Relationships, Resolutions, and Rules

September 8, 2014

Rep. Keith Ellison Talks Neurology at AAN Headquarters
By Tim Miller, Sr. Program Manager, Communications and State Advocacy 

While several AAN members have hosted members of Congress at their practices over the past month, the Academy recently welcomed Rep. Keith Ellison (D-MN) to our Minneapolis headquarters. Ellison met with staff to discuss some of the AAN's legislative priorities. Ellison, already a cosponsor of our original legislation to add neurology as an eligible specialty for the Medicaid bump provision of the Affordable Care Act, learned more about the practice environment for neurology and how the AAN hopes to shape the future of neurologic care amidst needed reforms. It was a great chance to connect with the member of Congress representing the AAN's headquarters and continue our ongoing dialogue on neurologic issues.View pictures of Ellison's visit.

Congress Is Back, but Not for Long
By Mike Amery, Esq, Legislative Counsel

Congress returned to DC after a month long recess. Members of the House and Senate will be here for a couple of weeks before adjourning until after the November elections.

I wouldn't expect anything substantial to occur during the September session though, other than passage of a “continuing resolution” (CR). While campaigning, members hesitate to take votes that may be used against them on the trail. As a result, less legislation goes to House and Senate conference committees, and the legislation that does make it to conference is likely pared down or uncontroversial.

The CR will take the place of the annual appropriation bills that would fund government through December or perhaps into early 2015. With the House in the hands of the Republicans and the Senate with the Democrats, negotiators between the sides have not been able to agree on funding levels. A CR will continue funding at 2014 levels and prevent another government shutdown. Speaker John Boehner (R-OH) recently said that the House will adjourn as soon as the CR is in place   

Adjournment will leave issues like SGR and the Medicaid bump to a potential post-election “lame duck” session when members return before the new 114th Congress convenes in early January.

Everything Counts
We received good news last week with the publication of an op-ed we submitted to Morning Consult, which is an online daily newsletter following health care issues. I hope you will look at Extend and Amend the Medicaid Bump for a good review of the issues surrounding the exclusion of neurology from the Medicaid bump.

Regulatory Corner
By Daneen Grooms, MHSA, AAN Regulatory Affairs Manager

AAN Comments on CCM and Other Topics in the 2015 MPFS and OPPS Proposed Rules
Shortly before Labor Day, I submitted to the Centers for Medicare & Medicaid Services (CMS) the AAN's official comment letters on the 2015 Medicare Physician Fee Schedule (MPFS) and 2015 Hospital Outpatient Prospective Payment Systems (OPPS) proposed rules. Unlike 2014, overall, the 2015 proposals are pretty favorable to neurology. In the MPFS letter, we thank CMS for recognizing and paying for the non face-to-face services of chronic care management (CCM). For the past three years we have been working with CMS and advocating they not limit this code to primary care because neurologists are often the principal care providers for their patients. Although we generally support the CCM proposal, we have concerns with the proposed payment of $43.67. Our position is that this amount does not sufficiently reimburse physicians for the scope of services CMS requires in order to bill the code. As such, the AAN recommends in a joint letter that CMS allow reimbursement for two CCM codes-standard and complex-as opposed to recognizing only one code. 

Another topic we comment on is CMS' proposal to eliminate all global surgical periods by 2018. We strongly support this proposal. We believe that this policy will not only reduce unwarranted payments by CMS, but it also will eliminate disparities between the payment for E/M services in global periods and those furnished individually. I mentioned earlier this summer that the AAN has been pushing for this policy change for many years and I am pleased to know that CMS agrees with us. I just hope they can withstand the political pressure this proposal has undoubtedly attracted from other specialties who benefit from the status quo. 

Finally, CMS is proposing to remove the stroke measurement set from the Physician Quality Reporting System in 2015. We of course strongly object to this proposal and request CMS retain these important measures in the program for future years.

The 2015 OPPS proposed rule included a few proposals of interest to neurology. In the OPPS letter, our comments focus on EMG/NCS and magnetoencephalograpy (MEG). We generally support CMS' proposed Ambulatory Payment Classification (APC) assignment for EMG/NCS codes, but request CMS keep a close eye on the data because another APC may be more appropriate next year. With respect to MEG, we thank CMS for responding to our concerns and agreeing with our recommendation to create a new, higher paying APC for MEG services.

Odds and Ends
By Karolina Craft, Senior Policy Analyst 

The health spending growth was still slow in 2013 due to sluggish economy but it will accelerate starting in 2014 and in future years as a result of faster economic growth, aging of the population, and the ACA-related coverage expansion, according to the recently published projections of the CMS Office of the Actuary. The national health expenditures, which accounted for 17.2 percent of the gross domestic product (GDP) in 2012, are projected to increase to 19.3 percent of the GDP in 2023. In 2013, growth in Medicare spending on physician services has decreased due to sequestration and multiple procedure payment reduction program, while Medicaid spending on physician services has increased due to the implementation of the Medicaid/Medicare parity rule for primary care services.  


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