Washington Committee Report

Katie O. Orrico

Washington Committee Sets 2019 Legislative and Regulatory Agenda

Based on a survey of the CNS and AANS members, the Washington Committee has developed the following legislative and regulatory agenda for 2019:

  • Protect patients’ timely access to care by reforming utilization review practices, such as prior authorization, step-therapy and Medicare’s appropriate use criteria program for advanced diagnostic imaging.
  • Fix the broken medical liability system by adopting proven reforms that are in place in California and Texas.
  • Improve the health care delivery system, including maintaining existing insurance market reforms and advancing solutions that will lower costs and expand choice, including out-of-network options, with appropriate patient protections for unanticipated medical bills.
  • Support quality resident training and education by increasing the number of Medicare-funded residency positions and preserving the ability of surgeons to maximize education and training opportunities within the profession’s current regulatory structures.
  • Alleviate the burdens of electronic health records, including promoting interoperability, reducing unnecessary data entry and improving the functionality of EHR systems to enhance, not hinder, the delivery of medical care.
  • Continue progress with medical innovation by repealing the medical device tax and implementing the 21st Century Cures Act.
  • End the opioid epidemic by implementing the Substance UseDisorder Prevention that Promotes Opioid Recovery and Treatment or Patients and Communities Act (SUPPORT Act).
  • Champion fair reimbursement by maintaining a viable fee-for-service option in Medicare and by empowering patients and physicians to privately contract fee arrangements. Additionally, Medicare must maintain the 10- and 90-day global surgery payment package and minimize the burdens associated with the global surgery code data collection initiative. 

CNS and AANS Urge Congress to Adopt Principles in Surprise Medical Bills Legislation

On Feb. 7, the CNS and AANS joined more than 100 state and national medical societies in sending Congress a letter outlining organized medicine’s core principles on so-called “surprise medical bills.” Given growing concern over the practice of unanticipated medical bills — largely driven by narrow insurance networks, which leaves some patients on the hook with the bill if they receive care from an out-of-network provider — Congress and the Trump Administration are considering legislation and/or regulations to address this problem. The principles include:

  • Insurer accountability to ensure network adequacy;
  • Limits on patient responsibility to in-network cost-sharing for unanticipated care;
  • Transparency about out-of-network providers and costs for scheduled care;
  • Payments based on charge data from an independent claims database (e.g., FAIR Health);
  • Alternative dispute resolution, such as baseball-style arbitration; and
  • Keep patients out of the middle.

Recently, there has been a flurry of activity on this topic, including:

  • Senator Cassidy Legislation Introduced. On May 15, a bipartisan group of senators, led by Sen. Bill Cassidy (R-LA), introduced S. 1531, the Stopping the Outrageous Practice (STOP) Surprise Medical Bills Act. The goal of this legislation to protect patients from surprise medical bills and establish a process for physicians and health plans to resolve billing disputes. In response to the draft legislation, the CNS and AANS sent the sponsors a letter pointing out that which we like and dislike about the bill and pledging to continue to work collaboratively with Congress as legislation on this topic is debated.
  • Physician-Sponsored Congressional Briefing. On May 16, the CNS and AANS joined the American College of Surgeons (ACS) and several other physician organizations in cohosting a Congressional briefing titled, “How to Protect Patients from Surprise Medical Bills: The Physicians’ Perspective.” Nearly 100 Congressional staff members and others attended the briefing. Panelists highlighted the physician community’s major concerns with recently proposed legislative solutions, as well as potential ideas for a path forward.
  • Ways and Means Committee Hearing. On May 21, the House Ways and Means Committee held a hearing titled, “Protecting Patients from Surprise Medical Bills.” Click here to watch the hearing.
  • Reps. Ruiz and Roe Release Framework. On May 23, Reps. Raul Ruiz, MD, (D-Calif.) and Phil Roe, MD, (R-Tenn.), among others, released a detailed outline of legislation to address surprise medical bills. Based on a preview of the summary, the CNS and AANS issued a press release supporting this legislation.
  • Senate HELP Committee Releases Proposal. On May 23, leaders of the Senate Health, Education, Labor and Pensions (HELP) Committee released draft legislation titled the “Lower Health Care Costs Act.” The bill includes provisions to address surprise medical bills, improve transparency and ensure that provider network directories are accurate.
  • Doc Caucus Sends Letter to Administration. On May 23, the House Doc Caucus sent a letter to the Administration regarding surprise billing. This letter promotes legislation based on the New York law, and takes issue with complicated, unproven and unworkable proposals related to a single bundled payment to hospitals for all out-of-network care and network matching. 

Congress Introduces Bills to Fund Additional Residency Training Slots

Legislation expanding Medicare funding for additional residency training slots has been introduced in Congress. Sponsored by Sens. Robert Menendez (D-N.J.), John Boozman (R-Ark.) and Charles Schumer (D-N.Y.) in the Senate, as well as Reps. Terri Sewell (D-Ala.) and John Katko (R-N.Y.) in the House, the “Resident Physician Shortage Reduction Act” (S. 348 / H.R. 1763) would:

  • Increase the number of Medicaresupported GME residency slots by 15,000 over the next five years;
  • Direct one-half of the newly available positions to training in shortage specialties;
  • Specify priorities for distributing the new slots (e.g., states with new medical schools); and
  • Study strategies to increase the diversity of the health professional workforce.

The CNS and AANS endorsed the bills, sending letters to both House and Senate sponsors.

Neurosurgery Sends Letters of Support for H.R. 594/S. 864, Ellie’s Law 

On Jan. 16, Rep. Yvette Clarke (D-N.Y.) introduced H.R. 594, Ellie’s Law. On March 25, Sen. Richard Blumenthal (D-Conn.) also introduced a senate companion bill, S. 864. Both bills would provide $25 million over five years for the National Institute of Neurological Disorders and Stroke (NINDS) to support brain aneurysm research. Following the introduction of both bills, the CNS and AANS sent letters of support for both the House and Senate legislation.

Neurosurgery Objects to Washington State Plan not to Cover SI Joint Fusion

On Jan. 18, the Washington State HTA Health Technology Clinical Committee (HTCC) voted not to cover SI Joint Fusion procedures. David W. Polly, Jr., MD, made a presentation at the meeting on behalf of the American Academy of Orthopaedic Surgeons (AAOS), AANS, CNS, International Society for the Advancement of Spine Surgery (ISASS) and the Washington State Association of Neurological Surgeons (WSANS), supporting coverage for SI Joint Fusion for appropriately selected patients. On Nov. 9, the AANS, CNS, Section on Disorders of the Spine and Peripheral Nerves (DSPN), AAOS, North American Spine Society (NASS) and the WSANS had sent a letter to the Washington State Health Care Authority (HCA) Health Technology Assessment (HTA) program regarding a draft evidence report for Sacroiliac (SI) Joint Fusion. ISASS sent their own more detailed letter, but was generally in agreement with the multispecialty letter. The negative coverage decision is a disappointment, as the evidence report prepared for the meeting was considered reasonable. On Feb. 20, organized neurosurgery sent a letter to object and request a reconsideration. More information on the Washington State HCA HTA program consideration of SI Joint Fusion is available here.

Anthem Reverses Course on Minimally Invasive Ablative Procedures for Epilepsy

Based on comments provided by the CNS and AANS, Anthem reversed course, finding that the treatment of medically refractory epilepsy using stereotactic laser techniques (MRI-guided laser interstitial thermal ablation [MRIgLITT]), including stereotactic laser amygdalohippocampotomy (SLAH) is considered medically necessary when the following criteria are met:

  • Documented disabling seizures, despite the use of two or more tolerated antiepileptic drug regimens; and
  • Documented presence of two or fewer well-delineated epileptogenic foci accessible by laser.

The use of stereotactic radiofrequency thermocoagulation (RF-TC) in the treatment of hypothalamic hamartomas is considered medically necessary.

Neurosurgery Joins Gun Violence Research and Prevention Efforts

On Feb. 21 the CNS and AANS joined 164 national, state and local medical, public health and research organizations in sending letters to House and Senate appropriation leaders urging them to provide $50 million in funding for the Centers for Disease Control and Prevention (CDC) to conduct public health research into firearm morbidity and mortality prevention.

Additionally, issued by the American College of Surgeons (ACS) on Feb. 21, the CNS and AANS, along with 43 medical and injury prevention organizations and the American Bar Association, supported a press release about the first-ever Medical Summit on Firearm Injury Prevention. Hosted by the ACS Committee on Trauma (COT), the Summit brought together national health care and legal leaders who have a compelling interest in reducing deaths, injuries and disabilities from firearms. Shelly D. Timmons, MD, PhD, FAANS, participated on behalf of neurosurgery.

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