March 27, 2020: State Advocacy Update

Many state policymakers, with guidance from medical societies, are working quickly to ensure continued access to care in this rapidly changing environment. The AMA has compiled a list of state policy options for governors, Medicaid directors and insurance regulators to consider as they address COVID-19. This document will be updated regularly as new ideas and best practices emerge.

Please continue sharing executive orders, bulletins and policy changes from your state with AMA staff so they can be made available as resources to other states.

This week, CMS approved 1135 (PDF) waivers to address COVID-19 in 21 additional states: Alabama, Arizona, California, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, New Hampshire, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, North Dakota, Rhode Island, South Dakota and Virginia. CMS had approved 1135 waivers in Florida and Washington last week.

The waiver approvals allow state flexibility in six main categories⁠—suspending prior authorization in fee-for-service Medicaid, extending pre-existing prior authorizations, waiving certain provider enrollment requirements, suspending PASRR Level I and Level II assessments, permitting services to be provided in alternative settings, and delaying timelines for fair hearings and appeals. A resource on these waivers is available through the AMA's COVID-19 resource center.

The AMA this week issued policy recommendations to help patients with an opioid use disorder (OUD), pain and harm reduction efforts amid the COVID-19 global outbreak. This is in addition to a new resource focused on substance use disorders. These recommendations and resources are to help guide policymakers and reduce stress being experienced by patients with an opioid use disorder and pain, as well as support efforts to continue harm reduction efforts in communities across the United States.

The policy recommendations focus on three areas:

• Ensuring access to care for patients with an opioid use disorder
• Protecting patients with pain
• Harm reduction to help prevent overdose and spread of infectious disease

The AMA, American Pharmacists Association (APhA) and American Society of Health-System Pharmacists (ASHP) issued a joint statement this week on inappropriate ordering, prescribing or dispensing of medications to treat COVID-19.

The statement highlights the important role that physicians, pharmacists and health systems play in being just stewards of health care resources during times of emergency and national disaster. The joint statement is in response to reports of some physicians prophylactically prescribing medications currently identified as potential treatments for COVID-19 (e.g., chloroquine or hydroxychloroquine, azithromycin) for themselves, their families or their colleagues.

There also are reports that some pharmacies and hospitals have been purchasing excessive amounts of these medications in anticipation of potentially using them for COVID-19 prevention and treatment. The organizations strongly oppose these actions.

"The AMA is calling for a stop to any inappropriate prescribing and ordering of medications, including chloroquine or hydroxychloroquine, and appealing to physicians and all health care professionals to follow the highest standards of professionalism and ethics," said AMA President Patrice A. Harris, MD, MA, to the New York Times.

The AMA and American Society of Addiction Medicine (ASAM) are recommending that states with declared states of emergency request blanket exceptions from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) that will help patients in an Opioid Treatment Program (OTP) during the COVID-19 pandemic.

The blanket exception will allow patients to obtain up to 28 days of take-home medication if they are stable, and up to 14 days for patients who are less stable but who the OTP believes can safely handle that level of medication. 

The AMA and ASAM recommend that state medical societies urge their State Opioid Treatment Authority to make this request. This is an important step to help patients with opioid use disorder during this time of national emergency, and the AMA and ASAM will continue to communicate further steps. Learn more (PDF).

• March 27, 2020: Advocacy spotlight on What's in the stimulus package 
• March 27, 2020: National Advocacy Update