Nov. 1, 2024: National Advocacy Update

The AMA is committed to addressing maternal mortality and morbidity in the U.S., which currently has one of the highest maternal mortality rates among developed countries. 

The AMA recently sent letters in support of several pieces of federal maternal health legislation: 

• Preventing Maternal Deaths Reauthorization Act (S. 2415/H.R. 3838): This bipartisan legislation, which passed the House in March, would increase federal funding for state-based efforts to improve and continue maternal mortality review committees (MMRCs). This would help identify solutions to prevent future maternal deaths and eliminate disparities in maternal health outcomes for pregnancy-related and pregnancy-associated deaths. 

• Connected MOM Act (S. 712/H.R. 8532): This bill would require the Centers for Medicare & Medicaid Services (CMS) to report on, and provide resources for states related to, coverage of remote physiologic devices and related services (e.g., blood glucose monitors) under Medicaid.  

• PREEMIE Reauthorization Act of 2023 (S. 1573/H.R. 3226): This bill, which passed the House, would reauthorize the PREEMIE Act until 2028, allowing for continued research and data collection on infants who are born prematurely, the continuation of programs aimed at improving treatment and outcomes, and the establishment of a study on the factors that lead to preterm births. 

• Pregnant and Postpartum Women Treatment Reauthorization Act (S. 3447): This bipartisan legislation would reauthorize funding for the Grant Program for Residential Treatment for Pregnant and Postpartum Women, which helps pregnant women and new mothers receive residential treatment for substance use disorders and offers a range of services for prevention and recovery support. 

• Rural Obstetrics Readiness Act (S. 4079/H.R. 8383): This bipartisan legislation would provide grant funding toward evidence-based training programs on emergency obstetrics services for rural health care facilities without dedicated obstetrics units.  

The AMA also supports several additional legislative efforts aimed at improving maternal health care and outcomes, and has been engaged with sponsors and leadership in advancing the following bills: 

• SHINE for Autumn Act of 2023 (S. 2647/H.R. 5012): This bill aims to prevent stillbirths through enhanced data collection, research, and education, authorizing grants to improve stillbirth data quality and train pathologists on fetal autopsies to better understand and prevent stillbirths. 

• Promoting Maternal and Child Health Through Substance Use Prevention Act (S. 3370): This legislation supports initiatives to prevent substance use during pregnancy, improving care coordination and access to treatment for pregnant women and new mothers struggling with addiction. 

• Improving Access to Maternal Health for Military and Dependent Moms Act of 2024 (H.R. 7214/S. 3722): This bill would expand maternal health services for military families by ensuring access to high-quality care for pregnant service members and their dependents.  

• NIH IMPROVE Act (S. 4147/H.R. 8037): This bill would provide additional funding for research to reduce maternal mortality and severe maternal complications through the NIH's IMPROVE initiative. 

• Advancing Safe Medications for Moms and Babies Act of 2023 (H.R. 1117): This bill promotes research on the safety and efficacy of medications used during pregnancy and breastfeeding to protect the health of mothers and infants. 

To learn more about the AMA’s maternal health advocacy, please visit the AMA website. In addition, the AMA earlier this year released a set of concrete recommendations (PDF) for the administration and Congress to improve maternal health outcomes in the U.S. 

In response to AMA advocacy (PDF) support, the Centers for Medicare & Medicaid Services (CMS) finalized (PDF) an appeals process for certain Medicare beneficiaries who are initially admitted as hospital inpatients but subsequently reclassified by the hospital as an outpatient receiving observation services. The rule establishes expedited, standard and retrospective appeal rights for beneficiaries and is a result of a court decision in Alexander v. Azar. CMS is projecting that implementation will begin early in 2025 after an operational implementation period. CMS has released a fact sheet (PDF) about the appeals process. 

On Oct. 21, the Departments of Health and Human Services (HHS), Labor, and the Treasury announced a proposal that would expand coverage of certain preventive services without cost-sharing. The proposed rule would require plans and issuers to cover recommended over-the-counter (OTC) contraceptive items without cost-sharing requirements. This includes newly approved OTC oral hormonal contraceptives, emergency contraceptives and others. The current coverage guidance requires a prescription, despite the fact that there are no statutory or regulatory requirements for prescriptions. The proposed rule would move to cover these options without a prescription requirement and without cost sharing. 

The AMA has long supported expansion of access to reproductive health services, including contraceptive options. In 2023, the AMA supported (PDF) the application of OPill, a progesterone-only oral contraceptive, to switch from prescription to non-prescription status. The application was approved by the Food and Drug Administration in July 2023 and became available in stores and online without a prescription in March 2023. The AMA has further advocated (PDF) to HHS to ensure widespread access to contraceptive options, including through ensuring coverage of OTC oral contraceptives and limiting financial barriers to access. 

The Departments will be accepting comments on the proposed rule through Dec. 27, 2024. 

AMA advocacy was instrumental in bringing interested parties together in support of Medicaid section 1115 waivers that recognize the value of traditional American Indian and Alaska Native healing services. Council on Medical Service Report Review of Payment Options for Traditional Healing Services (PDF) was developed after consultation with the administration and Indigenous physicians from the Johns Hopkins Center for Indigenous Health. On Oct. 16, HHS, through CMS, approved section 1115 demonstration amendments that allow, for the first time ever, Medicaid and Children’s Health Insurance Program coverage of traditional health care practices provided by Indian Health Service facilities, Tribal facilities, and urban Indian organizations. For more information, please visit the CMS website. 

The AMA and Manatt Health Strategies have released a new report detailing the many ways that the CPT® code set supports and accelerates the adoption of value-based care. The report notes that CPT is used to identify patients for clinical interventions and attribution to models, and to support quality improvement, benchmarking and risk adjustment. In addition, CPT enables innovative digitally enabled care bundles. The report also describes areas for continued evolution of CPT to further support value-based care, such as bundled service codes for new care delivery models and addressing new types of health care services being delivered as part of value-based care. Finally, the report describes several case studies of health care delivery organizations and an insurer that rely on CPT for their value-based care initiatives. 

The AMA submitted comments (PDF) on HHS’ Tribal Data Access Policy and HHS Tribal Epidemiology Center (TEC) Data Access Policy.  

In the letter, the AMA expressed support for HHS issuing guidance on public health and Tribal-affiliation data sharing with American Indian and Alaska Native (AI/AN) Tribes, Villages and Tribal Epidemiology Centers and commended the creation of both policies in order to foster greater Tribal sovereignty over their own data. These policies will allow Tribes to make informed, data-driven decisions that directly impact their health and well-being. 

The letter also discussed how poor data collection and reporting standards implemented by states left significant gaps in understanding how COVID-19 disproportionately impacted people of color across the U.S., particularly for AI/AN people. In addition, the letter highlighted AMA work to advance an interoperable health care ecosystem with an eye toward ameliorating disparities using granular data segmentation. The AMA co-founded Shift to advance granular data segmentation standards and implementation guidance and reinforce the safe, equitable and patient-empowered sharing of health information. 

After the Change Healthcare cyberattack earlier this year, cybersecurity has become a central concern for physicians and patients alike. Watch this AMA Advocacy Insights webinar to learn about how to implement appropriate cybersecurity measures to protect your practice as well as your patients against the cybersecurity challenges of today. Also, hear about advocacy that is underway to strengthen cybersecurity systems and provide support to physician practices for enhancing their cyber hygiene.  

Moderator: 

• Michael Suk, MD, JD, MPH, MBA, chair, AMA Board of Trustees 

Speakers: 

• Christian Dameff, MD, Department of Emergency Medicine, School of Medicine, University of California, San Diego  

• Greg Garcia, executive director for cybersecurity, Health Sector Coordinating Council 

• Nov. 1, 2024: State Advocacy Update