The Ohio Academy of Family Physicians (OAFP) advocacy team monitors healthcare related legislation throughout the legislative process.
Read on for this week’s updates and contact Workforce and Advocacy Manager Caitlin Laudeman with questions or ways to get involved.
New CMS Prior Authorization Rule Reflects Academy Advocacy: Medicare Advantage, Part D Rule Cuts Administrative Burden
Source: American Academy of Family Physicians
In the latest win for the Academy’s administrative simplification advocacy, the Centers for Medicare and Medicaid Services (CMS) has finalized a 2024 Medicare Advantage (MA) and Part D rule largely in line with the American Academy of Family Physicians’ (AAFP) guidance. The rule streamlines prior authorization requirements (in part by introducing continuity of care requirements) and bolsters access to behavioral health services in Medicare Advantage — reflecting the AAFP’s response to the proposed rule in February.
- Improve MA coverage criteria, increase transparency of prior authorization and medical necessity determinations, and prevent inappropriate coverage denials by MA organizations
- Strengthen MA network adequacy requirements and standards related to behavioral health
- Codify appointment wait-time standards for primary care and behavioral health services in MA
- Require that prior authorization be used only to confirm the presence of diagnoses or other medical criteria “and/or ensure that an item or service is medically necessary” — not to delay or dissuade care
- Set a minimum 90-day transition period for enrollees undergoing treatment while changing MA plans, during which the new MA plan may not require prior authorization for the active course of treatment
- Require that approval of a prior authorization remain valid as long as medically reasonable and necessary, according to the treating clinician.
U.S. Supreme Court Rules to Continue Access to Mifepristone
Source: NEA Consulting’s Ohio Government and Politics Weekly Update
The U.S. Supreme Court, by a 7-2 vote, ruled April 28 to continue full access to mifepristone, a drug commonly used for medication abortions. This puts on hold a lower court’s ruling out of Texas by U.S. District Judge Matthew Kacsmaryk that held the federal Food and Drug Administration was wrong to make the drug more widely available and thus suspended the approval altogether. The two dissents were from Justices Clarence Thomas and Samuel Alito.
Fact Sheet: HHS Announces Intent to Amend the Declaration under the PREP Act for Medical Countermeasures against COVID-19
Source: American Academy of Family Physicians
On April 14, Xavier Becerra, secretary of the Department of Health and Human Services, announced that in the coming weeks, he will issue an amendment to the declaration under the Public Readiness and Emergency Preparedness (PREP) Act for medical countermeasures against COVID-19. The PREP Act declaration has been a key tool for ensuring that Americans have broad access to critical COVID-19 countermeasures including vaccines, tests, and treatments. The PREP Act declaration has provided flexibilities and protections for those individuals and entities who have been involved in providing these critical tools that have helped the United States get to a better place with COVID-19. For the past three years, much of the healthcare landscape—including pharmacies—has relied on these flexibilities and liability protections. By issuing this amendment, Secretary Becerra intends to allow pharmacies to continue their critical roles in our response, even after certain products transition to traditional healthcare pathways. The end of the COVID-19 public health emergency (PHE) alone does not automatically terminate PREP Act coverage for countermeasures.
This fact sheet explains some of the key planned changes that partners can expect regarding PREP Act coverage as well as some of what will not change.
- The PHE Needs a Thoughtful Wind-Down
- PHE Ending: 6 Things to Know
- The End of the PHE: What You Need to Know.
Ohio Academy of Family Physicians Bill Tracker
The OAFP’s online Bill Tracker has been updated and can be accessed on the OAFP website. The bill tracker was created to keep members updated on healthcare legislation in Ohio that OAFP is monitoring or has taken a position on.
View the Bill Tracker to see bill numbers; sponsors; the OAFP’s official position, descriptions; and current status of each bill.