capitol hill report: congress considers access to care

The past few weeks saw significant interest from Congress in how the federal government can best ensure patients can access the care they need. Hearings in the Senate Finance Committee and House Energy & Commerce Committee covered the AAN’s priority issues including Medicare physician reimbursement, telehealth, and administrative burden.

Senate Finance Hearing: Bolstering Chronic Care through Medicare Physician Payment
On Thursday, April 13, the Senate Finance Committee held a hearing titled: Bolstering Chronic Care through Medicare Physician Payment. While the title of the hearing was focused on chronic care, members of the committee, including Chairman Ron Wyden and Ranking Member Mike Crapo, focused their questions on the broader impact that the implementation of the Medicare and CHIP Reauthorization Act (MACRA) and the prevalence of Medicare Advantage Plans have had on patient care.

One of the top issues covered by committee members was the unsustainable cycle of cuts triggered by budget neutrality requirements in the Medicare Physician Fee Schedule (MPFS). When new codes are proposed, if their financial impact on the fee schedule exceeds a certain amount CMS is required to cut the conversion factor to ensure the addition of this new code is “budget neutral”. This threshold has not been updated in several years and both Senators and witnesses pushed for an update to that threshold. The AAN will continue working with Congress to ensure that when an appropriate code is proposed to address a patient’s need, it does not require the rest of the fee schedule to be cut.

Another theme throughout the hearing was the ever-increasing burden of prior authorization and Step Therapy requests in Medicare Advantage plans. For years the AAN has been advocating for Congress to address this problem and ensure patients can access the care they need in a timely manner. Witnesses expressed that while prior authorization requirements were initially meant to help tamp down costs, they now exacerbate them. Between the administrative time required to process the requests to the more expensive care patients seek when they can’t receive the treatments they need, health care costs have skyrocketed due to increasing prior authorization requirements. While the recent CMS rule on prior authorization will hopefully ease some of the administrative burden associated with these requirements, the AAN will continue advocating for Congress to pass legislation to address this issue.

The AAN will provide comments to the committee and continue working with them to ensure the needs of neurology and the cognitive specialties are considered as they pursue reforms to the MPFS.

Energy & Commerce Hearing: Legislative Proposals to Support Patient Access to Telehealth Services
Last week, the House Energy and Commerce Committee Health Subcommittee held a hearing addressing proposals to improve telehealth titled, “Legislative Proposals to Support Patient Access to Telehealth Services.” The hearing addressed 15 legislative proposals related to telehealth. Discussion during the hearing touched on many aspects of telehealth policy, including ensuring the certainty of the future of telehealth, cross-state licensure, payment parity, potential guardrails for permanent telehealth, and remote patient monitoring. The Alliance for Connected Care, of which the AAN is a member, submitted a joint statement for the record in conjunction with the hearing.

Neurologic care was an underlying focus of the hearing. Health Subcommittee Chair Guthrie (R-KY) presented the following question to panelist Dr. Eve Cunningham:

Chair Guthrie (R-KY): “What are the services that had the highest utilization for telehealth during the pandemic?”
Dr. Cunningham: “Within my portfolio of services, I would say tele-neurology, telepsychiatry, other virtual behavioral health, and telecardiology. There are huge opportunities in neurology. I think more cognitive-focused specialties is where you can see a lot of opportunity for virtual care deployment.”

Another panelist, Jeanette Ashlock, who is patient advocate representing the National Multiple Sclerosis Society, talked about the positive impact telehealth has made on her ability to receive care. The Academy is grateful to the House Energy and Commerce Committee for continuing to explore and highlight the impact of proposed legislative action on neurologic care and patients.

Telehealth reform is a top advocacy priority for the Academy. The AAN continues to push for permanent telehealth flexibilities as the deadline for extension of pandemic-era flexibilities approaches. Visit the House Energy and Commerce website for more information or to watch a recording of the hearing.