capitol hill report: 2023 Advocacy year in review

2023 was a very busy year for AAN advocacy! Throughout the year, AAN members and advocacy staff worked with policymakers in Washington, DC, to find common ground to advance the interests of neurology patients and the neurologic profession. Over 180 AAN members from 45 states gathered in Washington, DC, for the 21^st annual Neurology on the Hill, and many more have met with their representatives locally throughout the year. Additionally, AAN member leadership and AAN staff have met with and provided written feedback to regulators and other executive branch officials throughout the year to ensure that the administration understands the perspective of neurologists on a variety of key issues.

These efforts have led to several critical successes including:

Reimbursement

• Implementation of the G2211 complexity add-on code, which is projected to be widely used in neurology and will substantially improve reimbursement for office/outpatient evaluation and management services.
• Modification of policies impacting split/shared billing to promote adequate reimbursement for team-based care.
• The Strengthening Medicare for Patients and Providers Act (H.R. 2474) was introduced in the House. This is the first piece of legislation introduced to provide an inflationary update to Medicare physician reimbursement.
• At the urging of the AAN and other physician associations, 194 members of the House sent a letter to congressional leadership urging them to avert impending cuts to Medicare physician reimbursement.

Telemedicine

• Extension of much-needed Medicare flexibilities through the end of 2024 to allow for continued provision of telehealth services across geographies and in the patient’s home, as well as remote supervision of auxiliary personnel and residents.
• Continued Medicare coverage of audio-only services through 2024.
• Delay of requirement for practitioners to publicly disclose home address if delivering telehealth from the practitioner’s home.
• Delay of restrictions on prescribing of controlled substances via telehealth to allow for further stakeholder input concerning permanent post-pandemic policy.

Regulatory Relief

• Permanent cancellation of all implementing regulations associated with the appropriate use criteria program.
• Rulemaking from the Centers for Medicare and Medicaid Services (CMS) implementing critical guardrails on Medicare Advantage plans’ use of prior authorization.
• The Safe Step Act (S. 652) was reported out favorably by the Senate Health, Education, Labor and Pensions Committee as an amendment to the Pharmacy Benefit Manager Reform Act (S. 1339). This would provide much-needed reform to step therapy requirements imposed by insurers.
• The Improving Seniors’ Timely Access to Care Act (H. 3173) was reported out favorably by the House Ways & Means Committee as an amendment to the Pharmacy Benefit Manager reform bill.
• At the urging of the AAN and other stakeholders, 233 members of the House and 61 members of the Senate sent a letter to the Department of Health and Human Services (HHS) urging the agency to finalize a rule that would implement critical guardrails on the Medicare Advantage Plan’s use of prior authorization.

Access to Care

• Modification of coverage policies to broaden Medicare beneficiary access to beta-amyloid PET scans.
• Modification of coverage policies to broaden Medicare coverage for percutaneous transluminal angioplasty of the carotid artery concurrent with stenting.
• The ALS Better Care Act (S. 3258/H.R. 5663) was introduced in the House and Senate for the first time. This bill would provide additional reimbursement to multidisciplinary clinics that treat patients with ALS.

Neurology Workforce

• The AAN led a coalition advocating for the reauthorization and improvement of the Conrad State 30 program, which led to the reintroduction of the Conrad State 30 and Physician Access Reauthorization Act (S. 665/H.R. 4942).

High Cost of Prescription Medications

• Implementation of critical regulations allowing for negotiation of certain Part D drugs under the Inflation Reduction Act.

Monoclonal Antibodies for Alzheimer’s Disease Advocacy

• Collaborated with CMS to reduce the burdens associated with complying with coverage with evidence development policies for monoclonal antibody products for the treatment of Alzheimer’s disease.
• Natalia Rost, MD, FAAN, testified before the House Energy & Commerce Health Subcommittee on the importance of ensuring appropriate access to these therapies.

Inclusion, Diversity, Equity, Anti-Racism, and Social Justice (IDEAS)

• Submitted comments on strengthening protections against discrimination in medical care for patients with disabilities.
• Submitted comments on integration of artificial intelligence tools into the electronic health record and the need to ensure that such integration does not exacerbate health disparities or promote bias.

Brain Health

• Released a position statement on brain health and held the second Brain Health Summit to convene stakeholders and policymakers around the AAN’s vision.