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Progress Report on the AANS/CNS 2017-18 Legislative and Regulatory Agenda

The AANS and CNS are making steady forward progress on our legislative agenda. Positive outcomes to date include:

  • Legislation expanding funding for the Children’s Health Insurance Program (CHIP) for ten years was signed into law (P.L. 115-120). CHIP provides coverage to nine million children in families who earn too much to qualify for Medicaid, but cannot afford private insurance. Neurosurgery has long supported reauthorization of this program to ensure that our nation’s children have health insurance coverage.
  • Support continues to grow for bills that provide additional Medicare graduate medical education (GME) funding. If enacted, these bills H.R. 2267/S. 1301, the Resident Physician Shortage Reduction Act — will fund an additional 15,000 slots over a five-year period. To ensure an adequate supply of physicians, organized neurosurgery has been on the frontlines, advocating to improve the current GME system. The AANS and CNS have also helped prevent legislation (H.R. 2373) that would effectively eliminate the single accreditation system for allopathic and osteopathic residency training from gaining traction.
  • The House passed comprehensive medical liability reform legislation and multiple other medical liability reform bills have been introduced. The House passed H.R. 1215, the Protecting Access to Care Act and, most recently, the House Energy and Commerce Committee passed H.R. 1876, the Good Samaritan Health Professionals Act, out of committee where it now awaits floor action. Bills that have been introduced in the House and Senate include:
  • Legislation suspending the medical device tax for an additional two years, through 2019, was signed into law (P.L. 115-120). This excise tax — a 2.3 percent tax on medical device companies’ gross revenue — was initially adopted to help fund the ACA. Repealing the device tax is one of organized neurosurgery's top legislative priorities as it would hinder medical device innovation and reduce incentives for medical device research.
  • Improvements to Medicare’s Quality Payment Program (QPP) to reduce the reporting burden and minimize penalties have been made, including:
  • 2018 program rules provide greater flexibility, reduce complexity and reduce the potential for penalties;
  • Bipartisan Budget Act of 2018 (P.L. 115-123) included additional flexibility for 2012-23 to make it easier for physicians to meet program requirements and eliminate the mandate that electronic health record (EHR) standards become more stringent over time, while also maintaining EHR hardship exemptions. 
  • Massive changes to global surgery codes will not likely be forthcoming in 2019. Last year, the Centers for Medicare & Medicaid Services (CMS) contracted with RAND to conduct a national survey on global surgery services. Last fall, in the Surgical Coalition letter, the AANS and CNS raised significant concerns about the survey, not the least of which is that it is too long and any data collected will be flawed and from too small a sample. RAND made some changes and is currently piloting the survey. Following a meeting earlier this year with CMS, it appears that the agency has received quite a bit of data from the claims-based data collection effort, but the data have not yet been analyzed. The lack of progress on the data collection front means that it seems highly unlikely that CMS will make wholesale changes to the global surgery codes for 2019. The AANS and CNS estimate that, if implemented, changes to global surgery code values could result in cuts in neurosurgical reimbursement of more than 25 percent.

For more information on this or other health policy issues, contact Katie O. Orrico, director of the AANS/CNS Washington Office at korrico@neurosurgery.org.

June 2018