June 2, 2023: National Advocacy Update

U.S. Surgeon General Vivek H. Murthy, MD, recently released “Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory,” (PDF) an advisory on the importance of understanding and addressing the mental health risks associated with social media use by children and adolescents.

In a statement supporting the advisory, AMA President Jack Resneck Jr., MD, said “With near universal social media use by America’s young people, these apps and sites introduce profound risk and mental health harms in ways we are only now beginning to fully understand. As physicians, we see firsthand the impact of social media, particularly during adolescence—a critical period of brain development. As we grapple with the growing, but still insufficient, research and evidence in this area, we applaud the Surgeon General for issuing this important advisory to highlight this issue and enumerate concrete steps stakeholders can take to address concerns and protect the mental health and wellbeing of children and adolescents. 

“We continue to believe in the positive benefits of social media, but we also urge safeguards and additional study of the positive and negative biological, psychological, and social effects of social media.” 

Dr. Resneck was also featured in the Surgeon General’s news release about the advisory. 

The next two in a series of “Medicare basics” issue briefs—intended to provide relatively straightforward explanations for policymakers and physician advocates about elements of the payment system and why they are in need of reform—are now available. 

• The Medicare Economic Index (PDF)
• Advancing value-based care with alternative payment models (PDF)

The full series can be found on this page.  

As a reminder, the following charts are also available to use in conversations with members of Congress to let them know the Medicare physician payment system needs reform to become a more sustainable, value-based system that better meets the needs of patients and physicians:   

• Medicare provider updates for 2023 (PDF)
• Medicare updates compared to inflation (with comparison) (PDF)
• Medicare updates compared to inflation (without comparison) (PDF)
• Key measures of practice expense in the Medicare Economic Index (PDF)
• Medicare spending per enrollee (PDF)
• Real (inflation-adjusted) Medicare physician spending per enrollee (PDF)

Recently, #FixPriorAuth champions in the House and Senate introduced “Dear Colleague” letters urging the Centers for Medicare & Medicaid Services (CMS) to strengthen and finalize proposed rules to improve the prior authorization process for physicians and patients.  

Due to overwhelming advocacy, the House and Senate sponsors were inundated with colleagues who wanted to sign on. In fact, the response has been so great that the sponsors have extended the sign-on deadline to June 9. 

Please urge your legislators to sign the #FixPriorAuth “Dear Colleague” letter today. 

The proposed rules align with many of the key provisions of the Improving Seniors' Access to Timely Care Act, which despite passing the House with over 300 cosponsors and having strong bipartisan support in the Senate, failed to receive a vote on the Senate floor leaving millions of patients without these prior authorization protections they so desperately need. 

These proposed rules would require Medicare Advantage plans to: 

• Identify and issue real-time decisions for routinely approved services 
• Adopt federally developed standardized electronic prior authorization processes 
• Provide greater transparency surrounding the development and use of utilization management guidelines 
• Provide rationales for denials 

As of May 19, 39 bipartisan Senators and 120 bipartisan House members had already cosigned this important letter to the U.S. Department of Health and Human Services and CMS related to these pending Medicare Advantage prior authorization regulations.    

There is still time—if you are tired of the unnecessary burden that prior authorization imposes on both physicians and patients, please contact your Representative and Senators and urge them to sign onto this important "Dear Colleague" letter today. 

This flawed system must be fixed, and now it is up to CMS to move electronic prior authorization forward and hold big insurance companies accountable for the undue burden their policies put on the country's health care system.

On May 23, the Biden Administration announced new efforts to “advance the research, development, and deployment of responsible artificial intelligence.” Relevant items in the announcement include:  

• Updated National Artificial Intelligence (AI) Research and Development Strategic Plan (PDF), encompassing an updated roadmap for federal investment in augmented intelligence 
• Office of Science and Technology Policy (OSTP) Request for Information (PDF), seeking stakeholder input on national priorities for mitigating AI risks, protecting rights and safety, and harnessing AI to improve lives 

The announcement comes during a time of heightened interest in and concern around AI after the release of OpenAI’s ChatGPT technology. The AMA is pleased to see the Administration’s increased focus on the responsible and safe deployment of AI technologies, while acknowledging additional action is needed to limit risks and ensure patient safety. The AMA is planning to submit comments urging increased focus on health care in government-wide efforts on AI and additional actions to ensure the responsible, ethical, safe and transparent deployment of health care AI.  

The AMA has also developed a ChatGPT primer for physicians with questions regarding the technology and use in medical practice. The primer, which outlines considerations for physicians and patients when considering utilizing the tool, is available (PDF).

At the first 2023 public meeting of the CMS Healthcare Common Procedure Coding System, the AMA provided information to demonstrate that self-measured blood pressure (SMBP) devices are an important tool for patients with hypertension to control their blood pressure and meet Medicare criteria for durable medical equipment. Physicians develop treatment plans for patients explaining what actions they should take if their SMBP readings are low, in the expected range or high.

These treatment plans include changes to sodium intake, alcohol consumption, exercise, fluid intake and medication that patients can make immediately if their SMBP readings are high or low. The AMA noted that the way patients with hypertension can self-manage their blood pressure based on SMBP readings is the same as how patients with diabetes self-manage their condition based on self-measured glucose readings. CMS is expected to issue a final decision on a benefit category for SMBP devices in Aug. 2023. 

On May 17, the AMA submitted a letter (PDF) to the U.S. Department of Agriculture (USDA) Food and Nutrition Service in support of a proposed rule designed to promote innovation, reduce burden and expand access to nutritious foods for participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The rule would do so by permanently removing barriers to online ordering and food delivery, transitioning to electronic benefit transfer (EBT), and allowing states to test mobile payment options, many of which enjoyed popular support when allowed on a temporary basis during the COVID-19 Public Health Emergency.  

If finalized, the rule would also create new flexibilities intended to expand the supply of WIC suppliers, such as allowing online-only and mobile retailers. The AMA expressed support for a number of the proposals, noting the importance of increasing consumption of nutritious foods and decreasing food insecurity, particularly in rural and historically underserved areas. 

CMS recently issued a National Coverage Decision (NCD) that establishes coverage under Medicare for power seat elevation for power wheelchairs as durable medical equipment (DME). Previously, seat elevation equipment was not considered DME under Medicare. This newly covered DME will allow beneficiaries to better transfer from wheelchairs and perform activities of daily living that requiring reaching from a wheelchair. The AMA supported coverage for seat elevation under Medicare (PDF) and continues to urge similar action for standing systems in power wheelchairs. 

A recording of the latest webinar in the AMA’s Advocacy Insights webinar series is now available.  

Patients deserve care led by physicians—the most highly educated, trained and skilled health care professionals. Through research, advocacy and education, the AMA vigorously defends the practice of medicine against scope of practice expansions that threaten patient safety.  

Learn more in this webinar about the importance of these issues to organized medicine from the AMA, the Medical Association of Georgia and Washington State Medical Association. Speakers discuss the unique challenges states encounter when facing multiple scope bills, how to overcome these issues and ways physician advocates can get involved.

As a reminder, beginning on June 27, physicians and others obtaining a new Drug Enforcement Administration (DEA) registration or renewing their current registration will be required to attest to requirements under the federal Medication Access and Training Expansion (MATE) Act. To ensure you have the most accurate information, the AMA encourages you to review the guidance issued by the DEA (PDF). 

While the AMA opposed the MATE Act’s 8-hour education requirement, the AMA also has worked to identify the educational resources that will satisfy the MATE Act. Please visit the AMA EdHub™ for courses that satisfy the MATE Act.  

The AMA asked DEA in a May 8 letter (PDF) to clarify if SAMHSA’s content guidance can be relied upon by medical organizations and physicians when determining if courses fulfill the MATE Act requirements. The AMA also asked that the DEA grant a one-year grace period for registrants to comply.

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