This Week – November 11, 2017

This Week in Washington, D.C.

  • State Ballot Issues Impacting GI: Maine and Ohio Vote on Health Care Ballots
  • Federal and State Call to Action: Step Therapy Bills Need Your Advocacy!
  • Help ACG Help You: CMS Seeks Your Feedback on MIPS Colonoscopy Episode
  • ACG on Capitol Hill: Joining the Discussion to Promote and Preserve Independent Health Practices

From ACG Legislative and Public Policy Council Chair, Whitfield L. Knapple, MD, FACG

State Ballot Issues Impacting GI: Maine and Ohio Vote on Health Care Ballots

On Tuesday, Maine voters approved a state ballot to expand its Medicaid program under the Patient Protection and Affordable Care Act (known as the “ACA”).  This is the first time voters have directly approved a Medicaid expansion via a ballot initiative.  According to reports, Utah and Idaho are considering similar state ballots for 2018 that would bypass state legislators.

The vote makes Maine the 32nd state to agree to expand Medicaid to thousands of low-income adults who qualify for coverage.  Maine Republican Governor Paul LePage vetoed expansion bills on five occasions, and has vowed to block implementation again.  According to reports, roughly 80,000 adults will qualify under the expansion and add to the nearly 12 million people in the 31 states and District of Columbia who have already obtained coverage through Medicaid.  The last state before Maine to agree to expand Medicaid was Louisiana, taking place nearly two years ago.  Of the 18 states that have not expanded their programs under Obamacare, all but Virginia and North Carolina are led by a Republican governor.  As ACG mentioned this summer, one of the significant obstacles during the debate to repeal the ACA was the growing popularity of Medicaid and Medicaid expansion.

The ACA expanded Medicaid coverage to low-income adults with incomes up to 138% of the federal poverty line, or roughly $16,600 for an individual or $34,000 for a family of four.  The Federal Government also reimburses states at least 90% for this expansion under the ACA.

Also on Tuesday, voters rejected an Ohio ballot measure aimed at lowering drug prices by requiring that state agencies purchase prescription drugs at prices no higher than those paid by the U.S. Department of Veterans Affairs.  California voters rejected a similar measure in 2016.


Federal and State Call to Action:
Step Therapy Bills Need Your Advocacy!

ACG and several patient advocacy organizations are focusing efforts to support legislation regarding Step Therapy at both the federal and local level.  Step Therapy necessitates the “fail first” drug therapy requirements, in which patients are forced by insurers to try and fail with one or more medications before the cost of the medication their doctor originally prescribed will be covered.

At the federal level, Representative Brad Wenstrup (R-OH) has introduced the “Restoring the Patient’s Voice Act of 2017” (HR 2077), which would allow for exemptions to be made to the Step Therapy protocol to remove the current barriers in allowing patients to gain access to the medication they need at a faster pace. This legislation currently has 28 cosponsors, and is supported by both Democrats and Republicans.

At the state and local level in Massachusetts, an “Act to Reduce Health Care Costs Through Improved Medication Management” (S.551/H.492) has been introduced in both the House and Senate, by State Representative Jennifer Benson (D-MA) and State Senator Barbara L’Italien (D-MA). An amendent addressing Step Therapy was also released by Senator L’Italien as a part of a larger health care package, which was debated by the Massachusetts Senate Ways & Means Committee this week.

To help make an impact, these legislators need to hear from you directly, and the ACG website makes this process quick and simple.  Use the links below to advocate your support for these important patient-focused bills.

All ACG members: click here to take action on the federal bill!

ACG members in Massachusetts: click here to take action on the state bills!


From ACG Legislative and Public Policy Council Member and ACG Board of Trustee, Caroll D. Koscheski, MD, FACG

Medicare Seeks Your Feedback on MIPS Colonoscopy Episode

As ACG and the GI societies notified you earlier this month, CMS recently announced that it will begin a trial run or test period for a “Screening/Surveillance Colonoscopy” episode of care.  We need your feedback and input!

What does this mean? 

From October 16 to November 20, 2017, ACG members may receive a confidential report with information about their performance on this draft episode of care.  According to CMS, the report is available for group practices and solo practitioners who meet a 10-episode case minimum during the measurement period of 06/01/16 to 05/31/17.

The purpose of this report is to help improve the accuracy and understanding of the process, and for our members to provide feedback to CMS.

Your Feedback is Important- Complete the Survey

CMS will be seeking feedback from all stakeholders through an online survey.   Please complete this survey here.

This survey opened on October 16, 2017 and closes at noon Eastern time on November 20, 2017.  The field test reports for group practices and solo practitioners will be distributed through the CMS Enterprise Portal, which CMS has previously utilized for “Quality and Resource Use” Reports.   If you do not already have an account, you can set one up and get access to a “Physician Quality and Value Programs” role in preparation for the field test report by using this guide.

Some background- Why do we need to do this? Click here to read the full blog.


ACG on Capitol Hill:
Joining the Discussion to Promote and Preserve Independent Health Practices

On Sunday and Monday, ACG Governor for Northern Texas, Daniel C. DeMarco, MD, FACG, was invited to Washington D.C. by Rep. Pete Sessions (R-TX) to participate in a physician forum regarding health care issues impacting private practitioners and independent practices. The National Physicians’ Council for Healthcare Policy meets regularly in Washington D.C.  Members of the GOP Doctors Caucus, as well as officials from the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) regularly participate in these meetings as well.  Private practitioners from various specialties this week discussed the issues associated with MACRA and other Medicare payment policies impacting independent physician practices. ACG will continue to be your voice for clinical GI and independent practices in both Washington D.C. and at the state and local level.