April 24, 2020: State Advocacy Update

In a letter to the CEO of the National Governors Association (NGA), the AMA called on governors to adopt civil immunity for physicians providing COVID-19-related care and those adhering to federal, state or local directives.

The AMA urged that such measures are necessary to preserve and expand the COVID-19 workforce, alleviate the strain on front-line physicians, remove obstacles for physicians seeking to fill workforce gaps, and safeguard physicians adhering to federal, state or local directives necessary to protect valuable health care resources and mitigate the spread of COVID-19.

The AMA provided clear guidance for governors moving forward, including recent Executive Orders in Connecticut and New York which provided immunity for care provided in support of the state's COVID-19 response, as well as recent legislation in New York which provided additional protections for care provided pursuant to state or federal directives.

Important liability protections were adopted this past week by state legislatures in Massachusetts and Wisconsin. On April 15, Wisconsin enacted A.B. 1038 (PDF), which provides civil immunity to health care professionals for care provided in good faith pursuant to a governmental directive, guidance or order related to the public health emergency. The legislation notes the civil immunity extends to services provided 60 days after the expiration of the public health emergency. 

On April 17, Massachusetts Governor Charlie Baker signed S. 2630 into law. S.2630 grants civil immunity to physicians and health care facilities for care provided during the COVID-19 emergency. The language is quite broad, extending immunity for any damages alleged to have been sustained by care provided in good faith pursuant to a COVID-19 emergency rule or where the care was impacted by the health care facility or health care professional's decisions or activities in response to or as a result of the COVID-19 outbreak or emergency rules.

The AMA joined the Indiana State Medical Association in seeking clarification from the state medical licensing board as to whether existing patients with chronic pain can be evaluated via telephone-only communication to satisfy state-specific controlled substances prescribing rules.

The new flexibility "may have been satisfied by Executive Orders (EO) 20-12 (PDF) and 20-13 (PDF), but we seek clarification – along with the Indiana State Medical Association – as to whether those EOs specifically supersede 844 Indiana Administrative Code 5-6-6 (PDF)," wrote AMA Executive Vice President and CEO James L. Madara, MD, in a letter to the Indiana Medical Licensing Board (MLB).

Dr. Madara also encouraged the Indiana MLB to "adopt, in full,guidance provided by the U.S. Drug Enforcement Administration (PDF) (DEA) to help ensure patients with pain receive the medications they need while simultaneously helping support public health measures to protect patient safety, reduce unnecessary travel and potential exposure to the COVID-19 virus." This includes urging the MLB to allow for "multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of a Schedule II controlled substance, subject to specific conditions being met."

If you have any specific examples of states/institutions taking action to help patients with chronic pain, please consider sharing them with the AMA. Information can be sent to [email protected].

Language always matters to addiction medicine physician Yngvild Olsen, MD, MPH: "Whether we are talking to our patients about medical concerns—or to policymakers about terminology—we must be clear, honest and accurate." Dr. Olsen explained that the emphasis on using correct terminology is one of the prime reasons why the American Society of Addiction Medicine (ASAM) updated its definition of "addiction" (PDF) as well as clarifying how people use the term "MAT."

Dr. Olsen commended the work of a special ASAM Task Force, which recommended that "addiction" should be viewed as a treatable medical disease that has many interrelated parts. The updated definition, she said, reflects that complexity:

"Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment and an individual's life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences. Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases."

Dr. Olsen also explained that while ASAM recognizes the widespread use of "MAT" to be defined as "medication-assisted treatment," it is important to update the term to be defined as "medications for addiction treatment."

"This is not about semantics," said Dr. Olsen. "This is about highlighting the fact that treatment is not just medication, and that addiction is a highly complex medical disease. As physicians, we want to ensure that complexity is understood. This is important for the current epidemic, but also for future generations of physicians. The updated definition captures the known factors that enter into the development of a diagnosable substance use disorder in any given individual. It highlights and concisely explains the underlying brain disease of addiction and acknowledges the symptoms that form the basis for the accompanying substance use disorder diagnoses that clinicians make."

Any change in health care-related terminology can disrupt care or policy as providers, policymakers and the public work to understand new or revised definitions. However, Dr. Olsen emphasized that ASAM's update only underscores already needed policy change.

"Like the AMA and the AMA Opioid Task Force, ASAM is focused on promoting evidence-based care and removing all barriers to that care," said Dr. Olsen. "This new definition doesn't change the fact that health insurance companies and state policy need to change to support physicians and patients. It doesn't change the fact that mental health and substance use disorder parity laws need to be enforced. It's simply an important advancement to help us all speak and work together for our patients."

• April 24, 2020: Advocacy spotlight on Highlights of this week's new supplemental COVID-19 bill 
• April 24, 2020: National Advocacy Update