May 29, 2020: National Advocacy Update

The AMA sent a letter to Representatives Schrier, Roe, Morelle and Van Drew in addition to Senator Smith expressing strong support for H.R. 6644, "The Health Care at Home Act." Currently physician practices are working hard to quickly establish the ability to decrease patients' risk of exposure to COVID-19 by providing care to patients through virtual means.

However, the ability to access needed care through telemedicine remains limited for many patients, which is why legislative approval for health plans regulated by ERISA is needed to ensure coverage of telehealth services. Telehealth services have never been more vital, and are especially important for the elderly, individuals with chronic conditions and patients with mental health needs.

While some health plans have taken voluntary steps to increase access to telehealth services, overall access remains limited and there is a lack of uniformity among plans governed by ERISA. This leaves physicians and other health care providers unsure of whom, and under what conditions, they are permitted to provide medical services via telehealth. This has led to a disruption in continuity of care and created additional anxiety and confusion for patients during an already stressful time.

Similar to the guidelines provided by Medicare, the AMA is advocating that telehealth coverage is expanded to ERISA plans. As outlined in H.R. 6644, this coverage should include requiring that services provided via telehealth be reimbursed at the same rate as in-person services, allowing for the use of expanded modalities for the provision of telehealth to include telephone visits and common audio-video technology, as well as enabling physicians to offer telehealth services to new and established patients. These changes will make it possible for ERISA plan patients to access the care they need without having to increase their risk of exposure by traveling to their physician's office or a hospital.

The AMA has been concerned for several years about the cost of insulin for patients with diabetes. Physicians have reported that their patients are rationing their insulin therapy due to its cost or being forced to try and make less-effective alternatives work. Patients with Medicare are particularly vulnerable, as they are often on numerous medications and at increased risk for diabetes-related complications. 

In response to these concerns, this week the Centers for Medicare & Medicaid Services (CMS) announced implementation in 2021 of a new Medicare Part D model, called the Part D Senior Savings Model, that will significantly reduce patients' out-of-pocket costs for insulin. Participating Part D prescription drug plans will provide Medicare patients access to a broad set of insulins at a maximum $35 copay for a month's supply. Under the regular Medicare Part D program, patient cost-sharing amounts change over time as they move through different phases of the Part D benefit. The new model will not only reduce out-of-pocket costs but will also make them more stable and predictable. One-third of Medicare beneficiaries have diabetes, and more than 3.3 million patients with Medicare rely on insulin to manage their condition. 

In response to recent reports of family separation at the border, the AMA, along with other medical organizations, sent a sign-on letter to the U.S. Department of Homeland Security (DHS) and U.S. Immigration and Customs Enforcement urging the administration to halt family separation, which is known to be irreparably detrimental and traumatic.

Recent reports indicate that the administration is forcing immigrating families at the border to choose between either remaining indefinitely detained with their children or relinquishing custody of them and being separated. This policy ignores the overwhelming evidence of harm from separating children from their parents as well as being detained.

A judge has recently ruled that Immigration and Customs Enforcement has not implemented sufficient measures to ensure that children and families in its detention centers are protected against COVID-19. Families in these centers are unable to practice social distancing and often lack frequent access to hand washing and cleaning supplies. Prior to COVID-19 physicians visiting family detention centers reported seeing sick children in need of urgent medical care. These facilities are not appropriate places for families, especially now.

The AMA spoke out strongly against the Zero Tolerance policy before, and watched in dismay as DHS carried it out, separating thousands of children from their parents. This failed policy harmed countless children and families and was implemented despite overwhelming evidence of harm to child health and development. The AMA is urging the administration to immediately abandon any policy that seeks to separate parents from their children and to put an end to family detention.

A letter was sent to U.S. Department of Health and Human Services (HHS) Secretary Alex Azar urging his agency to address the dire situation that American Indians and Alaskan Natives are facing when it comes to confronting the COVID-19 pandemic. The AMA is very concerned that promised federal funding to native populations has either been very slow to be released or has not reached many tribal nations at all. Such assistance is vitally important to ensure that the tribes have the resources to mount a full response to the virus.

The Paycheck Protection Program and Health Care Enhancement Act included $11 billion for COVID-19 testing for states, localities, territories, tribes, tribal organizations, urban Indian health organizations or health service providers to tribes, of which not less than $750 million is to be allocated to tribes and tribal organizations. Such funding will provide critical support to develop, purchase, administer, process and analyze COVID-19 tests, conduct surveillance, trace contacts and related activities. However, there has been a delay in the distribution of these funds and so the AMA is urging that HHS rapidly address distribution of testing funding, Indian Health Service funding and provider relief funding to tribal hot spots and in rural areas.

As physician practices across the country begin to reopen and see patients in person again, the threat of COVID-19 still looms, and therefore it is essential that physicians and their staff institute proper infection control procedures in their practices. Personal protective equipment (PPE) and other critical infection control supplies have been directed towards COVID-19 hotspots and to facilities treating COVID-19 patients, but as non-hospital physicians return to work and reopen practices, the need for these supplies is rapidly expanding to these other care sites.

The AMA sent a letter urging the administration to provide additional assistance to these non-hospital physicians in securing PPE, disinfectants and sanitizers. This assistance may include providing points-of-contact within each state or locality that can provide guidance to physicians as to where to secure these items, listings of legitimate manufacturers or suppliers that may be able to supply physician practices, or dedicating additional federal infection control resources to help supply these providers. The sustainability of the physician practices that are beginning to reopen is critical to not only addressing the pandemic but the future health of the nation. Adequate infection control resources for those practices is essential in minimizing risks to physicians, patients and staff.

• May 29, 2020: Advocacy spotlight on Updated CDC serology testing guidelines follow AMA's recommendations 
• May 29, 2020: State Advocacy Update