APA’s Government, Policy, and Advocacy Update (September 2024)
APA, Medical Groups Work to Reform Medicare Payments to Physicians
APA is pushing the federal government for inflationary updates and a revision to the formula governing the fees paid to physicians who accept Medicare.
In July, the Centers for Medicare and Medicaid Services (CMS) proposed lowering the dollar figure used to determine physicians’ Medicare payments for 2025 by 2.8% from the previous year, representing the fifth straight year of reductions in clinicians’ payments.
APA is preparing to submit formal comments to CMS, incorporating concerns gleaned from members who attended a listening session held by APA staff in late July. APA also joined dozens of national and state medical associations in co-authoring a letter to congressional leaders urging legislative action on the matter.
APA has had some successes so far in helping to shape aspects of CMS’ proposed rule, including:
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Allowing clinicians to use the same billing codes for telehealth or audio-only care as for in-person outpatient evaluation and management services.
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Allowing teaching physicians to virtually supervise residents and allowing clinicians to use an office address when providing telehealth services from home—both through the end of 2025.
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Implementing new billing codes for suicide safety planning.
The deadline for submitting comments to CMS on the Calendar Year 2025 Medicare Physician Fee Schedule Proposed Rule is September. 9.
Read the Medical Association Coalition letter on physician payments here. For more information, contact APA staff at [email protected].
APA Endorses Legislation to Simplify Prior Authorization in MA Plans
APA is working to cut administrative burdens for clinicians and improve care for older adults by endorsing legislation that would require insurers to clarify, simplify, and streamline prior authorization processes in Medicare Advantage (MA) plans. The bill would build on recently implemented final rules governing the use of prior authorization in MA plans.
If enacted, the Improving Seniors’ Timely Access to Care Act (H.R. 8702/S.4532), introduced by Sen. Roger Marshall, M.D. (R-Kan.), would:
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Require MA plans to comply with uniform electronic prior authorization technical standards;
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Require increase transparency around prior authorization requirements; and
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Clarify federal authority to require MA plans to notify clinicians and enrollees of prior authorization decisions within certain time limits.
The bipartisan legislation was overhauled after a previous version passed in the House but failed to move forward when the Congressional Budget Office (CBO) assessed its cost at $16 billion. The new legislation is expected to have a significantly lower CBO score.
Arizona Latest State to Veto Psilocybin Services Legislation
Arizona became the latest state to defeat psilocybin legislation when Gov. Katie Hobbs (D) vetoed a bill that would have allowed psychedelic-assisted therapy centers.
Hobbs cited a lack of evidence to support widespread clinical expansion of psilocybin. Arizonans with depression or posttraumatic stress disorder “should not be the subject of experiments for unproven therapies with a lack of appropriate guardrails,” she wrote in her veto letter. Arizona’s bill also would have required $400,000 in annual ongoing cost that was not funded for fiscal year 2025.
APA holds that there is inadequate scientific evidence to support the use of psychedelics to treat any psychiatric disorder, except within the context of approved investigational studies.
APA staff collaborates closely with DB/SAs to advocate for patient safety. For more information, please contact [email protected]. ■
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Psychiatric News
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Published online: 26 August 2024
Published in print: September 1, 2024 – September 30, 2024
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