and welcome to today's webinar. It's our 2024 AAOE Policy Update. Just a few housekeeping items before we begin. So everyone is in listen-only mode, so if you have questions for our presenters today, please do drop those in the Q&A or the chat. I'll be monitoring both of those and can bring those to our team as things get going. And if you'd like to interact with the other participants, you can always use the chat for that. Just make sure that you have everyone selected. So today we are joined by Jake Kahn from LobbyIt and Cameron Wheeler from LobbyIt as well. I'm going to go ahead and pass it over to Jake to get us started. Thanks, Jessica. And it's good talking to everyone again today, letting Cameron get herself set up with our PowerPoint really quickly. But in the meantime, I'll do some quick introductions. For those who do not know, at this point, I feel like we should all be close friends. I think this is the third or fourth webinar we've all done together. But for those who don't know who I am, I am Jake Kahn, Vice President Government Relations here at LobbyIt, where my portfolio includes a pretty broad range of policy issues, but health care still remains my primary focus. I've been working in government relations, GR, for about a decade now. And I've been here at LobbyIt, I think I can now say in 2024, for almost three years. And I've been working closely with AAOE for really almost that entire time, something I really enjoy working with you and your full team. We're also joined over on my left, although you guys can't see him, with our Director of Government Relations, Cameron Wheeler, who is going to be manning the PowerPoint. And I also know Jessica is going to be watching for your comments, for your questions, and I'll do my best to address those at the end of the presentation. And for any questions I don't know off of hand, we'll be sure to circle back and share those answers with the whole group. There we go. So first, you know, going from the macro first, the 2024 agenda focusing in on health care. You know, health care was one of the most active issue areas in 2023. And this trend is expected to continue with Congress back for the second session of the 118th Congress. The activity by the health care committees in both the House and the Senate has been fueled in part by the efforts to reauthorize various expiring provisions. This Congress continues to be defined really by a juxtaposition between an extraordinarily high level of activity at the committee level, but with really few health bills having passed the full Congress, getting a vote on the House floor, a vote in the Senate, and then being signed by the President. And that includes reauthorizations on a number of bipartisan pieces of legislation. And with these dynamics in mind, we'll be closely watching to see how Congress looks to address its unfinished 2023 legislative health care business at the beginning of this year. And just touching on a few of the some of the major ones, you may remember from our summer webinar, but we are still focused on the Pandemic and All Hazards Preparedness Act, or PAPA, as it's abbreviated, is still on the congressional to-do list. And the purpose of that piece of legislation is to improve the nation's public health and medical preparedness and response capabilities for emergencies, whether deliberate, accidental, or natural. And as you might imagine, preparing the country for the next pandemic continues to be top of mind. And then also Congress has extended some of PAPA's programs as part of the recent continuing resolutions or CRs. However, we are still focused on the PAPA Act, which is resolution on a final bill between the House and Senate has thus far been pretty elusive. Both Senate HELP and the House Energy and Commerce Committees have advanced legislation. But disagreements really focused on on drug shortages, and then also some pet projects and pet issues from a few members has been holding back a vote, a final vote in both chambers. Another major program or reauthorization that we're watching includes the SUPPORT Act, which focuses on efforts to combat the opioid epidemic, which was actually enacted with overwhelming bipartisan support just five years ago. That's right, just five years ago, things could pass Congress with bipartisan support. And then in December, the House voted very strong bipartisan vote again to pass reauthorization, with new efforts focused on the fentanyl and opioid crisis. Meanwhile, Senate HELP has advanced their own SUPPORT Act reauthorization bill. And there are still some differences between the two bills that need to be reconciled. But this seems something that will likely hopefully get a final vote in the next few weeks or so. And then finally, some other reauthorizations that Congress is tackling kind of, again, left over from that 2023 agenda includes funding for the Community Health Center Fund, the National Health Service Corps, funding for the Special Diabetes Program, and then delay of a Medicaid disproportionate share hospital or dish allotment reductions. And then finally, something that we really do care about is still protection for cuts under the Medicare physician fee schedule. And then in terms of new legislation, this is something I remember discussing with everyone at the beginning of this Congress, but we've really reached a new stage. And that's in the House and Senate, they have both maintained their focus on drug pricing and pharmacy benefit manager legislation. Most recently, the House passed a lower cost, more transparency act by bipartisan vote advancing provisions that ban spread pricing, spread pricing and Medicaid and impose additional transparency requirements on PBMs, pharmacy benefit managers. The bill also included $3.7 billion in limited site neutral cuts, not in a sphere that is AAOE specific, but still good to see Congress taking some action on site neutral, site neutrality. Hospitals, however, have been pushed back pretty aggressively, as I'm sure many of you could assume, over those changes when it comes to site neutral payment cuts. But it still seems likely these payment changes will be on the table as negotiators seek to look for offset for other 2024 priorities, which is a long way of me saying that this is something that might actually end up getting cut in a final version of the bill. Meanwhile, over in the Senate, Senate Finance and Health Committees have advanced their own PBM legislation, that's the Better Mental Health Care, Lower Cost Drugs and Extenders Act, S3430. That includes many of the House passed provisions, but also deals with pharmacy access, formulary requirements, de-linking rebates for drug prices, and other more reformative issues being coming from a Democrat led Senate. Whether Congress ultimately comes to bipartisan bicameral agreement on legislation affecting these two bills is something still being hashed out. But there is some traction that again, hopefully over the next few weeks, or maybe the next couple of months, this was something that we'll finally see passed. And then finally, and I don't want to get too deep in the weeds here when it comes to the FY24 budget process, I think may result in me having some form of anxiety or possibly cursing. So I'll leave it just to say that the latest CR, continuing resolution, kicked the can down the road to early March, I believe March 1st and March 8th are the two new deadlines for the FY24 budget. And Congress is still working to come to an agreement. There has been some agreement now on top line spending for these appropriation bills. We're keeping close watch on it. Nothing that directly really impacts the AAOE community. But something that is worth noting is that having spoken to committee staff and hearing from the GOP DOC caucus, other healthcare related members in the House and Senate, is that the FY24 appropriations bill could include that position fee schedule cut legislation. It could be with the budget, it could be with any of the healthcare packages I just touched on. Really, whichever can come first. There's a strong push in Congress to get those position fee schedule cuts amended as soon as possible. So I know that's a top priority for the AAOE community, something that we voiced in previous letters. So whatever the developments are, we'll be sure to keep everyone updated. Now, having gone from the macro of what Congress is dealing with right now, we want to focus in on what AAOE's legislative priorities are. While these aren't likely to be really included in the previous mentioned reauthorizations or that larger PBM package we just talked about, we do know that a number of our priorities, particularly telehealth, are tied to this kind of sun setting in 2024. So we have been working in our meetings when speaking to committee staff to get as many of our issues connected to that likely end of year telehealth-led healthcare package. First, as I already talked about, the position fee schedule, there are efforts right now to try to amend the current cuts that we've seen in 2024, but something that AAOE has been strongly advocating for is a more long-term solution. As many of you, of course, know, year-over-year cuts to Medicare physician reimbursements jeopardizes your abilities to keep your doors open and care for patients in our communities. While costs of running medical practices has actually gone up by 47%, physician payments have declined 26% from 2001 to 2023. One adjusted for inflation, making it hard for many practices, and particularly small, rural, and low-income serving practices to stay open. In fact, the number of doctors not accepting Medicare has actually more than doubled since 2009. And so a piece of legislation that we're strongly supporting is the Strengthening Medicare for Patients and Providers Act, that's H.R. 2474, which would tie the annual physician fee schedule updates to inflation, a move that we view as both fair and efficient, provide stability, provide predictability for the healthcare field. The lead sponsor on this legislation who we've met with before is Representative Ruiz, Democrat from California. The good news is since the last time we spoke, even just in August, the co-sponsors on this bill has gone from 33 to 82. 47 Democrats support the bill, 35 Republicans, which is actually a pretty strong balance. But we're continuing to bring attention to this bill, and again, try and have a more permanent solution to this ongoing annual crisis that we're looking to avoid. Next, another issue that we've been tracking is the Site-Based Invoicing and Transparency Enhancement, or SITE Act, that's S.1.869, which would ensure that Medicare reimburses care fairly for off-campus services, regardless of who owns the provider, and provides a crucial step in making healthcare affordable for everyone. This bipartisan legislation also invests savings from this bill in national nurse training programs that would support bio-network partnerships, create new positions, and provide payments for specific training costs at a time where the healthcare workforce is under strain. And I know particularly coming out of the pandemic, the healthcare workforce is something I know AAOE is sensitive to and something I know Congress has been taking a lot of focus on. And the implementation of site-neutral payments in Medicare, we recognize is a small but essential step forward in relieving Americans from crushing medical expenses, preserving the fiscal health of Medicare, and fighting back against the harm of hospital consolidation. This bill is currently just in the Senate. It's led by Senator Mike Braun, but does have a balance of two co-sponsors, Democrat and Republican, something that we're really, again, pushing when we go into all of our meetings. Naturally, no healthcare conversation can be complete unless you talk about prior auth reform. We hear from all the AAOE members who participate in our calls how much of a labor this is. You know Congress truly understands that really it comes down to finding the right vehicle, balancing on costs. A piece of legislation that we tracked from earlier this Congress is the Health Care Price Transparency Act that's HR 4822 with proposed improvements for the use of prior off including establishing an electronic prior authorization process, requiring HHS to establish a process for real-time decisions for items and services that are routinely approved, improving transparency, and also encouraging plans to adopt prior authorization programs that adhere to evidence-based medical guidelines in consultation with physicians. So this bill was introduced with only Republican support. Democrats had some some issues with the bill but the good news is, and I'll get to this in just a moment, is that CMS you know took previous legislation from last Congress, took really the some of the core elements of this bill, and have actually recently introduced a final rule that we'll touch on that we think there's a lot of the good work that this bill and previous efforts have have promoted. And then getting close to the end in terms of our things we're tracking, of course you know something that we're big advocates of is protecting and extending telehealth. Congress has extended telehealth flexibilities for Medicare through 2024. It is widely believed to be one of the few bipartisan sure things to pass this Congress, and I know what I'm putting out there, but I promise this is something that no one has any interest being responsible for seeing expire. And while there are truly numerous telehealth bills that we're tracking, one that we're paying particular focus on is the Connect for Health Act. It's H.R. 4189-S2016, which would permanently expand access to telehealth services, ensuring that Medicare beneficiaries can continue to receive this essential care. The bill is bipartisan House and Senate. In particular, the Senate has 61 co-sponsors, up from 59 the last time we spoke, which means that the bill could pass today if they really wanted to. Over in the House, 17 co-sponsors, up from four just from a few months ago. But like I said, there's a number of telehealth bills that are out there, a lot of different offices wanting to make sure that they have their fingerprints on it. So we have confidence based on the Senate bill that that's likely going to be the template that they use for whatever that end of 2024 health care package might look like. And then finally, increasing and protecting care, focusing on the removal of the ban on physician-owned hospitals. You know, the AAOE community understands the importance of quality, efficient, and cost-effective patient care. That is why physician-owned hospitals play such a vital role in the American health care system. And not only are physician-owned hospitals among the top facilities in the country, but a recent analysis actually found that those facilities are saving Medicare $3.2 billion over 10 years. And that restriction on physician-owned hospitals penalizes physicians and patients by imposing burdensome restrictions on doctors who are trying to innovate and improve patient care. And that's why we strongly endorse and promote the Patient Access to Higher Quality Health Care Act, H.R. 977-S470, over in the Senate, which would repeal the ban on new physician-owned hospitals and help ensure lower costs, increased access to care, and more options for patients. It is bipartisan in the House. The bill has only Senate support, only Republican support in the Senate. And our real focus has been to try to increase that Democratic support, both in the House and the Senate. A lot of Democratic offices get their hackles up a little bit when someone mentions that Republicans want to tinker with the Affordable Care Act. But with the support of the Republican sponsors who are really encouraging us to go out there and spread this message, this focuses on increasing access to care, increasing benefits for patients and doctors alike, pushing back on that hospital consolidation issue that we know Congress cares about. So we're getting out there and promoting this. And again, they're really hoping to see this tied in as well towards that end-of-year health care package. And finally, you know, while we track for a lot of health care regulations that come out there, I'm sure some of you may take the time to check those regulatory updates. The one I really want to focus on is the interoperability and prior authorization final rule that was recently released just on January 17th, where CMS finalized the CMS interoperability and prior final rule, which sets requirements for Medicare Advantage organizations, Medicaid and the Children's Health Insurance Program, fee-for-services programs, so CHIP FFS programs, Medicaid managed health plans, health care plans, CHIP managed care entities, and issuers of qualified health plans offered on the federally facilitated exchanges. It's a mouthful. My apologies. With the goal of improving the electronic exchange of health information and prior authorization process for medical items and services. There is a lot of information in this final rule. Some of you may have seen, and I encourage you to go back if you haven't, and review the summary that we circulated. I'm going to touch on just a thing I think is really the top issue that AAOE cares about, but take the time, review the final rule. There's some great summaries that are out there that we shared links to, and any questions that maybe we don't touch on, you know how to get in contact with me, Jessica, or Addie, and we'd be happy to answer those, but I do want to flag that starting in 2026, Medicare Advantage and Medicaid plans will have 72 hours to answer urgent requests and seven days for standard requests, cutting the current decision time frames for standard decisions in half, and the rule also requires all impacted payers to include a specific reason for denying a prior authorization request. Like I said, there's a lot of great things in this final rule. This is an issue that we were working on diligently last Congress. It's something that we've been focused on legislatively this Congress as well, but with congressional pressure, outside groups strongly pushing it, it's good to see CMS finally taking some steps to improve the prior authorization program, and being 2024, it may have seemed just like yesterday, and I'm sure you're all getting the same amount of campaign ads as I am. Surprise, it's an election year. Right now, we're looking at a likely head-to-head matchup between President Biden and Donald Trump or possibly President Biden and Nikki Haley, and again, this is a snapshot. As I love to say, polls do not decide elections. Election day does, but keeping all that in mind, what we have here is a snapshot of a composite of the average of a number of polls that have come out. I think I pulled this just from last week, and as you can see, the possible matchup between President Biden and Donald Trump is effectively a toss-up, but it does seem that Donald Trump does currently have a slight edge, and then in a potential matchup between President Biden and Governor Nikki Haley, Haley certainly seems to have a more decisive edge in that potential matchup. The Republican South Carolina primary is February 24th. That's the next primary that's coming up. Depending on how Governor Haley does in her home state, I think will really dictate how the rest of this campaign goes. If she wins decisively, she will certainly, I believe, stay in the campaign at least through Super Tuesday, but if she loses decidedly on their other end, I think I and a lot of other experts who do a lot more work on the campaign side expect her to likely drop out, and then we'll be heading full force towards November, and then when it comes to the congressional races, again just being a snapshot, most experts predict that the House will likely flip to the Democratic Party, while the Senate will likely flip over to the Republican Party, particularly with some very competitive races for Democrats in Montana, Ohio, and Arizona, and the one thing I'll say about it being an election season when it comes to health care is that Republicans have learned their lesson, I firmly believe, and got very tired of getting hammered on health care on the campaign trail. You don't really hear anyone going around talking about repeal and replace Obamacare at this point. Republicans, particularly frontline Republicans, those Republicans representing districts where President Biden won in 2020, want to go home. They want to be able to campaign on doing something for constituents, particularly on health care, which is good news for us. I think it gives them momentum and encouragement, despite where they might have odds on other issues, is they want to be able to go home and raise it so that they've extended telehealth, that they can improve the care in their community, so I'm taking that as a positive sign for us. So that is the presentation. I guess I'll pause here and see, Jessica, if we have any questions. Awesome. I don't see any yet, so if you do have questions for Jake, feel free to drop them into the Q&A or the chat. I did share some recent AAOE blog posts that we've done on advocacy, as well as the link to that Physician B Schedule Lookup Tool that we provide, so just wanted to share those resources with this group as well, and I'll give it a moment just to see if anything comes in. While I do that, I do want to share that we have recorded this whole session, and so if you want to revisit anything, you can always get access to that in the AAOE Learning Center, along with all of our other webinars. And something else mentioned, as I had everyone's attention for a little bit longer, on the Physician Fee Schedule, we were just talking about this the other day, we spoke with an office who's a member of the GOP Doc Caucus, Doctors Caucus, over in the house, they're putting another letter together encouraging action from leadership to take some steps on the current cuts on Physician Fee Schedule. What I've heard is that those, that legislation would not be retroactive, so anyone who would receive that cut from January 1st, 2024 until that bill is passed would likely be affected, but my understanding is that CMS has been looking to slow roll as much as they can so that people aren't as affected. But again, there's a lot of fire coming from Congress to get this done, particularly from those coming from the healthcare field themselves. So on the Physician Fee Schedule, as soon as they can find a way to pass legislation on that, they're going to do it. And obviously once that happens, we'll be hearing any updates with the AAOE community. All right, I don't see anything in chat, but if you think of something later, like Jake said before, feel free to reach out to him, myself, Addy, and we'd be happy to make sure that you have answers to your questions to the best of our ability. Of course, none of us can predict elections, but certainly pass things along. And also, if there's anything that you feel strongly about that's coming up that you've got thoughts on, I'm sure that we'd be happy to hear from the members on the different things that we're looking at. So don't hesitate to reach out anytime. We're here as your association to support you, and we have a pretty good finger on the pulse of what everybody wants. But if something comes up and you've got thoughts on it, feel free to let us know, and we can always share resources on how you can get in touch with your representatives if you don't know how to do that too. So, yeah, just thank you everyone for joining us today. You'll get an email later once that recording is ready and available to you, and hope everyone has a great rest of the week. We'll see you the next time around.

2024 AAOE Policy

healthcare issues

legislative priorities

Pandemic and All Hazards Preparedness Act

SUPPORT Act

telehealth expansion