AMA House of Delegates

Thomas E. Sullivan, MD, defended a report backing expanded Medicaid choice and limits to insurance churning. Photo by Ted Grudzinski / AMA

Greater range of Medicaid finance options wins support

The AMA also adopts policies to give patients more rights if they are enrolled in state health programs automatically.

By Charles Fiegl — Posted July 2, 2012

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Low-income individuals would have more health coverage alternatives under a revised policy on Medicaid and state health plan financing adopted by the American Medical Association House of Delegates at its Annual Meeting.

Delegates debated a Council on Medical Service report recommending that states have the option either to maintain current Medicaid programs or to transition low-income patients who are nonelderly and nondisabled to a system of tax credits that would be used to purchase private health coverage. The credits would need to be equivalent to the cost of coverage and involve little or no patient cost-sharing, the report stated.

Some delegates praised the council for its report and recommendations because of the fiscal challenges facing state governments. But several raised concerns about potential adverse impacts to patients and urged the AMA to adopt several safeguards.

Patients qualifying for state health programs do not always have coverage when they seek treatment, said Richard Pan, MD, an alternate delegate for the American Academy of Pediatrics from Sacramento, Calif. He successfully advocated for retaining AMA policy on presumptive assessment of eligibility and retroactive coverage. Delegates also agreed to support the development of safety-net mechanisms that would backdate coverage for eligible patients to the time when they sought care.

The council report also contained new language that backed limiting patient churning in insurance programs by adopting 12-month continuous eligibility across Medicaid, the Children’s Health Insurance Program and upcoming health insurance exchange plans. But the delegation had been split on whether to support auto-enrollment structures that move certain patients who don’t sign up on their own into programs without first obtaining their consent.

When Massachusetts adopted its 2006 health system reforms, it included an auto-enrollment policy, said Thomas E. Sullivan, MD, chair of the Council on Medical Service and a cardiologist from Beverly, Mass. “Auto enrollment worked reasonably well. It doesn’t mean to say it’s perfect. None of these things are perfect.”

Delegates agreed to an AAP amendment that gives patients the right to switch health plans within 90 days of an auto enrollment.

In a separate resolution, delegates resolved to have the AMA advocate to the Centers for Medicare & Medicaid Services against automatically enrolling individuals eligible for Medicare and Medicaid programs into dual-eligible demonstration projects.

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Meeting notes: Legislative action

Issue: The health system reform law created a basic health program as an option for providing health care to low-income individuals in lieu of exchanges and other state plans.

Proposed action: Establish principles for state basic health programs, including adequate physician and health professional networks, negotiated payment rates, and state medical society involvement in legislative and regulatory processes. [Adopted]

Issue: Pregnant women and postpartum mothers lack insurance coverage for mental health services.

Proposed action: Support improvements to mental health services for women who are pregnant or postpartum, and advocate for inclusive coverage of such services during gestation and up to one year postpartum. [Adopted]

Issue: Budget cuts have led states to eliminate or reduce coverage for mental health services.

Proposed action: Support maintaining essential mental health services, including inpatient and outpatient mental hospitals, community mental health centers, addiction treatment centers, and other state-supported psychiatric services. Also support enforcement of the Mental Health Parity Act and state mobile crisis teams to treat the homeless. [Adopted]

Issue: Medical clinics sponsored by employers offer access to preventive and other health services to employees at the workplace.

Proposed action: Study employer-sponsored clinic benefits and develop guidelines on patient privacy, safety and access, and the staffing of clinics by physicians or supervised practitioners. [Adopted]

Issue: Pursuing solely punitive penal action in drug offender cases may not be the most beneficial for drug abusers and the community. Drug courts, which focus on intensive treatment and supervision of drug offenders, are being used in some parts of the country.

Proposed action: The AMA should support the establishment of drug courts as an effective method of intervention for individuals with addictive disease who are convicted of nonviolent crimes. [Adopted]

Issue: Physicians are concerned that the Physician Payments Sunshine Act will be burdensome and lead to overregulation by the government. The measure, approved as part of the Affordable Care Act, requires the reporting of gifts and payments to physicians from drug and device manufacturers. The data collection will start in 2013.

Proposed action: The AMA should continue its efforts to minimize the burden and unauthorized expansion of the Sunshine Act by the Centers of Medicare & Medicaid Services. The Association also should recommend to CMS that a physician comment section be included on the “Physician Payments Sunshine Act” public database. [Adopted]

Issue: The switch from ICD-9 to ICD-10 diagnosis code sets for billing physician services will create unnecessary and significant financial and workflow disruptions for doctors. ICD-11 is on the horizon and may be a less-burdensome transition for physicians if they wait and move from ICD-9 to ICD-11 at a later date.

Proposed action: The AMA should evaluate the feasibility of moving from ICD-9 to ICD-11 as an alternative to ICD-10 and report back to the House of Delegates. [Adopted]

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