CMS Resolutions Go to State

House of medicine to debate a strong lineup of measures April 20-22

EXERTING A powerful presence, the Chicago Medical Society speaks up for local physicians in medicine’s deliberative bodies. That tradition continues in 2018 when CMS brings fresh legislative proposals to the Illinois State Medical Society and the American Medical Association. With the ISMS House of Delegates coming up on April 20-22, your CMS has major resolutions to advance.

Some of the burning issues from CMS: compensation reporting under the Physician Payments Sunshine Act, E&M encounters with 25 modifier codes, use of health savings accounts for direct primary care, pharmaceutical pricing reform, direct dispensing of generic medications, prescription drug importation, healthcare system financing, and mandatory influenza vaccination for healthcare workers.

Your Path to Legislation
The Chicago Medical Society’s resolutions process creates a path to state and federal legislation. Counties act as launch sites for issues to be considered by ISMS and then AMA. Their respective House of Delegates’ function as medicine’s legislative bodies.

For physicians who want to advance resolutions, CMS offers resources and support – all the way from inception to implementation. Once vetted by CMS, measures move up to ISMS. Sponsors can count on their CMS colleagues to give supportive testimony during deliberations at ISMS.

This April CMS physicians will join delegates from across the state. In addition to CMS resolutions, the ISMS House will debate measures from other county medical societies. Many Chicago resolutions go on to shape Illinois’ legislative agenda and to succeed as bills in Springfield. That’s the power of resolutions!

Here are excerpts of CMS measures that await action in 2018 by ISMS and AMA:

Physician Compensation Reporting by Drug and Device Companies
RESOLVED, that ISMS introduce a resolution to the AMA stating that any compensation reported as part of the Physician Payments Sunshine Act should be accompanied by a verifiable receipt signed by the physician acknowledging receipt of said compensation; and be it further RESOLVED, that ISMS resolution to the AMA stipulate that contested reported compensation should be removed immediately from the OpenPaymentsData.CMS.gov website until the reporting company validates the compensation with a signed receipt; and be it further
RESOLVED, that ISMS resolution stipulate that companies reporting physician payments as part of the Physician Payments Sunshine Act without proper documentation shall be fined $1,000 per occurrence.

Reduced Reimbursement for E&M Encounters with Modifier 25 Codes
RESOLVED, that ISMS immediately and aggressively advocate through any legal means possible, including direct payer negotiation, regulation, legislation, or litigation to ensure that when an evaluation and management (E&M) code is appropriately reported with a modifier 25, that both the procedure and E&M codes are paid at the non-reduced, allowable payment rate.

Reform of Pharmaceutical Pricing
RESOLVED, that ISMS urge the AMA to support federal legislation that modifies the HatchWaxman Act and Biologics Price Competition and Innovation Act (Biosimilars Act) to institute the replacement of time-specific patent protections with negotiated payment schedules and indefinite exclusivity for FDA-approved drugs in the Medicare Part D Program.

Direct Dispensing of Generic Medications
RESOLVED, that ISMS investigate Michigan Public Health Code, Section 333.17745, which allows physicians to dispense generic medications from their offices at a nominal cost, and report back for consideration of similar legislation in Illinois.

Prescription Drug Importation
RESOLVED, that ISMS adopt policy in support of the FDA allowing patients to purchase prescription medications from Canada; and be it further
RESOLVED, that ISMS urge AMA to work with the U.S. Congress and the FDA to establish oversight of any imported Canadian prescription medications to protect consumers from counterfeit, contaminated, and harmful drugs.

Healthcare Financing System Survey of Illinois Physicians
RESOLVED, that ISMS conduct a survey of Illinois physicians to determine their attitudes toward different healthcare financing models currently under consideration, to include the current Affordable Care Act, a single payer system, and one or more of the proposals currently under consideration in the U.S. Congress; and be it further
RESOLVED, that ISMS survey of Illinois physicians be short, clear, and based upon prior research to assure unbiased questioning of the participants opinions. If such questions cannot be agreed upon by proponents of the various proposals, then those who feel they have not been able to accurately poll for their point of view be able to add a single question of their choice.

Use of HSA’s for Direct Primary Care
RESOLVED, that ISMS establish policy that supports patients’ using Health Savings Accounts (HSA’s) to access Direct Primary Care (DPC) providers, to help improve access to all primary care providers, including those who practice in a DPC model, for individuals who need primary care services; and be it further
RESOLVED, that ISMS policy on patients’ use of HSAs for DPC include the following concepts: DPC medical homes do not constitute a health plan under Internal Revenue Code (IRC) Section 223(c); periodic payments to DPC practices for primary care services are to be treated as qualified medical expenses under IRC code 213(d); and be it further
RESOLVED, that ISMS introduce a similar resolution to the AMA June 2018 meeting requesting the AMA to adopt policy on patients’ use of HSA’s for DPC; and be it further
RESOLVED, that ISMS resolution request AMA to seek federal legislation that will address and clarify Internal Revenue Codes (IRC) section 223 (c) so that DPC medical homes do not constitute a health plan; and that further establish the legality of treating periodic payments to DPC practices for primary care services as qualified medical expenses under IRC code 213(d), thus allowing the use of HSA’s to help pay for DPC and enabling patients to enter DPC periodic-fee agreements without IRS interference or penalty.

Engage and Collaborate with the Joint Commission
RESOLVED, that ISMS engage and collaborate with the Joint Commission’s Board and Leadership to provide and survey appropriate medical standards, as per its mission statement; and be it further
RESOLVED, that ISMS request the AMA to engage and collaborate with the Joint Commission’s Board and Leadership to provide and survey appropriate medical standards, as per its mission statement.

The Illinois Cranial Anticoagulation Reversal (ICARE) Initiative
RESOLVED, that ISMS support initiatives that reduce barriers to the use of anticoagulation reversal agents that are up to date with contemporary guidelines in emergency settings for hemorrhagic stroke and other life-threatening clinical indications, including the Illinois Cranial Anticoagulation Reversal (ICARE) initiative or subsequent iterations for the benefit of Illinois stroke patients.

Care and Services for Victim-Survivors of Human Trafficking
RESOLVED, that ISMS create a directive that physicians take the lead in their institutions to ensure hospitals and clinics have policies and procedures in place to provide affordable, trauma-informed medical care to victim-survivors of human trafficking; and be it further
RESOLVED, that ISMS educate clinics, hospitals and physicians about the new Illinois State Law PA 99-870: Illinois Department of Healthcare and Family Services Medical Benefits for Non-Citizen Victims of Trafficking, Torture or Other Serious Crimes, which became effective Jan. 1, 2018, and which amends the Public Aid Code to cover healthcare services for eligible non-citizens.

Automating PDM and PBM within the Electronic Medical Record
RESOLVED, that ISMS take action to require the automation of Prescription Drug Monitoring (PDM) and Pharmacy Benefit Management (PBM) within the Electronic Medical Record (EHR) and the further integration of EHRs and PBMs with every other PDM program throughout the United States; and be it further
RESOLVED, that ISMS request the AMA to take action to require the automation of Prescription Drug Monitoring (PDM) and Pharmacy Benefit Management (PBM) within the Electronic Medical Record (EHR) and the further integration of EHRs and PBMs with every other PDM program throughout the United States.

Taxes on Soda and Sweetened Beverages
RESOLVED, that ISMS adopt policy that supports excise taxes on soda and other sweetened beverages as a tool or strategy to reduce consumption and thereby help reduce rates of obesity in children and adults.

Abused and Neglected Children Reporting
RESOLVED, that ISMS research and investigate the process for reporting cases of alleged child abuse as provided under the Abused and Neglected Child Reporting Act (325 ILCS 5/); and be it further
RESOLVED, that ISMS pursue an amendment to the state law so that the Department of Children and Family Services and other agencies involved in the process investigate any and all reported and alleged cases of abuse to a minor regardless of the alleged perpetrator’s relation to the child, lack of responsibly for the child, or the alleged perpetrator’s residence.

Mandatory Influenza Vaccination for Healthcare Workers
RESOLVED, that ISMS adopt as policy that no health care worker (HCW) should be terminated from employment due solely to their declination of the influenza vaccine, and be it further
RESOLVED, that ISMS introduce this resolution to the AMA and request that AMA create policy that no health care worker (HCW) should be terminated from employment due solely to their declination of the influenza vaccine.