President's Messagelegislative update
This month Robert C. Bernstein, MD, FACC, Advocacy Chair from Norfolk, updates us about federal and state issues. Dear Colleagues: The 2023 congressional and state advocacy updates are summarized below. I am happy to provide additional details, respond to any questions, and welcome your input on issues you feel are important to address on a national or state level. First, a couple take-aways from the past year: You can have an impact
Frustrating process
Proactive voice/Patience
Resources
Anticipated issues for 2023-2024
Please contact me with any questions, comments, ideas: Rob Bernstein, MD, FACC advocacy@vcacc.org 2022 SUMMARY VCACC Congressional Advocacy Update VCACC members met with staff from 8 of 11 Virginia US Representatives and both Senate offices. Thank you to participating VCACC members - Annette K Ansong, MD, FACC; Ian Burrows, MD; Linda Hart, DNP, FACC; Christopher M Kramer, MD, FACC; Victor Soukoulis, MD, PhD, FACC; and Robert C Bernstein, MD, FACC SCORE CARD ACC Legislative Conference 10/2022 Six bills - 4 died 1/3/2023 (new Congress), One was altered then incorporated in another bill - now law, one now law Congressional advocacy on behalf VCACC constituents (pursued separate from ACC effort). One bill - died 1/3/2023 (new Congress)
SUPPORTED BILLS SUMMARIES/ACTIONS Increasing patient access to care Supporting Medicare Providers Act of 2022HR8800/Senate supporting letter Address Medicare cuts. Bipartisan support. Status: Bill held in House Committee then included in 2023 omnibus spending bill (passed 12/2022). Bill reduced but did not eliminate overall cuts scheduled for 1/2023. Overall 8.5% cut not addressed. Instead of 4.5% reduction physician reimbursement, expected 2% cut 2023, circa 3% 2024. Remaining concerns: 1) long term planning for Medicare budget not addressed; 2) lack of an annual inflationary factor not addressed; and 3) flawed reimbursement formulas such as assigning atrial fibrillation ablation same work value as peripheral vascular intervention remain problematic. Increasing Access to Quality Cardiac Rehabilitation Care Act of 2021. HR 1956/S1986. PAs/NPs and CNS to supervise day-day CR/PR in 2023 rather than 2024 and newly authorize APPs to order/refer pts for cardiac and pulmonary rehab. House and Senate: in committee. Status: Dead 1/3/2023 Improving clinician well-being/Increasing patient access to care Improving Seniors’ Timely Access to Care Act of 2021.HR3173/S3018 Streamline prior authorization practices. Also requested support Gold Card ACT HR 7995 Passed House 9/2022. Senate: sponsored by 53 senators. Remained in committee Status: Dead 1/3/2023
Improving clinician well-being Safety from Violence for Healthcare Employees (SAVE ACT) HR 7961/ Senate no bill. Creates federal penalties for knowingly committing violence or intimidation toward healthcare workers, hospitals and offices. House vote: in committee 11/2022. Status: Dead 1/3/2023
Developing public health initiatives South Asian Heart Health Awareness & Research Act of 2022. HR 3771/Senate no bill. Funds heart disease research and addresses health equity. Passed House. Senate: still in committee Status: Dead 1/3/2023
Cardiovascular Advances in Research and Opportunities Legacy Act. HR1193/S1133 Supports valvular heart disease, research and awareness. Note, currently no screening recommendations included as part of Medicare annual wellness visit or general preventative task force recommendation. Passed House 9/2022. Passed Senate 12/2022 Status: Became law 12/2022. Of note, bill sponsor was House Representative who lost spouse to valvular heart disease at age 39.
Congressional advocacy on behalf VCACC constituent - Increasing patient access to care Access to Genetic Counselor Services ACT of 2021. HR 2144/S1450. Note, not specifically cardiac legislation. Requesting Medicare access/reimbursement for Genetic Counselors (despite possessing Masters or Doctorate degrees and national society certifications, genetic counselors are not reimbursed by Medicare (they are covered by Virginia Medicaid and private insurers). House and Senate - no action. Status: Dead 1/3/2023
Additional Congressional legislation Budget Winners: Veterans Administration; Behavioral Health; Substance Abuse; Maternal Fetal Medicine; NIH; Health Equity, and Biosecurity PAYGO Sequester: Delayed for two years (end of 2024). This prevents $38 billion in Medicare cuts 1/2023. (PAYGO - Congress must pay for legislative package by either reduction in entitlement spending or increasing revenue). Graduate medical education: Beginning 2026, additional 200 Medicare-funded GME residency positions. At least half dedicated to psychiatry and psychiatry subspecialty training. At least 10% of positions to be distributed to rural hospitals, hospitals operating above their cap, hospitals in states with new medical schools, and hospitals that serve health professional shortage areas. Conrad 30 Program: Extends program that allows states to request J-1 visa waivers for foreign born physicians who have completed US residency training programs to work in federally designated shortage and underserved areas. Telehealth Extension: Extends support through 12/2024. Expands originating sites, eligible practitioners, and duration of service without in-office recertification. Also extends audio only Telehealth reimbursement. Hospital at Home- Extended 2 years
STATE ADVOCACY UPDATE Met with multiple House Delegates and a State Senator. Participating VCACC member - Robert C Bernstein, MD, FACC SCORE CARD MSV Legislative Conference 1/2023. Four bills - 0 died; 2 remain in committee; 2 passed legislature; signed by Governor Two budget amendments - 0 died; 1 approved full funding; 1 approved funding below target BILLS AND BUDGET AMENDMENT SUMMARIES/ACTIONS Increasing underserved patient access to care Support Medicaid Reimbursement - Budget Amendment Target increase reimbursement rate for non-primary care physicians to 80% Medicare rate. Target increase reimbursement rate for primary care physicians to 100% Medicare rate. Tie rate increases to inflation. Status: Approved funding below target. Approved increase to 80% Medicare rate for physician (but not 100% target for primary care physicians) Support Expansion Virginia Mental Health Access Program - Budget Amendment Target expands existing mental health resources from 6-18yo to add 0-5yo (complex developmental disorders) + perinatal maternal mood and anxiety disorders Status: Approved funding at target Oppose HB2183 - Nurse Practitioner to Practice Independently Immediately Upon Graduation. Current Virginia law requires NPs have 5 years supervision before transition to autonomous practice. Pro Rationale - Add providers to underserved areas sooner. Problem - NPs have not relocated to underserved areas. Current 5 year restriction is in line with minimal total hours for post graduate physician training. Status: Remains in committee - Amendment anticipated Improving clinician well-being Support HB1573/ SB970 - Mental Health Question for Physician licensure Bill directs Dept of Health Professions to amend licensure, certification, and registration applications to remove direct mental health questions which force many physicians to then avoid seeking diagnosis and care due to fear of stigma or threat of license. Question change to “Do you have any reason to believe that you would pose a risk to the safety or well-being of your patients? Are you able to perform the essential functions of a practitioner in your area of practice with or without reasonable accommodation?” Status: Passed legislature; signed by Governor Support HB1835 - Threats Against Providers Current law protects healthcare workers from threats of violence in hospitals and ERs This law extends protections to providers in physician offices, urgent care centers, health clinics, pharmacies, or when treating patients in the field. Class 1 misdemeanor. Status: Passed legislature; signed by Governor Improving patient access to care/Business of medicine Support HB1600 - Expedite COPN process. Allows for existing practices to expand services and build more healthcare facilities more quickly and affordably. Status: Remains in committeeVCACC is proud be the official international exchange partner with the British Cardiovascular Society (BCS).
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