for Maternal Health and seek input from physicians providing obstetrical services about the barriers to implementing these patient safety bundles.
• Increase payments from Medicaid programs and commercial insurance plans for maternity care services, particularly services for individuals with complex needs and those who have difficulty accessing and utilizing traditional services.
• Implement the recommendations (PDF) of the HHS Interagency Pain Management Best Practices Task Force, which highlight pregnant women as a special population.
• Grow and retain the physician workforce to provide complex care to higher risk pregnant, birthing, and postpartum patients. This includes increasing compensation for Indian Health Service (IHS) physicians as well as increasing funding for the IHS Maternal Child Health program to increase access to OBGYNs and maternal-fetal medicine specialists.

To learn more about the AMA’s extensive and ongoing maternal health advocacy, please visit the AMA website. Additionally, view the recording of the AMA’s latest Advocacy Insights webinar—“What we need to do—now—to address the maternal health crisis”—for more information on the AMA’s recommendations.

On April 2, the Department of Health and Human Services (HHS) released a new white paper outlining potential policy considerations to help mitigate and prevent drug shortages in the U.S. The paper highlights factors that contribute to drug shortages, such as:

• Economic factors stemming from low or unpredictable sales volumes, low generic drug prices and profit margins, uncertain revenue streams, and high costs of manufacturing
• Concentration in pharmaceutical purchasing and distribution
• Economic pressures on purchasers such as hospitals and health systems that lead to certain purchasing patterns

According to the report, this lack of economic stability consistently reduces investment in facilities and redundance efforts to help ensure manufacturing lines are kept in continuous service.

The white paper lays out two marquee policy recommendations:

• Creation of a Manufacturer Resiliency Assessment Program (MRAP) to measure resilience of drug manufacturers and increase transparency to the supplier base
• Creation of a Hospital Resilient Supply Program (HRSP) to establish demand incentives and/or penalties to help facilitate hospital purchasing that prioritizes resilience

The white paper also proposes a number of legislative initiatives that could further help mitigate shortages and create supply chain resiliency, including new requirements to notify FDA of certain factors that may impact drug availability and other efforts that would allow HHS to increase involvement in development of domestic manufacturing capacity.

The AMA continues to carefully monitor drug shortages and support advocacy activities promoting policy changes to help mitigate shortages. The AMA has recently joined the Drug Shortages Task Force—a coalition of physician, pharmacy and patient groups—to develop new policy recommendations on the drug shortages issue.

The Office of the National Coordinator for Health IT (ONC) released two documents that are open for public comment: the draft 2024–2030 Federal Health IT Strategic Plan (PDF) and a white paper on Health Equity by Design (PDF).

The draft strategic plan is a comprehensive strategy developed by ONC in collaboration with more than 25 federal organizations that is deliberately outcomes-driven, with goals and objectives focused on improving access to electronic health information, delivering a better, more equitable health care experience, and modernizing our nation’s public health infrastructure. Of the plan’s four goals, goals 1-3 focus on plans to improve the experiences and outcomes for health IT users, while goal 4 addresses the policies and technologies needed to support those users. The public comment period on the draft Plan ends on May 28.

With April serving as National Minority Health Month, HHS is also highlighting its commitment to promoting health equity and combating health disparities. Advancing data equity is an important piece of the department’s health equity commitment, and HHS is using its Health Equity by Design white paper to finalize a vision that helps ensure that health equity is “baked in” when new technology is designed, developed and deployed. ONC wants to go beyond merely using health IT to reduce individual disparities, but attempts to use health IT to improve systemic data structures for identifying and quantifying unknown and hidden disparities as well. Public feedback on the white paper is due on June 10.

In 2023, the AMA was pleased to provide comments and recommendations (PDF) to the U. S. Department of Agriculture, Food, and Nutrition Service (FNS) in response to proposed revisions to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Packages. This month the FNS published their updates to the WIC food packages, many of which aligned with AMA recommendations. The following is a sampling of just a few of the changes that were made to the WIC program and how they compare to AMA recommendations.

CHANGE 1

The AMA asked for: Permanent increases in the fruit and vegetable benefit and allowance of cash value voucher (CVV) amounts to be used for infants six months and older to purchase fruits and vegetables.

The WIC Package final rule includes: The following base monthly amounts, adjusted annually for inflation:

• Children: $24
• Pregnant, postpartum: $43
• Breastfeeding: $47

Increased CVV substitution amounts for infant fruits and vegetables, allowing forms other than fresh, and lowering the minimum age for infants to receive a CVV from 9 to 6 months.

CHANGE 2

• The AMA asked for: Inclusion of plant-based alternatives to cow’s milk that meet federal WIC nutrient specifications.
• The WIC Package final rule includes: Establishment of an added sugars limit for plant-based milk alternatives of ≤ 10 grams per 8 ounces and addition of plant-based yogurts and plant-based cheeses as substitution options for milk.

CHANGE 3

• The AMA asked for: Increased support for breastfeeding among WIC-participants, such as in the form of breastfeeding consultations and support groups.
• The WIC Package final rule includes: Creation of a separate and enhanced food package for partially breastfeeding participants rather than issuing the same package provided to pregnant participants.

CHANGE 4

• The AMA asked for: Additional guidance and specific recommendations on which nut and seed butters would meet the same nutrient requirements as peanut butter or legumes.
• The WIC Package final rule includes: Allowance of WIC state agencies the option to authorize nut and seed butters as a substitute for peanut butter.

The AMA believes that there should be increased endometriosis research that addresses health disparities in the diagnosis, evaluation and management of endometriosis, as well as increased funding for endometriosis-related research for patients of color. As such, on April 4, the AMA sent letters of support for S. Res. 90 (PDF) and H. Res. 217 (PDF). These bipartisan resolutions encourage the administration to provide information to women, patients and health care providers concerning endometriosis, including available screening tools and treatment options, and ask the administration to conduct additional research on endometriosis and possible clinical options. If passed these bills will help address health disparities and increase funding for endometriosis research.

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