Four NASS members recently attended the annual fly-In organized by the Alliance for Specialty Medicine in Washington DC. Dale Blasier, MD (Little Rock, AR), David Weiner, MD (Washington, DC), Gregory J. Przybylski, MD, MBA (Warren, NJ), and Phil Schneider, MD (Potomac, MD) attended on behalf of NASS Advocacy.

The Alliance of Specialty Medicine is a coalition of national medical societies representing specialty physicians in the United States. This non-partisan group is dedicated to the development of sound federal health care policy that fosters patient access to the highest quality specialty care.

This year from July 19-22 the Annual Legislative Fly-In was held in Washington, DC. At the meeting, specialty physicians, medical societies, and health experts met with members of Congress and senior officials from HHS and the Centers for Medicare and Medicaid Services. Attendees discussed urgent health care topics and attended expert briefings.

The attendees visited the offices of their respective congress members to lobby for policy changes. This year’s Key Topics and Focus Areas included:

• Physician Reimbursement: Stopping impending Medicare payment cuts and fixing the payment system.
• Utilization Management: Reforming burdensome prior authorization and step therapy rules.

The NASS members requested support from their congress persons regarding four specific proposed articles of legislation including:

1. Improving Seniors’ Timely Access to Care Act (Seniors’ Act), The Act builds upon the Centers for Medicare and Medicaid Services (CMS) Interoperability and Prior Authorization final rule1 to streamline and modernize the prior authorization (PA) process in the Medicare Advantage (MA) program. The legislation:
• Establishes electronic-PA (e-PA) for MA plans including standardization of transactions and clinical attachments
• Increases transparency around MA prior authorization requirements and their use
• Clarifies CMS authority to establish timeframes for e-PA requests including expedited determinations, real-time decisions for routinely approved items and services, and any other PA request
• Expands beneficiary protections to improve enrollee experiences and outcomes
• Requires reporting to Congress on program integrity efforts and ways to further improve the e-PA process.
2. The Safe Step Act (H.R. 5509/S. 2903) provides a clear and timely appeals process when a patient is subjected to step therapy. The legislation:
• Establishes a clear exemption process: Requires insurers to implement a clear and transparent process for physicians or patients to request an exception to a step therapy protocol.
• Outlines exceptions to fail first protocols. Requires insurers to grant an exception if an appeal clearly demonstrates any of the following:
  • Patient has already tried and failed on the required drug.
  • Insurer-preferred treatment will cause irreversible consequences.
  • Required treatment is contraindicated and will/is likely to cause an adverse reaction.
  • Required treatment will/is expected to prevent a patient from working or fulfilling activities of daily living.
  • Patient is stable on their current medication.
• Requires timely response: An insurer is required to respond to an exemption request within 72 hours under normal circumstances, and within 24 hours if life threatening.
3. The Strengthening Medicare for Patients and Providers Act (H.R. 6160) replaces the separate conversion factors for qualifying APM participants and other physicians with a single conversion factor and provides for an update that is equal to the annual percentage increase in the Medicare Economic Index (MEI).
4. The Provider Reimbursement Stability Act (H.R. 8163) seeks to modernize and update the budget neutrality mechanism of the Medicare Physician Fee Schedule (MPFS) to improve stability for physician reimbursement and patient access by:
• Increasing the payment threshold to present day values and indexing it to inflation
• Improving transparency and accountability by requiring the Centers for Medicare and Medicaid Services (CMS) to compare policy change cost estimates with actual utilization data and provide correction adjustments
• Providing payment predictability by preventing CMS from making changes to the MPFS that would result in year-to-year changes greater than 2.5%
• Promoting payment accuracy by requiring CMS to incorporate more frequent and accurate cost inputs when determining the value of services

It is hoped that action on these proposed items of legislation will be beneficial to providers of spine care. NASS Advocacy continues to work on behalf of spine care providers.