IMA Hosts Reproductive Health Forum
On Wednesday, June 21, the IMA Board and Lobby Team hosted a forum providing an overview of IMA’s advocacy efforts on reproductive health. Focusing on the 2023 legislative session, the 90-minute forum highlighted the progress made, the path ahead, and the trials and tribulations along the way.
With enough time having passed since the Legislature adjourned, IMA Lobby Team members can now more freely share behind-the-scenes events and dynamics that impacted the ultimate outcome of our advocacy efforts. The two most challenging aspects of sharing IMA’s progress with the membership during the session were: 1)Most conversations with legislators were confidential, and 2) information was fluid with the state of play often changing multiple times a day.
The 2023 legislative session, and the months leading up to it, was a whirlwind. First, IMA worked to educate legislators by holding meetings throughout the state. IMA physicians and Lobby Team members explained the very troubling consequences of Idaho’s Total Abortion Ban (TAB), which is delaying access to healthcare for pregnancy complications and putting women at risk of serious health conditions. These are women that want to begin or grow their families but have received a devasting diagnosis, potentially impairing their ability to have children in the future. IMA’s messaging was very effective in communicating our goals and resulted in a growing number of legislators supporting our efforts.
Following the directives from the House of Delegates, the Lobby Team drafted legislation that made our agenda clear from the beginning:
- Replace the affirmative defense standard (guilty until proven innocent) with true exceptions
- Provide exceptions for severe mental health situations
- Provide exceptions for lethal fetal anomalies
- Provide exceptions for pregnancy caused by rape or incest without a police report
In an effort to distribute our draft legislation, educate legislators, and continue the momentum, the Lobby Team built a coalition of like-minded organizations. After many months, the hard work paid off. The narrative had changed; a majority of rank-and-file legislators were supportive of our efforts.
However, IMA’s outreach to legislative leadership made it clear that no bill would go forward without the cooperation and support of a major pro-life organization. This gave IMA a very narrow pathway for achieving our directives. IMA physicians and Lobby Team members engaged in good faith negotiations and succeeded in making the case for needed changes to the TAB.
Finally, HB 342 was agreed to by a group of stakeholders. If passed, HB 342 would have removed the affirmative defense and provided a partial health exception that would allow physicians to treat their patients prior to a full-blown emergency. Unfortunately, largely due to a misleading email, the bill was pulled and replaced with an alternative – HB 374.
While HB 374 didn’t include the full array of fixes we sought, the legislation was progress from current law and earned the support of IMA. Signed into law on April 4, this new legislation:
- Removes the affirmative defense
- Codifies Idaho Supreme Court ruling and provides exceptions for ectopic or molar pregnancy, removal of a dead unborn child, and treatment of a woman who is no longer pregnant
- Contains an exception for rape and incest with a copy of a police report, which the victim is entitled to within 72 hours
Most importantly, because we stayed engaged in negotiations and supported even small steps forward, our team will have an opportunity to be at the table for discussion of future fixes. In fact, IMA is in active conversations at this very moment about next steps.
IMA Board members and staff would like to thank everyone that participated in the Reproductive Health Forum. The review and conversations that have followed have been enlightening and therapeutic for all. The Lobby Team worked incredibly hard to deliver all the directives from the House of Delegates and share physicians’ deep disappointment that the effort came up short. However, while small, progress was made. We continue to work on this issue and make progress daily.
To view a recording of the forum, click the button below.
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Highlights from the
2023 AMA Annual Meeting
Fixing Medicare Physician Pay System a Top Priority for the AMA
The AMA has been on the road fighting for Medicare physician payment reform for well over a decade, and the system remains on an unsustainable path. Temporary patches and ongoing cuts to the Medicare physician payment system have left physician practices and patient access to care at serious risk.
Payment cuts, freezes, and redistributions have further exacerbated the challenge. When adjusted for inflation, Medicare physician payment has effectively declined (PDF) by 26% from 2001 to 2023.
Oversight Needed on Payers’ Use of AI in Prior Authorization
As health insurance companies turn to AI to speed up patient claim and prior-authorization decisions, the AMA will advocate for greater regulatory oversight of the practice.
"The use of AI in prior authorization can be a positive step toward reducing the use of valuable practice resources to conduct these manual, time-consuming processes. But AI is not a silver bullet,” said AMA Trustee Marilyn Heine, MD.
Train Doctors on Extreme Risk Protection Orders
Extreme Risk Protection Order (ERPO) laws vary by state, but are generally risk-based, temporary, and preemptive protective orders that authorize the removal of firearms from individuals at high or imminent risk for violence against themselves or others.
Petitioning for an ERPO can be complicated and time-consuming for clinicians, and the AMA is already at work to develop a toolkit on how to use ERPO laws. Delegates directed the AMA to work with relevant parties to “update medical curricula and physician training regarding how to approach conversations with patients and families and to use Extreme Risk Protection Orders.”
The House of Delegates also modified existing policy to support the establishment of “laws and procedures through which physicians and other medical professionals can, in partnership with appropriate parties, contribute to the inception and development of such petitions.”
This expands on the existing list of petitioners noted in AMA policy, which included family members, intimate partners, household members, and law enforcement personnel.
AMA Will Educate Doctors, the Public on How Loneliness Affects Health
Social isolation and loneliness have been recognized as significant public health concerns, adversely affecting mental well-being as well as quality of life.
To address this growing public health problem, delegates adopted a new policy to “encourage research to assess how forming networks earlier in life helps to reduce loneliness and social isolation for adults, with a special focus on marginalized populations and communities with limited access to resources.” They also directed the AMA to develop educational programs for patients and physicians on the topic.
Meanwhile, the AMA also will work to address alarming rates of suicide, depression, and other mental health problems among kids.
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Congress Takes a Back Seat on Federal Abortion Policy
Over a year ago, the U.S. Supreme Court overturned Roe v. Wade and set forth controversial arguments over abortion and how, if, and why it can be implemented in a healthcare setting. Even though many Republicans campaigned U.S. House for a nationwide abortion ban, the chamber hadn’t brought such a bill to the floor six months after the GOP took control.
Conversely, Democrats didn’t have the 60 votes needed to overcome the legislative filibuster, leading to a stalemate on abortion legislation and protections for birth control access.
It is thought that the following nationwide policy on abortion is much more likely to be written by the same U.S. Supreme Court that wrote one year ago “the authority to regulate abortion is returned to the people and their elected representatives.” That court is dominated 6-3 by conservative justices.
The impasse within Congress sharply contrasts new laws from dozens of state legislatures, where lawmakers have moved to either restrict abortion access or solidify it within the last year. But many of those proposals have landed in the state court systems, with some ending at a state’s Supreme Court.
Next up for U.S. Supreme Court - Access to Abortion Pill
The nine justices on the U.S. Supreme Court are expected to take up a case late this year or next spring on access to the abortion pill, known as mifepristone or its brand name Mifeprex, after a federal circuit court in New Orleans rules on the appeal. This case likely will be the highest-profile court case on reproductive rights since Dobbs reached the Supreme Court.
What About Idaho?
Abortion has long been a political wedge issue in the Idaho Legislature. IMA saw aspects of this in 2023. However, there seems to be an evolution among many Legislators – you can be “pro-life” and be “pro-health of the mother.” As highlighted in April, the legislation passed was not the win we had worked so hard for. However, the IMA Lobby Team educated legislators on the unintended consequences of the Total Abortion Ban and its impacts in a post-Roe world. The IMA Lobby Team also built meaningful relationships with the pro-life lobby, Idaho Chooses Life specifically, and received assurances from them and other legislators to advance meaningful legislation in the 2024 session.
Recap of HB 374: 2023 Fixes to Idaho’s Total Abortion Ban
HB 374 eliminates the affirmative defense standard (guilty until proven innocent), but does not address the health of the mother, only her life. The bill provides exceptions for ectopic or molar pregnancy, removal of a dead unborn child, and treatment of a woman who is no longer pregnant. HB 374 contains an exception for rape and incest with a copy of a police report, which the victim is entitled to within 72 hours. Even though it isn’t the full array of fixes we sought, HB 374 progresses from current law and is supported by the IMA. HB 374 was signed into law on Tuesday, April 4. In the April 1 edition of the IMA Wire, we provided an in-depth analysis regarding the political context of HB 374, which you can review by clicking the button below.
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Safer Opioid Prescribing
Opportunities for Surgical Teams
Opioid safety in the surgical setting requires multiple strategies. Comagine Health, with support from Dr. Huang, is offering grant-funded improvement support for practice leaders, providers, and staff interested in improving the management of opioid prescriptions, enhancing patient opioid and pain control education, increasing naloxone prescribing, integrating best practice EHR alerts, and providing resources and education on safe disposal practices.
Comagine can help with
- Information and resources based on surgical teams’ unique goals
- Individual consultation and support
- The latest evidence-based information
- Expert collaboration
- Patient and provider resources
- Time commitment tailored to surgical team availability
Process Improvements will
- Improve patient-centered opioid prescribing
- Enhance opioid and pain control education for patients and families
- Increase naloxone co-prescribing
- Improve protocols for providing safe disposal education and resources
- Establish procedures for the use of patient medication logbooks
- Integrate EHR best practices and alerts
Dr. Huang is the Subject Matter Expert for this Initiative
Dr. Lyen C. Huang, MD, MPH, FACS, FASCRS, is an Assistant Professor of Surgery at the Spencer Fox Eccles School of Medicine and an Adjunct Assistant Professor of Family & Preventative Medicine and Population Health Sciences at the University of Utah. He specializes in complex and minimally invasive intestinal surgery. His research has included peri-operative opioid stewardship, appropriate disposal of unused opioids, and patient recovery after surgery. He is a committee member for the University of Utah Health, Opioid Taskforce.
Comagine Health is currently funded by the Utah Division of Health and Human Services (UDHHS) to provide additional support to surgical teams who want to improve surgical team processes around opioid prescribing.
Contact Information: Jamee Millsap - jmillsap@comagine.org
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Updated Virtual Care (i.e. Telehealth) for Idaho Medicaid
By Jana Weis, Gill Compliance Solutions
In a recent newsletter, the post-pandemic virtual care policy was published and covers most current regulations. Idaho Medicaid uses virtual care and telehealth interchangeably and defines this as “providing medically necessary health care services without actual physical contact, through the use of electronic means.” Patient and provider need to be interacting in real-time or “live” from two physically different locations, by video or telephone. Idaho Medicaid requires that whoever is providing virtual care must be within the provider’s scope of practice and billed as per Medicaid regulations and accurate NPI.
Below is a list of requirements for billing these services:
- The service can be safely and effectively delivered via virtual care
- The service fully meets the code definition when providing virtual care
- Idaho Medicaid uses places of service 02 (Telehealth provided other than in the patient’s home) and 10 (Telehealth provided in the patient’s home). Providers must use these places of service on claims for virtual care
- The service is billed with the FQ or GT modifier
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FQ – A telehealth service was furnished using real-time audio-only communication technology
- GT – A telehealth service was furnished using real-time audio-visual communication technology
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FR – A supervising practitioner was present through a real-time two-way, audio/video communication technology.
- Federally qualified health centers (FQHC’s), rural health centers (RHC’s), and Indian health clinics (IHC’s) providers should not report the GT or FQ modifier with encounter code T1015, but should include it with each applicable supporting code
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Informed consent must be obtained and documented in the chart. If the participant (or legal guardian) indicates at any point that they want to stop using the technology, the service should cease immediately, and an alternative (in-person) appointment should be scheduled
- Any written information must be provided to the participant before the virtual care appointment in a form and manner which the participant can understand, using reasonable accommodations when necessary
- The rendering provider at the distant site must also disclose to the participant their identity, current location (must be within the United States), telephone number, and Idaho license number
- Medicaid policy does not follow Medicare restrictions for virtual care unless the participant has Medicare primary. Otherwise, all Medicaid providers, including FQHC's, RHC’s, and IHC’s, may bill for virtual care services according to these guidelines
- Reporting of test results only is not covered as a telehealth service
- Services provided via asynchronous communication are not reimbursable under Idaho Medicaid. However, remote monitoring services are covered.
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