Feb. 9, 2018: State Advocacy Update

The AMA launched a new effort this week to gather physician and patient stories about obstacles they encounter when trying to access multidisciplinary pain care and comprehensive treatment for a substance-use disorder. As part of the AMA opioid microsite, physicians can share their stories about treatment, using prescription drug monitoring programs, co-prescribing naloxone and more. The new initiative also includes a digital toolkit where medical societies can download social media messages, graphics, blog posts and other information for their own use.

"We know that prior authorization and other administrative tools used by health insurers can impede appropriate, necessary care—resulting in unnecessary harms and sometimes fatal consequences—for a patient with a substance-use disorder," said Patrice A. Harris, MD, chair of the AMA Opioid Task Force. "These stories will enable us to identify the unique challenges faced by patients and physicians and share them with health insurers and policymakers in support of solutions to increase access to care. Without proper treatment and access to care, this crisis will only get worse."

For information about how your medical society can become part of the Share Your Story initiative, please contact Daniel Blaney-Koen, AMA senior legislative attorney.

Indiana has become the second state to gain federal approval to implement a work requirement for Medicaid beneficiaries. In 2015, the Obama administration blocked a similar waver proposal to require work as a condition of Medicaid eligibility, and instead the state implemented a voluntary work referral program.

Under the new waiver program, adults under the age of 60 will be required to participate in 20 hours per week of community-engagement activities. The requirement can be met through employment, job search activities, education, volunteering or public service, caregiving or other qualified activities. Review of a beneficiary's activities will occur every December and compliance will be required for 8 months of the year. Beneficiaries who do not meet the work requirements will be disenrolled.

Exempt populations include pregnant women, beneficiaries identified as medically frail, beneficiaries undergoing active treatment for a substance use disorder, full- and part-time students, primary caregivers of a child under six or a disabled dependent, the homeless, individuals incarcerated within the last six months, and beneficiaries with a temporary illness or incapacity as documented by a third party.

The AMA opposes work requirements as a condition of Medicaid eligibility. For information, please contact Annalia Michelman, AMA senior legislative attorney.

Quite a few states are seeking to join the 22 states that are currently members of the Interstate Medical Licensure Compact. The compact is a licensing option under which qualified physicians seeking to practice in multiple states would be eligible for expedited licensure in all participating states. The AMA supports the compact because it streamlines the process for physicians to obtain licenses in multiple states. This expedited process will help facilitate license portability and allow physicians to practice medicine—including telemedicine—in a safe and accountable manner while protecting patients and expanding access to care, particularly in rural and underserved areas.

The AMA submitted testimony in Georgia (PDF) and Maryland (PDF) to this effect, and encouraged legislators there to join. Please contact Kristin Schleiter, AMA senior legislative attorney, for support in passing compact legislation in your state.

Last week, the AMA submitted testimony (PDF) in Vermont, urging legislators to not weaken state law requiring advanced practice registered nurses (APRN) to practice in collaboration with a physician for the first two years or 2,400 hours of clinical practice. APRNs' education and training simply does not prepare APRNs to practice without physician collaboration, the AMA stressed, especially for new APRNs, for which physician collaboration and mentorship are essential to gain the clinical expertise that is critical to success.

This collaboration is essential to ensuring quality patient care, and deserves careful consideration before any collaboration requirements are removed. Please contact Kristin Schleiter, AMA senior legislative attorney, for assistance with APRN independence legislation in your state.

• Feb. 9, 2018: Advocacy spotlight on Congress approves fifth spending bill  
• Feb. 9, 2018: National Advocacy Update