ACP Chapter Action Tool Kit
Prepared by ACP’s Division of Governmental Affairs and Public Policy
April 17, 2020
ACP is advocating for specific regulatory relief to remove unnecessary burden on physicians so they are able to focus their efforts on addressing the COVID-19 crisis. The College has focusedits advocacy on a broad array of regulatory relief topics specifically in correspondence with the Centers for Medicare and Medicaid Services (CMS), the National Governors Association, the National Association of Insurance Commissioners, the National Association of Medicaid Directors, America’s Health Insurance Plans, BlueCross BlueShield Association, andcommercial insurers including United Healthcare:
- Adequate Payment and Coverage for Telehealth and Phone Calls
- Waivers of Prior Authorizations
- Waivers for Performance Measurement Requirements
- Relaxation of Home Health Requirements
- Delays in Appropriate Use Criteria Requirements
- Hardship Exceptions for New Health Information Technology Requirements
CMS has issued a series of guidelines and interim final rules detailing a number of waivers offered during this crisis regarding:
- Medicare Telehealth – virtual check-ins and e-visits, remote patient monitoring, removal of frequency limitations
- Workforce improvements
- Stark Law waivers
- Quality Payment Program hardships
- Medicare appeals processes
In addition, in a recent letter to House and Senate leaders, ACP urged Congress to direct CMS to waive all prior authorization (PA) requirements during this period of national emergency, and urged Medicare Advantage organizations that contract with CMS to waive PA requirements as well. Delays in patient care resulting from PA restrictions may result in patients occupying hospital beds that could be used during this emergency. ACP appreciates the agency’s work on efforts to reduce physician burden, and we urge CMS to allow additional flexibilities so that physicians may focus on patients, not paperwork.
Administrative obstacles imposed by prior authorizations have become even more problematic given the current COVID-19 national emergency when frontline physicians need to focus their time and resources on curtailing the pandemic. The numerous and varying requirements for prior authorization requests often result in substantial adverse effects on the health care system, physicians, and most importantly patient outcomes and well-being.
While federal agencies, as well as a number of state-level organizations including private payers, have taken action, burden and confusion may still exist due to differences in how states and local entities are waiving certain requirements.
ACP urges chapters to contact local and regional private insurers, insurance commissioners, and your governor’s offices to advocate for waiving unnecessary regulatory and administrative burdens during this period of national emergency, including:
- prior authorization requirements;
- state telehealth coverage, payment, and licensure barriers;
- performance measurement requirements
Chapters should also advocate for State Medicaid Waivers that temporarily suspend Medicaid fee-for-service prior authorization requirements.
- CMS Summary of regulatory flexibilities during the COVID-19 public health emergency
- KFF’s Medicaid Emergency Authority Tracker: Approved State Actions to Address COVID-19
- CMS list of 1135 waivers
- ACP’s Letter to CMS Regarding Regulatory Relief for COVID-19
- ACP’s Letter to National Governor’s Association and National Association of Insurance Commissioners
- COVID-19 Practice Management – State and Private Payer Resources
- COVID-19 Private Payer Coverage Chart
- Leadership Academy Presentation: ACP Advocacy in Action and Tips for the Busy Physician