My name is Megan O'Hara. I am the president of AAOE for the 2024 calendar year. Today I'm going to be speaking on the distinction between federal and state legislation. Most importantly, professional advocacy communicates a viewpoint or a policy against an issue and is used to influence change on public policy, including healthcare. It's driving the need to address and bring attention to important issues, to bring attention to important issues such as promoting change, protecting rights, influencing policy and legislation and ensuring accountability and responding to emergent issues. The scope and authority for federal and state legislation are mostly the same at most levels. So federal is obviously enacted by Congress, where state is enacted by the state legislatures. Federal needs to follow the U.S. state constitution, where the state legislation needs to follow the state constitution as well as the United States constitution. And it only applies within the state that the legislation was written for, where federal is uniform throughout the states. The next matter would be federal on national importance, obviously, immigration, national defense, interstate commerce, where state legislation would deal with matters that fall under their jurisdiction, education, criminal law, transportation within state borders, insurance law, those things would be at the state legislation. The lawmaking process, while most people probably know this, I'm just going to go over it, requires approval by both the House and the Congress and is signed into law by the President. And state legislation typically involves the bicameral divisions of the state legislation and it's signed in by the Governor. I'll just leave that there for a second. Again, constitutional limitations, the state would be for both constitutions and federal would just be the United States constitution. State legislation would be subject to preemption if there's a federal law, and then federal legislation can override state legislation with supremacy clauses. Enforcement for both is similar, but a little different. Federal legislation would be FBI, EPA, CMS, HHS, OPMC, Department of Justice, things like that, where the state agencies, which are not cut down so distinctly, would take care of anything at the state legislation enforcement side. Some examples of state legislation, one would be the Texas Gold Star Program. It's currently setting its sights on prior authorization rules for Medicare Advantage plans. Texas decided that they were going to create a policy that they could follow to have providers obtain a gold star standing from the insurance company that they would not have to get prior authorizations for all their patients for a period of time, and as long as they stayed within those guidelines, they would be able to maintain that, cutting down work in their offices, time, money, all the things that go along with it. This is one example of where state legislation may influence federal legislation, as this is now, at the federal level, the same kind of program, trying to make it uniform for all the states, and then they will use the Texas as the template, and then federal legislation will follow behind. Another state legislation would be scope of practice rules here in New York, where we've been fighting very hard on lobbying for podiatry providers being able to operate up to and including the knee, which would include joint emplacement for the knee. As orthopedic practice managers, we don't think that this is a good idea, so we have been fighting this for quite a while. There are other states with similar legislation, but that's where you'll see the difference between state to state and how they'll have similar but varying opinions on legislation, but we use that information to be able to use it as our talking points in our lobbying on our side. Some examples of federal legislation would be the Surprise Billing Act. Again, this came from some state legislation, including New York, to be used as a template. This allows patients to be given advance notice of what they're expected to pay for medical services and ensuring that the patient is not being improperly billed. The federal legislation has been modified to allow for insurance regulations from state to state, and it's broader in its language to account for market differences. Prior authorization, Medicare fee schedule, these would all fall under federal legislation. When we start talking about Medicare, that's when we get into regulatory versus legislation. So the primary difference between legislation and regulation is legislation is the law is written, this is the law, and then the regulations are the bits and pieces that they put together in order to determine how that law is going to be carried out. These are some examples of federal regulations. CMS would be a good example. So they make a Medicare law, but then CMS comes up with the regulations on how to follow those Medicare. Both legislation and regulations are important components to the legal landscape, and they shape healthcare policies and practices at the federal level. And ultimately, advocacy is the mechanism for individuals like us, practice managers, communities like our groups that we have, and organizations to participate in the democratic process, influence decision, make things work for their needs, and work towards a more just and equitable society through lobbying. Thank you so much. ♪♪♪

Megan O'Hara

AAOE President

federal legislation

state legislation

healthcare advocacy