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AANS Neurosurgeon | Volume 28, Number 2, 2019

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Neurosurgery in Washington

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Prior Authorization Legislation Introduced in the House

On June 5, H.R. 3107, the Improving Seniors’ Timely Access to Care Act, was introduced. Sponsored by Reps. Suzan DelBene (D-Wash.), Mike Kelly (R-Pa.), Roger Marshall, MD, (R-Kan.) and Ami Bera, MD, (D-Calif.), this legislation would protect patients in Medicare Advantage from unnecessary prior authorization practices that limit timely access to medically necessary care. The bill is based on a neurosurgery-supported consensus statement on prior authorization, which was developed by leading national organizations representing physicians, hospitals and health plans. The CNS and the AANS issued a press release in support of the legislation, at which time we simultaneously released the results of our prior authorization survey.

House Energy and Commerce Committee Advances Surprise Billing Legislation

On July 17, the House Energy and Commerce Committee favorably reported H.R. 3630, the No Surprises Act, which would protect patients from unanticipated medical bills in emergency cases and when medical services are rendered by an out-of-network provider at an in-network hospital. Prior to the full committee mark-up, on May 28, the CNS and the AANS submitted comments to committee leaders, offering suggestions on how to improve this bill.

Under the latest version of the legislation, which was incorporated into H.R. 2328, when a billing dispute arises between a provider and insurer, the payment rate is based on the median in-network rate for the area in which the service occurred. The initial payments in 2021 would be based on rates in place in 2019. Rates would be adjusted for inflation each subsequent year. The committee adopted an amendment from Reps. Raul Ruiz, MD, (D-Calif.) and Larry Bucshon, MD, (R-Ind.), allowing providers to appeal the payment rate to an independent dispute resolution (IDR) process for claims over $1,250. The CNS and the AANS supported this amendment and issued a press release expressing our support. Click here to watch the committee mark-up.

Protecting People From Surprise Medical Bills Act Introduced

On June 26, H.R. 3502, the Protecting People Surprise Medical Bills Act, was introduced. Sponsored by Raul Ruiz, MD, (D-Calif.) and Phil Roe, MD, (R-Tenn.), this legislation, endorsed by the CNS and the AANS, is modeled after New York’s out-of-network law and would, among other things, establish an independent dispute resolution (IDR) process to resolve billing disputes between insurers and providers. Proponents of H.R. 3502 have pointed to the New York law as an example of a successful approach to surprise billing, which has reduced out-of-network billing by 34% compared to neighboring states. Efforts to gain support for H.R. 3502, the preferred solution for surprise medical bills, are ongoing and action in the House Education and Labor and Ways and Means Committees is expected in the fall.

Comprehensive Medical Liability Reform Legislation Introduced

On July 9, H.R. 3656, the Accessible Care by Curbing Excessive lawSuitS (ACCESS) Act, was introduced by Reps. Richard Hudson (R-N.C.), Roger Marshall, MD (R-Kan.) and Larry Bucshon, MD (R-Ind.). Endorsed by the CNS and the AANS, this comprehensive reform legislation is modeled in part on the laws in California and Texas, which include reasonable limits on noneconomic damages. The bill also includes the following provisions:

  • Defines who qualifies as an expert witness;
  • Requires an affidavit of merit before bringing a lawsuit;
  • Allows a physician to apologize to a patient for an unintended outcome without having the apology count against them in the court of law; and
  • Requires a 90-day cooling-off period before lawsuits can be filed to facilitate voluntary settlements.

The Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) estimate that the provisions included in the bill would reduce federal spending by about $14 billion over five years and almost $50 billion over 10 years. 

Emergency Preparedness Legislation Signed Into Law

On June 24, President Donald J. Trump signed into law S. 1379, the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAI). This bill will reauthorize programs within the Department of Health and Human Services (HHS) relating to health emergencies. Championed by the AANS and the CNS, this legislation also addresses medical liability protections for volunteer physicians and other health professionals who have pre-registered with Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) or the Medical Reserve Corps. Finally, the bill includes H.R. 880, the MISSION Zero Act, which would assist U.S. military health care providers in maintaining a state of readiness by embedding military trauma teams and providers in civilian trauma centers. As part of the Trauma Coalition, the AANS and the CNS sent out a press release applauding passage of this crucial legislation.

Neurosurgery Endorses Legislation to Repeal the Medical Device Excise Tax

On June 17, the AANS and the CNS sent a letter to Sens. Patrick Toomey (R-Pa.) and Amy Klobuchar (D-Minn.), endorsing S. 692, the Protect Medical Innovation Act of 2019, legislation to permanently repeal the medical device tax. The AANS and the CNS also sent a letter to Reps. Ron Kind (D-Wis.), Scott Peters (D-Calif.), Jackie Walorski (R-Ind.) and Richard Hudson (R-N.C.) in support of the House version of the bill, H.R. 2207. Senate Finance Committee chair Chuck Grassley (R-Iowa) and ranking member Ron Wyden (D-Ore.) created a health tax task force to examine the impact of the 2.3 percent medical device excise tax. The AANS and the CNS submitted a letter to health task force chairs, Sens. Patrick Toomey (R-Pa.) and Robert Casey (D-Pa.), and participated in a task force roundtable where we reiterated our support for repealing the tax. Since 2015, Congress has twice enacted two-year moratoria to delay implementation of the tax, which will take effect on Jan. 1, 2020, if Congress does not act.

Concussion Awareness Act Reintroduced

Earlier this year, Rep. Joyce Beatty (D-Ohio) introduced H.R. 280, the Concussion Awareness and Education Act. Endorsed by the AANS and the CNS, this legislation would provide for systemic research, treatment, prevention, awareness and dissemination of information concerning sports-related and other concussions. The bill directs the National Institutes of Health (NIH) to conduct specific research on youth concussions, directs the Centers for Disease Control and Prevention (CDC) to develop and disseminate information to the public, and establishes a Concussion Research Commission to formulate systemic recommendations based on research developed form the legislative directives.

Neurosurgery Endorses the Cerebral Cavernous Malformations Clinical Awareness, Research and Education Act

On June 27, the Cerebral Cavernous Malformations Clinical Awareness, Research and Education Act (H.R. 3573/ S. 2010), was introduced. Sponsored by Rep. Ben Ray Lujan (D-N.M.) in the House, and Sen. Tom Udall (D-N.M.) in the Senate, this legislation would provide crucial insights into cerebral cavernous malformation (CCM) by expanding research at the NIH, CDC and the U.S. Food and Drug Administration (FDA), to increase awareness, treatment and prevention of CCM. The AANS and the CNS endorsed both the House and Senate bills.

Health Care Safety Net Enhancement Act Reintroduced

On July 29, H.R. 3984, the Health Care Safety Net Enhancement Act of 2019 was introduced. Sponsored by Reps. Bill Flores (R-Texas), Roger Marshall, MD, (R-Kan.), and Brian Babin, DDS, (R-Texas), this legislation will help ensure that patients have access to emergency care by extending liability protections to on-call and emergency physicians through the Federal Tort Claims Act. Specifically, the bill would ensure that emergency department and on-call physicians who are providing medical services under the Emergency Medical Treatment and Labor Act (EMTALA) receive the same liability coverage currently extended to employees of Community Health Centers and health professionals who provide Medicaid services at free clinics. The AANS and the CNS have endorsed this bill.

Neurosurgery Comments on Proposed Coverage for Vertebral Augmentation

On July 19, the AANS, the CNS and the AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves sent a letter to Noridian, the Medicare Administrative Contractor (MAC) for 12 western states, regarding a proposed Local Coverage Determination (LCD) for Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture. In addition to Noridian, three other MACs — Wisconsin Physician Services (WPS), National Government Services (NGS) and Celerian Group Company (CGS) — have issued the same LCD and neurosurgery has also sent letters to those payers. The LCDs resulted from a March 20, multi-jurisdictional MAC Carrier Advisory Committee (CAC) conference call on the issue. Renee Chambers, MD, FAANS, served as a subject matter expert on the call and John K. Ratliff, MD, FAANS, and Philipp M. Lippe, MD, FAANS(L), participated as voting CAC members.  More information on the CAC meeting is available here.

Neurosurgery Supports Coverage for MRI Guided Focused Ultrasound (MRgFUS)

On June 3, the AANS, the CNS, and the American Society for Stereotactic and Functional Neurosurgery (ASSFN) sent a letter to Novitas, the MAC for Region JL that includes several Mid-Atlantic States. The letter expressed support for a request by the University of Pennsylvania Medical Center for reconsideration of the Novitas negative Local Coverage Determination (LCD) for MRI Guided Focused Ultrasound (MRgFUS) for Essential Tremor (ET). The letter included a position paper developed by ASSFN entitled “MR-guided Focused Ultrasound for the Management of Essential Tremor,” incorporating a robust review of the literature for the procedure. In addition to the letter to Novitas, on July 30, the AANS, the CNS and the ASSFN sent a similar letter to First Coast Service Options, Inc. urging coverage for MRgFUS.

2018 Open Payment Data Released

On June 28, CMS published the 2018 Open Payments program data, along with newly submitted and updated payment records for previous program years. The Open Payments program collects and publicly reports information annually about payments that drug and device companies make to physicians and teaching hospitals for items such as travel, research, gifts, speaking fees and meals. For 2018, device and drug companies reported $3.00 billion in general (i.e., non-research related) payments, $4.93 billion in research payments and $1.42 billion of ownership or investment interests held by physicians or their immediate family members. CMS will refresh the data in January 2020, updating records to reflect the status of disputed payments. Click here to access the data.

Class I Recall for Brainlab Spine and Trauma 3D Navigation System

The FDA has identified a recall of Brainlab’s Spine & Trauma 3D Navigation Software as Class I, the most serious. The manufacturer recalled the software because of the potential for incorrect information to display during surgery, which may prevent the surgeon from accurately navigating surgical tools inside the patient. More information is available on the FDA website by clicking here. The FDA reviews manufacturers’ responses to reported problems with their devices and can assign one of three classifications of risk to the identified problem: 

  • Class 1, referring to a reasonable chance of serious health threats or death;
  • Class II, when a temporary health condition can result, or when there is a small risk of serious injury or death; or
  • Class III, when no health problem or injury is likely.

Dr. Alex Valadka Pens Op-ed on Graduate Medical Education

On June 11, Alex B. Valadka, MD, FAANS, authored an opinion piece for The Hill about the need to expand Medicare’s support for residency training to ensure all Americans have access to the care they deserve now and into the future. In the piece, Dr. Valadka wrote, “An appropriate supply of well?educated and trained physicians is essential to ensure timely access to quality health care services for all Americans. America’s specialty physicians challenge Congress to meet these needs by adopting legislation to increase the number of Medicare-supported residency positions.”

Neurosurgery Joins ‘Out of the Middle’ Coalition to Address Surprise Medical Bills

Joining several other specialty medicine colleagues, the AANS and the CNS have joined forces to support a public outreach and grassroots campaign on the issue of surprise medical bills. Out of the Middle is a coalition of leading health care provider groups, who are advocating on behalf of the millions of patients they care for every day. In addition to a web-based platform, the group has deployed web-ads on key websites frequented by policymakers. Thus far, the effort has generated thousands of messages to Congress in support of H.R. 3502, the Protecting People From Surprise Medical Bills Act.

For more information on these or other health policy issues, please contact Katie O. Orrico, director of the AANS/CNS Washington Office at korrico@neurosurgery.org.

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