Medicaid Bump Expires with 113th Congress

December 16, 2014

By Mike Amery, Legislative Counsel, Federal Affairs 

Medicaid Bump Expires
Over the last two years, thousands of AAN members have participated in the effort to educate Congress about the exclusion of neurology from the Medicaid bump. The Medicaid bump paid many Medicaid providers higher Medicare rates but excluded our members because they are not boarded by the American Board of Internal Medicine. The bump, which was part of the Affordable Care Act but increased payments for just 2013-14, expired with the adjournment of the 113th Congress.

In early 2013, the AAN joined with the American Psychiatric Association and the American College of Obstetricians & Gynecologists to raise the issue of how the provision failed to treat our members fairly. Bipartisan legislation was introduced in both the House and Senate that would have added neurologists, psychiatrists, and OB/Gyns to the bump. The AAN generated thousands of contacts to Congress with our programs like Neurology on the Hill, our grassroots action alerts, and direct lobbying by our Washington, DC, office. 

In the end, we were in close contact with all of the key players on both sides of the aisle as a final government funding package was being put together. Our message was clear that we would like to see the bump extended and have neurology and our coalition partners included but Congress decided not to renew the increased payment for 2015. Next year, family practice physicians and all internal medicine subspecialists will see their Medicaid payments reduced to the same levels paid to neurologists (except in a few states that have extended this provision on their own).

114th Congress
I am confident that if Congress had extended the Medicaid bump that our efforts to add neurology would have been successful. But a complete expiration makes it very unlikely for legislation creating another program to be successful getting through Congress next year. 

Going forward in the 114th Congress beginning in January there will be many other issues on the table.

The AAN Government Relations Committee is currently putting together a list of issues to pursue and my guess is that one of the top issues will be the lack of inclusion of neurology and other cognitive care providers in the ACA’s Primary Care Bonus, which is an increased Medicare payment that expires at the end of 2015.

A permanent repeal of the Sustainable Growth Rate (SGR) formula will need to be passed, or at least patched, prior to March 31, 2015 when Medicare physician reimbursement will be reduced by more than 20 percent without congressional action. The AAN will be lobbying for increased payments for evaluation and management services as part of any SGR legislation just as we did in 2014.   

VA Epilepsy Centers of Excellence in Good Shape
2014 has been a tough year for the US Department of Veterans Affairs, but with the support of the AAN it has one program that really works—the Epilepsy Centers of Excellence (ECoE).

The ECoEs were created by federal legislation in 2008 that was originated by the AAN and the Epilepsy Foundation (EFA). The legislation created a national advisory board that I was fortunate to be appointed to and we had our annual meeting in Seattle in early December. 

The four centers work with VA sites across the country, which has resulted in improved care for veterans and lower costs for epilepsy care than prior to the creation of the ECoE. 

A year ago, funding for the centers was very much in doubt. The AAN and EFA launched a campaign with the key supporters of the original legislation, Sen. Patty Murray (D-WA) and Rep. Ed Perlmutter (D-CO), to make sure the VA leadership was aware if the success. Since then, the VA has taken steps to continue annual funding for the foreseeable future.  

At one point, we felt that we might need to go back to Congress to ask for a specific appropriation, but fortunately, when I asked my fellow advisory board members if there were any legislative issues that would help the ECoEs, the request was only to tell members of Congress about a VA program that works.

So many of the issues physicians have to deal with in Congress or in government in general are contentious and confrontational. With programs like the ECoE, it is good to know that there are efforts we can take that provide good results for everyone involved, especially for patients with epilepsy.

Dr. Cassidy Wins Final Senate Race
The final US Senate race was decided December 6 when Louisiana Rep. Bill Cassidy, MD, (R) won a run-off election against incumbent Mary Landrieu (D). 

Dr. Cassidy truly understands the issues facing neurology. The AAN has worked closely with Cassidy over the last several years to craft amendments to SGR repeal bills that would ensure that neurology was included in any new Medicare physician payment plans. 

When he takes his seat in the Senate on January 6, Cassidy will be one of the first members we approach as we continue to ensure that voice of neurology is heard on Capitol Hill. 


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