Capitol Hill Report: Pending Legislation Affects Neurologists, Patients

DECEMBER 11, 2017

Here Is the Latest from Washington

Congress Heads to the 2017 Finish Line
They do this every year. Congress heads to the end of the year with many of the year's “must-pass” legislation “unpassed”, leaving critical government programs hanging in the balance.

The AAN is interested in several of these programs, including:

  • FY2018 Appropriations: Congress passed another short-term resolution maintaining funding until December 22. Most expect another short-term funding plan that keeps the government open until early 2018, and if they fail to pass a bill, the government would shut down.

  • The Children's Health Insurance Program (CHIP): CHIP provides health insurance coverage to over nine million children and pregnant women with incomes that are modest but too high to qualify for Medicaid. Funding expired September 30 and states are running out of money for their programs. The AAN has sent action alerts to US Academy members asking them to urge their members of Congress to act and provide funding for CHIP.

  • Medicare/Other Health Extenders: Several policies impacting Medicare are set to expire affecting: Medicare dependent hospitals, rural home health programs, therapy caps, ambulances, and special needs plans.

  • The FAST Act: Both the CHIP reauthorization and the Medicare extenders packages are “must-pass” legislation for most members of Congress who have thousands of constituents who rely on these programs. This provides a great opportunity for the AAN.

Either bill will provide a legislative opportunity to include expanded reimbursement for The Furthering Access to Stroke Telemedicine (FAST) Act (S. 431, H.R. 1148), which would allow Medicare to pay for telestroke services in urban and suburban areas. It has passed the Senate as part of the CHRONIC Care Act, and has 175 House cosponsors and passed the House Energy & Commerce Committee.

The FAST Act is one of the top priorities for the AAN, and we are working hard to have the CHRONIC Care Act included in one of the year-end “must-pass” packages.

AAN Weighs in on Tax Reform Provisions
The Senate passed its version of tax reform, the Tax Cuts and Jobs Act (H.R. 1) by a vote of 51-49 in the early hours of Saturday, December 2, along a party-line vote.

The Senate bill must now be reconciled with the House passed bill from November. A House/Senate conference committee has been appointed to work out the differences. The AAN has concerns and sent an action alert and a letter to members of the conference committee asking for consideration of the following issues:

  • Repeal of the individual mandate
  • Elimination of tax-exempt status for graduate tuition waivers
  • Elimination of the student loan interest deduction
  • Elimination of the medical expense deduction

Tax reform and must-pass legislation like CHIP and Medicare extenders require action from Congress before the holiday break. The Senate special election in Alabama is also a factor for passing this legislation. The new senator will be seated December 20, which could change the makeup of the Senate where Republicans can only lose two votes. Stay tuned!

AAN, CMS Discuss Burdens of Prior Authorization

  • In late-November, the AAN joined a small group of medical societies focused on regulatory relief to discuss prior authorization in Medicare Advantage. We met with several staffers from CMS, including the agency's Deputy Administrator, Demetrios Kouzoukas.

  • We presented CMS with information about the burdensome impact of prior authorization on neurologists in the Medicare Advantage program. Many prior authorization requirements appear to be deliberately designed to dissuade physicians from ordering medically necessary services. This has a direct and negative impact on patient care.

  • We asked CMS to issue guidance addressing the appropriate use of prior authorization by Medicare Advantage plans and the requirements that must be met if it will be used as a utilization control tool. We also asked CMS to increase its oversight, including the use of audits, of these plans' adherence with existing prior authorization requirements.


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