March 21, 2025: National Advocacy Update

Merit-based Incentive Payment System (MIPS) eligible physicians have until 8:00 p.m. Eastern time on March 31 to submit their data or finish reviewing data that has been submitted on their behalf by a third-party vendor.

The Centers for Medicare & Medicaid Services (CMS) released a 2024 Traditional MIPS Data Submission User Guide (PDF) to provide details and screenshots for submitting MIPS data. Physicians who are unsure of their eligibility status should use the QPP Participation Status Tool. CMS encourages physicians to submit their 2024 MIPS performance period data early in case there are any issues. If physicians or their staff experience issues, they should contact the CMS QPP Service Center as soon as possible because there may be lengthy wait times. 

The AMA recently sent a letter (PDF) to CMS calling on the agency to reopen applications for the MIPS Extreme and Uncontrollable Circumstances (EUC) hardship exception for performance year 2024 due to the medication and intravenous (IV) fluid shortage emergency before the end of the data submission window on March 31. Unfortunately, physicians continue to face hardships due to the national shortage of IV fluids exacerbated by Hurricane Helene in Sept. 2024 and a severe winter respiratory virus season leading to lower supply and increased demand for these drug products.  

The AMA greatly appreciated CMS’ leadership in making the EUC readily available to MIPS-eligible clinicians in recent years due to the COVID-19 pandemic and the Change Healthcare cyberattack—two catastrophic situations that jeopardized the livelihood of private physician practices and access to care for older Americans and Americans with disabilities. The AMA urged the agency to utilize the same flexible approach to reduce the regulatory burden of MIPS data submission and hold harmless from MIPS financial penalties physicians who are continuing to make difficult decisions to limit resources that significantly impact patient care and, by extension, may impact MIPS performance. 

Representatives Brian Babin, DDS (R-TX) and Chrissy Houlahan (D-PA), as well as Senators John Boozman (R-AR) and Jacky Rosen (D-NV), recently introduced bipartisan federal legislation allowing physicians and dentists to qualify for interest-free deferment on their student loans while serving in a medical residency or dental internship. H.R. 2028/S. 942, the Resident Education Deferred Interest (REDI) Act, is one of the key bills associated with the AMA’s federal advocacy efforts related to medical students, residents and physician workforce improvements.   

“New physicians graduate medical school with, on average, over $205,000 in educational debt and are expected to start paying loans off even during residency,” said AMA President Bruce A. Scott, MD. “Allowing borrowers to defer student loan payments until they complete training would result in physicians starting out with less financial strain and better equipped to establish practices in rural and underserved areas. Thanks to the leadership of Reps. Brian Babin (R-Texas) and Chrissy Houlahan (D-Pa.), this one bill would remedy two ills in health care: It would increase access to care and reduce physician burnout. It deserves strong support.”  

AMA was pleased to join nearly 40 additional medical and dental organizations in support of this bipartisan bill. In addition, close to 300 medical students visited Capitol Hill on March 7 to discuss this important legislation (PDF) in Washington, DC, as part of the AMA’s 2025 Medical Student Advocacy Conference (MAC). AMA applauds the introduction of the legislation and appreciates the medical students for taking time to lobby in favor of this measure. 

In a March 13 letter (PDF) to the Department of Labor (DOL), Department of Health and Human Services (HHS) and the Department of the Treasury (TREAS), the AMA asked that the Trump administration vigorously defend the Mental Health Parity and Addiction Equity Act (MHPAEA) Final Rule against a lawsuit filed in Jan. 2025 by the ERISA Industry Committee (ERIC).  

President Donald Trump signed an update to the MHPAEA into law in 2020, and a new final rule implementing the law was issued in Sept. 2024. This final rule further advanced President Trump’s efforts to strengthen the fight against the nation’s overdose and death epidemic and helped improve access to evidence-based mental health and substance use disorder (MH/SUD) care for tens of thousands of Americans. ERIC’s lawsuit threatens to undo considerable positive progress made by the Trump administration. 

The AMA noted three compelling reasons that a strong defense of MHPAEA regulations aligns with President Trump’s efforts to protect patients with a MH/SUD condition:  

• Enforcement of MHPAEA will help reduce deaths from untreated SUD and mental illness. 
  MHPAEA and its implementing regulations help ensure that medications for opioid use disorder (MOUD) remain a core treatment and meaningful benefit for patients. The AMA wants to protect access to MOUD and preserve patients’ access to these life-saving medications.  

• Health insurance companies must be held accountable for compliance obligations that have long been mandated by law.
  Multiple reports and investigations have consistently found widespread failure of health insurance companies to comply with parity requirements. Meaningful enforcement of these important legal requirements is overdue. Each compliance failure is an example of how health insurance companies make it more difficult for individuals with an MH/SUD condition to access or continue care—resulting in patient harm, suffering and death. 

• Defending MHPAEA increases transparency and reduces administrative waste.
  MHPAEA and the final rule increase transparency and reduce administrative waste in government—and for physicians. The industry’s tactics result in state and federal regulators spending thousands of hours trying to uncover the facts and obtain details to determine parity compliance. MHPAEA provides the DOL and other agencies with important tools to counteract the industry’s tactics, including the statutory authority to evaluate “material differences” between MH/SUD benefits and medical surgical benefits. 

On March 15, the AMA submitted detailed policy recommendations (PDF) on the regulation of augmented intelligence (AI) to the Office of Science and Technology Policy (OSTP). The recommendations were submitted in response to a request for information from OSTP for detailed recommendations for the development of the administration’s AI Action Plan. The AI Action Plan was put forth in one of President Trump’s initial executive orders, seeking to “define the priority policy actions needed to sustain and enhance America's AI dominance, and to ensure that unnecessarily burdensome requirements do not hamper private sector AI innovation.” 

AMA comments focused on the need to prioritize focus on health care AI and to ensure that AI-enabled health care technologies are appropriately regulated to ensure performance and safety. The comments highlighted new AMA policy (PDF) in this space, which calls for a comprehensive national strategy for oversight of health care AI and promotes physician involvement in the design, development and deployment of AI. Specific recommendations included by AMA include a focus on AI transparency requirements, liability and accountability, data privacy and security, and payer use of AI. 

In a new comment letter (PDF) to the Drug Enforcement Administration (DEA), the AMA offers general support for its proposed special telemedicine registration framework but also expresses concerns about several elements of the proposal. The DEA proposes three categories of “special registration” for prescribing controlled substances: one for physicians and qualified health professionals who prescribe controlled substances in Schedules III-V; one for psychiatrists, hospice medicine and other physicians to prescribe Schedule II-V controlled substances via telemedicine; and one for covered online telemedicine platforms to dispense Schedule II-V controlled substances. The special registrations would also require state telemedicine registrations for every state in which a patient is treated by the special registrant. Importantly, these special registrations would only be required when the prescriber has never conducted an in-person medical evaluation of the patient prior to issuing the prescription. Physicians who prescribe controlled substances based on telemedicine encounters after at least one in-person visit with the patient would not need to utilize the special registration process. 

This new framework is a significant improvement from the previous 2023 DEA proposed rule requiring in-person visit within 30 days for patients receiving prescriptions for Schedule III-V medications and with no allowance for Schedule II prescribing unless there had been an in-person visit. Nonetheless, the AMA comments express opposition to several elements of the proposal. There are two arbitrary 50% limits proposed: clinicians with an in-person practice would not be eligible for a special registration if more than 50% of their controlled substance prescriptions are based on telemedicine encounters nor could telemedicine Schedule II prescriptions be more than 50% of all monthly Schedule II prescriptions. The AMA recommends that these proposals be withdrawn. 

AMA comments also urge the DEA not to allow special telemedicine registration eligibility for clinicians that it defines as “board-certified mid-level practitioners.” The AMA also expresses concern and recommends alternatives to the DEA proposals (1) to require special registrants to check prescription drug monitoring program (PDMP) data for every state beginning in three years, and (2) to require physicians to use a specific procedure for photographic verification of patient identities at every telemedicine visit. Last fall, the DEA extended the COVID-era telemedicine flexibilities it adopted in 2020 for prescribing controlled substances when there has not been an in-person visit through the end of calendar year 2025. The timeline for issuance of a final rule and implementation of the special registration proposals is not clear at this time but the AMA will continue to closely monitor these evolving policies.