AMERICAN ACADEMY OF OPHTHALMOLOGY

Issues related to implementation of legislative provisions of the Indian Health Service in the Interior, Environment, and Related Agencies Appropriations bill.

Legislative issues relating to vision care within the VA Health System.

Ophthalmologists' services in Department of Veterans Affairs programs. Monitor implementation of Surprise Medical Billing law. Advocacy on Risk Evaluation and Mitigation Strategy (REMS) issues. Monitor legislative action on healthcare workforce issues, including related provisions in S. 2840, the Bipartisan Primary Care and Health Workforce Act.

Update and reforms to Medicare payments for physicians and implementation of related provisions of the Medicare Access and CHIP Reauthorization Act (MACRA), including regulatory relief for physicians in the MACRA Quality Payment Program, evaluation and management (E/M) codes and related legislative issues related to payment for E/M codes, and qualified clinical data registries, including Medicare physician payment provisions in: (1) S. 3430, the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, Sec. 403 to extend work geographic index floor under Medicare; Sec. 404 to extend incentive payments for participation in eligible alternative payment models; and Sec. 407 to increase support for physicians and other professionals in adjusting to Medicare payment changes; (2) H.R. 6545, the Physician Fee Schedule Update and Improvements Act, including provisions to increase the work geographic index, increase the Medicare physician fee schedule conversion factor and extend and modify incentive payments for participation in eligible alternative payment models; and (3) H.R. 4366, the Consolidated Appropriations Act, 2024, P.L. 118-42: Sec. 304, Extending Incentive Payments for Participation in Eligible Alternative Payment Models; and Sec. 305, Temporary Payment Increase under the Medicare Physician Fee Schedule to Account for Exceptional Circumstances and Atypical Timing of Enactment. Maintain patient access to In-Office Ancillary Services. Issues related to adequate network coverage for ophthalmology care within Medicare Advantage plans and advocate for relief from prior authorization requirements under Medicare Advantage and Medicare Part D plans, including related provisions in: (1) H.R. 4822, the Health Care Price Transparency Act, to require Medicare Advantage plans to institute electronic prior authorization and establish requirements related to real time decisions; and (2) prior authorization transparency requirements included in H.R. 5378, the Lower Costs, More Transparency Act, and H.R. 4822, the Health Care Price Transparency Act; and MA plan provider directory accuracy issues, including provisions in S. 3430, the Better Mental Health Care, Lower Cost Drugs, and Extenders Act of 2023, in Sec. 109, to require MA plans to maintain accurate provider directories on a public website. Legislative issues regarding implementation of Meaningful Use of Electronic Health Records. Medicare reimbursement for telemedicine, including related provisions in S. 3430, the Better Mental Health Care, Lower Costs Drugs, and Extenders Act, including Sec. 105 regarding Medicare payment for mental health services furnished through telehealth, and Sec. 107 regarding communications regarding telehealth and interstate licensure requirements. Medicare RAC reform and use of step therapy in Medicare and health insurance coverage including related provisions in H.R. 2630/S. 652, the Safe Step Act. Enhance Center for Medicare & Medicaid Innovation quality initiatives and patient access to Medicare Part B covered drugs, including monitor CMMI Medicare Part B drug-related demonstrations.