How you can help: Visit the Legislative Action Center to find a pre-populated letter to legislators you can send showing your support for this funding.
Telehealth—Parity & Access
Prior to 2020, telehealth was practiced only by a few providers. Following the extreme drop in patient visits during the public health emergency (PHE), providers quickly learned and implemented telehealth practices to treat patients virtually. The CMS, followed by commercial payers, increased the reimbursement for telehealth to match in-person visits for audio-visual and, later, audio-only visits during the PHE. Several active pieces of legislation moving through Congress and in various states would expand access to telehealth beyond the PHE.
How you can help: Watch for a call to action to send letters to Congress, the administration and state legislators to continue to expand telehealth flexibility and ensure appropriate reimbursement.
Utilization Management & Reimbursement
Step therapy bills have been re-introduced in both the House (H.R. 2163) and the Senate (S. 464). This legislation requires Employee Retirement Income Security Act (ERISA) health plans to allow for reasonable overrides so physicians can use certain medications, helping relieve the burden placed on providers and patients.
We are awaiting re-introduction of bills on prior authorization and dual-energy X-ray absorptiometry (DXA) reimbursement, which had strong bipartisan support in the past Congress. The prior authorization legislation will protect patients in Medicare Advantage plans that delay or deny access to care. It also supports reporting back to the CMS how often Medicare Advantage plans approve or deny medications and services.
Additionally, we have seen some wins early in the state legislative year. Arkansas has passed step therapy reform, and Georgia has sent prior authorization reform to the governor. Utilization management reform legislation is on the move in California, Arizona, Oregon and Texas, while several other states have introduced bills that we are supporting. We expect additional wins as the year progresses.
How you can help: The Legislative Action Center contains pre-written letters urging utilization management reform.
Up Next
This May, we (virtually) visited Washington, D.C., to advocate for workforce expansion, step therapy legislation and provider solvency as we continue to practice during a pandemic. We are tracking a number of issues and would love to hear from you. Check out the ACR’s advocacy priorities and join us for a Hill Day in September. I look forward to having conversations with you about how advocacy and health policy affect your patients and your practice.
