Archive for October, 2020

2021 Legislative Agenda

As the professional association for some 7,000 physicians of all specialties in Alabama, the Medical Association of the State of Alabama exists to serve, lead, and unite physicians in promoting the highest quality of healthcare for the people of Alabama through advocacy, information, and education.

The Medical Association of Alabama is proud to advocate on behalf of physicians and their patients and, despite the challenges to care delivery and daily life brought by the COVID-19 pandemic, is committed to moving medicine forward in 2021.

General Legislative Policies Supported

The Medical Association supports the physician-led health team model and maintaining the highest standards for medical care delivery across all specialties of medicine. The Association supports physician autonomy in patient care and medical practice decisions as well as fair reimbursement for services. The Association also supports reducing the administrative tasks required of physicians by insurers which increase annual health spending and negatively impact patient health. Specifically, the Association supports reforming prior authorization processes and step therapy protocols and ending non-medical switching and co-pay accumulator programs.

Further, the Association supports increasing health insurance options for Alabamians, including expanding Medicaid. The Association supports increasing access to quality mental health care and continued state funding for the Maternal Mortality Review Committee and the Infant Mortality Review Committee. Recognizing the long-term effects of social determinants of health on individuals, families and ultimately communities, the Association supports comprehensive solutions to addressing these challenges.

Finally, by ensuring medical liability environment stability and pursuing further civil justice reforms, the Association believes Alabama can continue to attract highly-qualified physicians.

Specific Legislative Priorities Supported

For the 2021 Legislative Session, the Association specifically supports:

  • Legislation to provide physicians and medical practices “safe harbor” from COVID-related lawsuits.
  • Legislation prohibiting deceptive health care advertising and requiring health professionals identify their license to patients.
  • Reforming the “certificate of need”  process  to increase physician ownership of equipment and facilities and expand access to quality, affordable care.
  • Recommendations of the Rural Health Taskforce, including increased funding for the Board of Medical Scholarship Awards and broadening the rural physician tax credit.
  • Mandated review of the state vaccine registry prior to administration and uploading of patient vaccine information into the database.
  • Continued physician compounding and dispensing of drugs.
  • Same standards and reimbursements for telehealth as for face-to-face visits, and expanding broadband initiatives to facilitate increased use of telemedicine.

General Legislative Policies Opposed

The Medical Association opposes any scope of practice expansion for non-physicians, which could fracture the physician-led health team model and lower quality of care and increase costs for patients. The Association also opposes any interference with the physician-patient relationship and attempts to reduce a physician’s autonomy in patient care or medical practice decisions.

The Association opposes legislation or other initiatives that could increase lawsuit opportunities against physicians, including the establishment of statutory standards of care or any statutory dictums for medical care delivery. The Association also opposes any state- level increase of requirements for Maintenance of Certification. Finally, the Medical Association opposes tax increases disproportionately affecting physicians.

Specific Legislative Polcies Opposed

For the 2021 Legislative Session, the Association specifically opposes:

  • Expanding Prescription Drug Monitoring Program (PDMP) access for law enforcement.
  • Statutory requirements for mandatory Prescription Drug Monitoring Program (PDMP) checks.
  • Changes to workers’ compensation laws negatively affecting treatment of injured workers and medical practices.

Posted in: Advocacy

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Phase 3 Provider Relief Funds Announced by HHS

Phase 3 Provider Relief Funds Announced by HHS

On October 1, 2020, the Department of Health and Human Services (“HHS”) announced an additional $20 billion in funding for healthcare providers to assist with losses and changes in operating expenses caused by the current COVID-19 pandemic. This additional funding is a result of the CARES Act and the Paycheck Protection Program and Health Care Enhancement Act. Not only can providers who have already received Provider Relief Fund payments apply for additional funds during Phase 3, but previously ineligible providers may also apply during Phase 3. For example, providers who began practicing between January 1, 2020 and March 31, 2020, as well as additional behavioral health providers (e.g., addiction counseling centers, mental health counselors, and psychiatrists) can apply for payments during Phase 3. Providers who previously received Provider Relief Funds equating to approximately 2% of annual revenue from patient care can apply for an additional payment during Phase 3.

For eligible providers, the payments will be allocated as follows:

  • All applications will be reviewed to determine if the applicant has previously received a Provider Relief Fund payment equal to 2% of patient care revenue.
  • If an applicant has not received a previous Provider Relief Fund payment equal to 2% of patient care revenue, the applicant will receive a payment designed to bring the total payments to the applicant (when all payments are combined) to 2% of patient care revenue.
  • If an applicant has received a previous Provider Relief Fund payment equal to 2% of patient care revenue, the applicant may receive an additional add-on payment, as determined equitable and appropriate by the Health Resources and Services Administration (“HRSA”).
  • With regard to the additional add-on payment, payments will be made to applicants based on the following considerations: changes in operating revenues from patient care, changes in operating expenses from patient care, and payments already received through the Provider Relief Fund.

The application period for Phase 3 Provider Relief Funds runs through November 6, 2020. All providers receiving a Phase 3 payment will be required to attest to its receipt and accept the applicable terms and conditions.

For more information, visit https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/index.html.

Posted in: Coronavirus, Management

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2020 ALAPAC Voting Guide: Constitutional Amendments

2020 ALAPAC Voting Guide: Constitutional Amendments

OVERVIEW

On Election Day, the people of Alabama will have the chance to cast their votes for a number of federal and state officials. In addition, voters will decide whether several proposed amendments should be added to the Alabama Constitution.

The purpose of this guide is to explain the statewide constitutional amendments in plain language to help Alabama physicians make informed decisions on election day.

STATEWIDE AMENDMENT 1:

Amendment Text:

Proposing an amendment to the Constitution of Alabama of 1901, to amend Article VIII of the Constitution of Alabama of 1901, now appearing as Section 177 of the Official Recompilation of the Constitution of Alabama of 1901, as amended, to provide that only a citizen of the United States has the right to vote.

Basic Summary:

If adopted, Amendment 1 will have little to no impact on voting laws, as Alabama and federal voting requirements already require voters to be citizens of the United States.

Detailed Summary:

Amendment 1 concerns who has the right to vote in Alabama, making a wording change that has no legal effect.

Currently, the Alabama Constitution reads that “every citizen of the United States. . . .” This amendment, if passed, would exchange the word “every” for “only” so that the Alabama Constitution would read, “Only a citizen of the United States. . . .”

This language and the original language of the Alabama Constitution of 1901 mention U.S. citizenship. That has traditionally been interpreted to mean that U.S. citizenship is required to vote. Federal law requires only U.S. citizens vote in federal elections. Amendment 1 proposes to change the language of Article VIII to replace “Every Citizen of the United States” with “Only a Citizen of the United States.”

STATEWIDE AMENDMENT 2:

Amendment Text:

Proposing an amendment to the Constitution of Alabama of 1901, to increase the membership of the Judicial Inquiry Commission and further provide for the appointment of the additional members; further provide for the membership of the Court of the Judiciary and further provide for the appointment of the additional members; further provide for the process of disqualifying an active judge; repeal provisions providing for the impeachment of Supreme Court Justices and appellate judges and the removal for cause of the judges of the district and circuit courts, judges of the probate courts, and judges of certain other courts by the Supreme Court; delete the authority of the Chief Justice of the Supreme Court to appoint an Administrative Director Courts; provide the Supreme Court of Alabama with authority to appoint an Administrative Director of Courts; require the Legislature to establish procedures for the appointment of the Administrative Director of Courts; delete the requirement that a district court hold court in each incorporated municipality with a population of 1,000 or more where there is no municipal court; provide that the procedure for the filling of vacancies in the office of a judge may be changed by local constitutional amendment; delete certain language relating to the position of constable holding more than one state office; delete a provision providing for the temporary maintenance of the prior judicial system; repeal the office of circuit solicitor; and make certain nonsubstantive stylistic changes.

Basic Summary:

If adopted, Amendment 2 would implement changes to how the administration of Alabama’s court system functions and revise the process for appointing and impeaching judges.

Detailed Summary:

This amendment proposes six changes to the state’s judicial system. In summary, this amendment:

1. Provides that county district courts do not have to hold city court in a city with a population of less than 1,000;

  • This is largely a practical change.

2. Allows the Alabama Supreme Court, rather than the Chief Justice, to appoint the Administrative Director of Courts;

  • Currently, the Chief Justice of the Supreme Court chooses the Director of Courts, who oversees the $450 million and 2,500 employee state court system. Since 2010, there have been five different Chief Justices and therefore five different Directors of Courts. If approved, Amendment Two would allow for the entire Supreme Court to make an appointment out of three candidates brought to them by a nominating board of judges, a clerk, and a lawyer. Instead of changing every time the Court’s makeup changes, this appointment would last for ten years.

3. Increases from 9 to 11 the total membership of the Judicial Inquiry Commission and determines who appoints each member (the Judicial Inquiry Commission evaluates ethics complaints filed against judges);

  • Expanding the Commission’s composition from 9 to 11 allows for the inclusion of a probate judge and a municipal judge.

4. Allows the Governor, rather than the Lieutenant Governor, to appoint a member of the Court of the Judiciary (the Court of the Judiciary hears complaints filed by the Judicial Inquiry Commission);

  • Language elsewhere has already caused this shift to happen in practice. The amendment would simply clarify it in the Alabama Constitution.

5. Prevents a judge from being automatically disqualified from holding office simply because a complaint was filed with the Judiciary Inquiry Commission; and

  • Currently, judges are suspended from service, with pay, when a complaint is filed with the Judicial Inquiry Commission. Alabama, alone, suspends judges based simply on a complaint. Amendment 2 removes this provision.

6. Provides that a judge can be removed from office only by the Court of the Judiciary.

  • Currently, Supreme Court justices and appellate judges are the only judges suspect to impeachment. This change would place them under the same disciplinary procedures as other judges.

STATEWIDE AMENDMENT 3:

Amendment Text:

Proposing an amendment to the Constitution of Alabama of 1901, to provide that a judge, other than a judge of probate, appointed to fill a vacancy would serve an initial term until the first Monday after the second Tuesday in January following the next general election after the judge has completed two years in office.

Basic Summary:

This amendment changes the initial term of a judge that is appointed to fill a vacancy due to death, resignation, retirement, or removal. The current law and this proposed amendment do not apply to probate judges.

Detailed Summary:

Judicial vacancies, which are created by the death, resignation, retirement, or removal from office of a sitting judge, are filled by gubernatorial appointment. Judicial terms are six years. Per the Constitution, probate judges appointed by the Governor serve out the balance of the unexpired term. Also, per the Constitution, all other appointed judges serve until the general election after serving one year in office.

In practice, however, appointed judges routinely serve two, and sometimes almost three years, due to how the dates of general elections fall. Amendment 3 extends the time of service for an appointed judge from the general election after one year of service to the general election after two years of service.

STATEWIDE AMENDMENT 4

Amendment Text:

Proposing an amendment to the Constitution of Alabama of 1901, to authorize the Legislature to recompile the Alabama Constitution and submit it during the 2022 Regular Session, and provide a process for its ratification by the voters of this state.

Basic Summary:

Alabama’s constitution contains segregationist and racist language and has sections that are repeated or do not currently apply. If approved, Amendment 4 would allow the state legislature to rearrange the constitution and remove racist or repeated language.

Detailed Summary:

Alabama’s constitution can be changed only during a constitutional convention or when a majority of voters approve a constitutional amendment.

Amendment 4 does not change the requirement that a majority of voters must approve a constitutional amendment. Amendment 4, if approved, simply allows the Alabama Legislature, when it meets in 2022, to draft a rearranged version of the state constitution.

This draft could only:

(1) remove racist language;

(2) remove language that is repeated or no longer applies;

(3) combine language related to economic development; and

(4) combine language that relates to the same county.

No other changes could be made.

STATEWIDE AMENDMENTS 5 & 6

Amendment 5 Text:

Relating to Franklin County, proposing an amendment to the Constitution of Alabama of 1901, to provide that a person is not liable for using deadly physical force in self-defense or in the defense of another person on the premises of a church under certain conditions.

Amendment 6 Text:

Relating to Lauderdale County, proposing an amendment to the Constitution of Alabama of 1901, to provide that a person is not liable for using deadly physical force in self-defense or in the defense of another person on the premises of a church under certain conditions.

Basic Summary:

The amendments are identical other than the county to which they apply. Both would put into the Alabama Constitution a version of the state’s already-existing “stand your ground” law that applies to the use of deadly force in churches.

Unless the statewide “stand your ground” law changes, these amendments will have little practical effect.

Detailed Summary:

Alabama is among 27 states with stand your ground laws, which protect individuals from criminal prosecution if they use physical or deadly force in defending themselves or someone else from serious threat of harm. The law does not require the person to retreat before using physical force.

Even without specific language related to churches or the proposed amendment, lawful participants in a church have the right to defend themselves when under attack. But the stand your ground law and the proposed amendments would not prohibit churches from developing policies banning handguns and other weapons from church property.

If passed by the majority of voters in Alabama and by voters in Franklin and Lauderdale County, the state constitution would be amended to contain a special “Stand Your Ground” law that applies to churches in Franklin and Lauderdale Counties.

Posted in: Advocacy, ALAPAC

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Major Changes Coming to 2021 E/M Coding

Major Changes Coming to 2021 E/M Coding

Considerable changes are being made to Medicare outpatient evaluation and management (E/M) codes. The transition will take effect on January 1, 2021 and will likely affect physicians across all specialties.

The changes are currently restricted to new and established outpatient visits (CPT codes 99202-99205, 99211-99215) and will impact everyone who assigns codes, manages patient information, or pays claims including physicians, health information managers, coders, payers, health systems, and hospitals. 

Why was modification needed?

Because of advocacy by the Medical Association and other organizations, the Centers for Medicare and Medicaid Services (CMS) adopted a revised E/M documentation methodology proposed by the American Medical Association (AMA). 

The goal of the suggested adjustments is to reduce physician burden by simplifying documentation requirements and administrative responsibilities. By reducing managerial concerns, physicians will have the ability to spend more in-depth, quality time with their patients. 

What are the changes?

There will be various changes to office and outpatient E/M visits. However, the most notable is the removal of the Level 1 new patient visit (99201), a new 15-minute extended services code that can be used with codes 99205 and 99215, and the following modifications of office code selection:

  • History and physical exams are no longer elements for code selection
  • Physicians can choose to use total time or medical decision making as the basis of their E/M documentation
  • Medical decision-making criteria has been revised and clarified
    • Removed ambiguous terms and concepts
    • Defined vague terms
    • Re-established data elements to move away from adding up tasks and instead focusing on how those tasks affect the patient’s care

What can you do to prepare?

  • Visit our website to find more resources on the 2021 E/M coding and guideline changes
  • Watch our NEW Online E/M Coding Changes for 2021 webinars hosted by Dr. Thomas Weida and Kim Huey and earn CME
  • Contact your medical billing company and/or coders to develop a plan for training office staff to ensure a smooth transition at the first of the year
  • Connect with your Electronic Health Records (EHR) provider to confirm that your practice’s system will be ready to implement the new coding changes
  • Reach out to your payers to negotiate implementing the new E/M rates

With changes this substantial, we encourage you to prepare early. Watch for more information in the coming weeks on our website and email alerts. If you have further questions, please email us at staff@alamedical.org.

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Discussions with Decisionmakers: Finance Director Kelly Butler

Discussions with Decisionmakers: Finance Director Kelly Butler

About Kelly Butler:

Kelly Butler was appointed as the Director of the Alabama Department of Finance by Governor Kay Ivey on December 1, 2018, after serving as acting State Finance Director since August 15, 2018. As the State’s chief financial officer, Butler serves as an advisor to the governor and the Legislature in all financial matters and is charged with protecting the financial interests of the State of Alabama. He is responsible for the administration and oversight of the Department of Finance and serves on various advisory boards and authorities.

Butler has worked for the state of Alabama for over 30 years and previously served as Assistant State Finance Director for Fiscal Operations since December 2016. Mr. Butler was also the State Budget Officer since June 2014. Prior to his employment with the Finance Department, he worked for 19 years with the Legislative Fiscal Office, most recently serving as the Senate Fiscal Officer. Earlier in his career, Mr. Butler worked as a revenue examiner with the Alabama Department of Revenue, where his duties included serving as a corporate income tax and financial institution excise tax auditor and serving as an assistant to the Chief of the Income Tax Division.

Mr. Butler is a graduate of Auburn University Montgomery (BSBA) and Troy University (MBA).

COVID-19 Grant Program

As the Alabama Director of Finance, Mr. Butler is in charge of overseeing the disbursement of all COVID-19 funds received via the CARES Act, including the new Health Care and Emergency Response Providers Grant Program. We recently hosted a Zoom call with Mr. Butler to discuss this program and answer any questions Alabama physicians might have.

Simply click the video below to begin watching where the Q&A with Mr. Butler begins.

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