MSMS Legislative Update – Part 1

Current Legislative Projects – Part 1

• Scope of Practice

To proactively address “scope creep,” MSMS created Michigan for Advancing Collaborative Care Teams (MiACCT). This coalition of partner organizations will focus on the value of physician-led health care teams and the importance of medical school education in delivering quality, cost-effective care. Activities such as direct legislative and executive lobbying, coordinated lobby days, and a monthly e-newsletter for legislators and their staff will be key components of the initiative. Public-facing resources and communications, including earned media, will be deployed to generate legislative and public support for physician-led health care teams as well.

Talking Points

• Evolving health care delivery and reimbursement models require more integration and teamwork to deliver high quality, effective, and efficient person-centered care. • Team-based care fosters integration and coordination unlike independent practice which furthers care delivery silos. • Collaborative approach utilizes the unique skill set and training of each team member. • As the team members with the highest level of training, education and preparation, physicians guide the interplay of the team. • The public overwhelmingly wants a physician to have the primary responsibility for the diagnosis and management of their health care. • Advanced practice professionals (APPs) are increasingly engaged in what has traditionally been considered the practice of medicine and the practice of osteopathic medicine and surgery. • The public does not differentiate between health care delivery and the “practice of medicine” which perpetuates a misunderstanding of the scope of training of APPs. o More recently, some non-physician providers have attempted to change their professional titles which misleads patients about who is providing their care. • Team-based care is essential to protecting and maintaining public health and safety.

Current Status

While the bill which would have originally allowed certified registered nurse anesthetists to practice independently is now behind us, new scope-related legislation is expected to be introduced this fall which would allow for full independent practice for nurse practitioners. MSMS will share additional information as it becomes available when the bill is introduced.

• Prior Authorization Reform – Senate Bill 247

The prior authorization process diverts valuable resources away from direct patient care, can delay the start or continuation of necessary treatment and can negatively impact patient health outcomes. Over the course of the last two years, MSMS has worked closely with the legislature, regulators, and stakeholders on ways to streamline, standardize and make the prior authorization process more transparent, clinically appropriate and evidence based. To support this effort, MSMS also created the Health Can’t Wait coalition, which is a coalition of over fifty patient advocacy and health care organizations dedicated to reforming the prior authorization process.

Talking Points

Senate Bill 247 would reform the prior authorization process to do the following: • Requires an insurer to make available, by January 1, 2023, a standardized electronic prior authorization request transaction process. • Requires prior authorization requirements to be based on peer-reviewed clinical review criteria. • Require an insurer to post on its website if it implemented a new prior authorization requirement or restriction or amended an existing requirement or restriction, with respect to any benefit under a health benefit plan. • Requires an insurer or its designee utilization review organization to notify, on issuing a medical benefit denial, the health professional and insured or enrollee of certain information, including the right to appeal the adverse determination, and require an appeal of the denial to be reviewed by a health professional. • Prohibits an insurer or its designee utilization review organization from affirming the denial of an appeal unless the appeal was reviewed by a licensed physician. • For urgent requests, the prior authorization is considered granted if the insurer fails to act within 72 hours of the original submission. For non-urgent requests, the prior authorization is considered granted if the insurer fails to act within seven business days of the original submission. • Requires an insurer to adopt a program that promotes the modification of prior authorization requirements of certain prescription drugs, medical care, or related benefits, based on the performance of the health care providers with respect to adherence to nationally recognized evidence based medical guidelines and other quality criteria (i.e., gold carding).

Current Status

Senate Bill 247 unanimously passed the Senate in late-April and is now under consideration by the House Health Policy

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Committee. As a top strategic priority of MSMS and the Health Can’t Wait coalition, we will be focusing efforts on the passage of this important piece of legislation when the House returns in September.

• Telehealth

Reimbursement and Coverage Parity for Telehealth Services

To ensure continuity of care and minimize the spread of COVID-19, physicians quickly adopted telehealth during the pandemic. Payers also temporarily removed some of the regulatory and administrative barriers that were limiting telehealth use and payment of telehealth services, including payment at in-person rates during the public health crisis; however, payments are now reverting to pre-pandemic rates. MSMS believes the time is right to make these equitable policies permanent given that telehealth is, and will continue to be, an effective method of health care delivery.

Talking Points

• Telehealth has proven to be an important care delivery method for improving access in underserved communities, particularly rural areas, areas with physician shortages, and areas with limited access to primary care services. • The decision to see a provider in-person or via telehealth should be a case-by-case decision made between a patient and their provider. Payers should not be enabled to promote one care modality over another. • The standard of care does not change if a patient and provider opt to use telehealth (ex: the physician is still performing evaluations, determining course of treatment, coordinating follow-up care, etc.). • Telehealth should be utilized when medically appropriate and patients should still have access to their physician in person. • Equitable payment and coverage policies will ensure greater access to care and will also ensure telehealth remains a sustainable option for providers to offer. MSMS also recently created a telehealth advisory group of physicians. The purpose of the group is to gather information about telehealth best practices, plan for future needs, understand potential issues and develop solutions. The list below highlights a few of the topics we discussed at our first meeting that you might find useful: • The way telehealth has helped the physicians stay in touch with their elderly patients. For this patient demographic, both telephone and video telehealth has worked. Some patients do have younger family members help them with the technology. • It is also a way to interact with patients in rural areas, those who are homebound and for those who are still concerned about COVID exposure. • It is a way for the physicians to see their patients who are traveling and in different states (a lot of snowbirds). However, there needs to be further clarity on how to practice across state lines. • It is important that we do not go back to using telehealth as a replacement for urgent care. We need to ensure that patients will continue to see their physicians and not use the stand-alone or payer-sponsored telehealth applications (Amwell, MD Live, etc.).

Current Status

MSMS has drafted a model bill requiring insurers to cover and reimburse telehealth services the same as if the service were provided in-person and the bill is expected to be introduced in the House by Representative Richard Steenland (D-Warren) as soon as early October.

Out-of-State Telehealth Expansion - House Bill 4355

House Bill 4355 would allow out-of-state doctors to treat Michigan patients via telemedicine without a Michigan license or oversight requirements under the following conditions: • The health professional directly or indirectly obtains consent, as required under the code for a person licensed as a health professional in Michigan providing care through telehealth. • The health professional provides only those health services he or she would be allowed to provide if he or she were authorized to engage in that health profession in Michigan. • Before providing the health service to the patient, the health professional provides the patient with the hyperlink or address for his or her authorization to practice the health profession in the other state on the website of the licensing department, board or other authority of that other state. MSMS and the Michigan Health and Hospital Association have taken a public position of opposition and have offered amendments to the bill that would ensure the following: • The individual is currently licensed to practice a health profession in another state which is recognized by LARA for purposes of licensure. • The individual is not the recipient of a previous disciplinary action by any other state or jurisdiction including, but not limited to, the revocation or suspension of a license to practice a health profession. • The individual is not the subject of a pending investigation by a state health professional board or another state or federal agency. • The individual has passed the relevant medical examination for the services that are expected to be rendered.