Prior Authorization Reform

ACC's Ohio Chapter has actively pushed for prior authorization reform since early 2015. Laxmi S. Mehta, MD, FACC, governor of the Ohio Chapter, and 29 other members went to the Statehouse this spring to urge lawmakers to support the bill, which was signed into law on June 13. The Chapter worked closely with the Ohio State Medical Association and other organizations to pass a law that strengthens the communication between patients, providers, pharmacies and insurers, and ultimately makes the prior authorization process easier for patients to be granted coverage for the care they need.

After years of discussions with the payer community, state insurance commissioner and stakeholders, ACC's Pennsylvania Chapter and medical societies were able to get a bill introduced earlier this year that would increase transparency and consistency with the process for prior authorization. Andrew R. Waxler, MD, FACC, and William A. Van Decker, MD, FACC, have been spearheading this effort, and multiple letters have been sent to Pennsylvania legislators as part of a larger grassroots advocacy plan. Delaware passed a similar bill to Ohio's earlier this month, and the ACC is working with the state medical society on the implementation.

Legislation in Hawaii did not pass this session but ACC's Hawaii Chapter has been designated to work with the state insurance regulators to craft necessary reforms.

In West Virginia, the Step Therapy Regulation Act passed both the House of Delegates and the Senate with unanimous support. ACC's West Virginia Chapter supported the bill, which would permit physicians to reject insurance mandated step therapy protocols and substitute medically proven therapies for patients when medical evidence demonstrated that the insurance imposed formularies did not achieve the best results for patients.

STEMI Systems of Care

ACC's Illinois Chapter – working with the state hospital association and physician groups – defeated a proposal to update the state's ST-elevated myocardial infarction (STEMI) program by creating new agencies whose oversight would be duplicative of hospitals. The Chapter is working with the American Heart Association (AHA) and other stakeholders to improve STEMI response time and access without new and costly regulations. ACC's Colorado Chapter is undertaking a similar leadership initiative after legislation reflecting task force recommendations was tabled. Virtually all of the Chapter's recommendations were accepted as a result of their participation on the three-year taskforce.

CPR Training in High School

"Cardiopulmonary Resuscitation (CPR) in Schools" legislation continues to be a priority for ACC chapters. In collaboration with the AHA and through a successful grassroots approach that included meeting with legislators, providing testimony and reaching out to media, seven states (New Mexico, Kentucky, South Carolina, Wisconsin, Ohio, Arizona and Missouri) have enacted laws requiring high school students to receive training in CPR as a condition for graduation. These actions bring the total to 34 states. Final action mandating the requirement in Michigan and the District of Columbia is anticipated before the end of the year.

Pulse Ox Screening

Three more states (Kansas, Vermont and Wyoming) are on the way to requiring that newborns be screened for critical congenital heart disease (CHD) using pulse oximetry screening. In Kansas and Wyoming, the states' respective Departments of Health initiated rulemaking proceedings. In Vermont a legislative solution was achieved. These actions bring the total to 49 states and the District of Columbia with critical CHD screening requirements. Idaho is the only state that has not enacted legislation or addressed the issue through regulations.

Tobacco Control

California enacted five tobacco control laws this year including the nation's second tobacco-21 law raising the purchase age for all tobacco products to 21. A comprehensive e-cigarette law added the devices to the state's smoke free law. The District of Columbia Council appears positioned to follow in California's footsteps before the end of the year. The Council is reviewing a tobacco-21 bill and a smoke-free sports venue measure that would make all organized sports events in the District of Columbia completely tobacco free. Sarah B. Clauss, MD, FACC, testified on behalf of the ACC during a joint hearing before the Council's Committees on the Judiciary and Health and Human Services. Allen J. Taylor, MD, FACC, also testified on behalf of the ACC in strong support of an e-cigarette parity bill that would add e-cigarettes to the existing smoke-free law. Six states enacted tobacco tax increases in 2016: Connecticut (25 cents), Louisiana (22 cents), Minnesota (10 cents), Oregon (one cent). Pennsylvania ($1) and West Virginia (65 cents). The Indiana House passed a $1 cigarette tax hike, but the Senate rejected it. In November, California voters will decide on a $2 per pack increase strongly supported by the California Medical Association. A Missouri ballot proposal for a 23 cent cigarette tax hike faces long odds.

Medical Malpractice

States continue to reject proposals to scrap the current state litigation system and replace it with a workers compensation model that would create regulatory, quasi-judicial "expert panels" with authority to identify valid claims of injury and patient compensation. Proponents promise that physicians will no longer need legal representation or malpractice insurance but fail to explain how the administrative function and patient awards would be funded. Working with state medical societies and The Doctors Company this year, ACC chapters helped defeat proposals in Maine, Tennessee and Ohio. ACC's Indiana Chapter worked with the state medical society and others to pass legislation to raise the cap on non-economic damages. While the medical community does not usually support such increases, Indiana's cap had not been raised in several years rendering it vulnerable to elimination. Further adjustments may be needed to ensure the cap remains. Edward T. A. Fry, MD, FACC, and the chapter pushed this as part of lobby day in conjunction with Indiana Medical Association efforts.

Medicaid Reform

ACC's North Carolina Chapter has taken a leadership role in Medicaid reform and prevention issues. The Chapter has provided information to a state task force on how cardiovascular specialists interact with Medicaid patients and launched Improving Cardiovascular Care in NC Free and Charitable Clinics, a monitored grant from the North Carolina Chapter to the state's free clinics to provide medication and follow-up compliance and outcomes.

ACC Grassroots in Action

ACC's Kansas Chapter took steps toward addressing obesity and improving the prior-authorization process for the cardiovascular team. In response to a tough legislative environment, several members of the Kansas Chapter Council held a Stakeholder Engagement Day, hosting meetings with the Kansas Medical Society, Kansas AHA Chapter, Kansas Insurance Commissioner and several legislators. Participants included Dhanunjaya R. Lakkireddy, MBBS, FACC; Steven D. Owens, MD, FACC; Prashanth S. Katrapati, MD, FACC; Prasad C. Gunasekaran, MD; Jeffery L. Curtis, MD, FACC; and Donita Atkins, RN. Through a series of meetings, letter campaigns and legislative receptions co-hosted with the Vermont AHA, ACC's New England Chapter in Vermont was instrumental in getting several key pieces of legislation passed that included an e-cigarette ban, pulse oximetry testing for newborns and nutritional standards. Most notably Prospero B. Gogo Jr., MD, FACC, governor of ACC's Vermont Chapter; Sean Robert McMahon, MD; Shahab Moossavi, MD; Patrick Hohl, DO; Friederike K. Keating, MD, FACC, and many others, participated in sending letters to their legislators.

Get Involved in State Advocacy

ACC's State Advocacy team can provide resources and opportunities for members to communicate directly with state and local legislators and government officials, as well as help ACC chapters and members coordinate their advocacy efforts with stakeholders. Those interested in this type of opportunity should contact the ACC State Advocacy team: Kelly Memphis, kmemphis@acc.org, or Michael Lawrence, mlawrence@acc.org.