Legislative Update

Posted on March 5, 2013

AOMA hosted annual D.O. Day at the legislature on March 5, 2013

AOMA hosted it's annual D.O. Day at the Legislature on Tuesday, March 5, 2013 - featuring nearly 60 D.O.s and osteopathic medical students. We were fortunate to hear from several legislators and the Governor's Health Policy Advisor regarding the legislative issues of the year, including the restoration of AHCCCS coverage. Governor Brewer hosted a press conference during the D.O. Day proceedings regarding her proposal for AHCCCS, featuring health care professionals in support of the proposal. Visit our Facebook page to see photos and video from the event; http://www.facebook.com/azosteo. Governor Brewer also sent out a press release after the event - azgovernor.gov/dms/upload/PR_030513_MedicaidRestoration.pdf.


Posted on October 4, 2012

Important election deadlines and dates

  • The deadline to register to vote in the November 6, 2012 General Election is Tuesday, October 9, 2012 at midnight.
  • Early voting for the November 6, 2012 General Election begins on October 11, 2012.

Voting Tips:

  1. If you are a registered voter you will receive voter information packets well before any election.
  2. If you don't receive voter information, your address on file might not be correct and you should contact your County Election Department or visit the Secretary of State website.
  3. You should receive a voter registration card in the mail after your application has been processed.
  4. Prior to an election, you will receive information in the mail directing you where to go to vote in that upcoming election.
  5. Make sure you have the proper identification with you when you go to the polls to vote.

For additional voting tips, election information, candidate surveys, voting guides and more, visit www.azvoteforhealthcare.org. Make sure to sign up on the website for future updates.


Posted on August 3, 2011

2011 Physicians' & Pharmaceutical Fee Schedule Summary of Changes

On May 26, 2011, the Industrial Commission of Arizona held its 2011 Fee Schedule Hearing under A.R.S. §23-908(B). A summary of Commission action taken subsequent to the public hearing, including action taken to conform the Arizona Physicians’ and Pharmaceutical Fee Schedule to the 2010 edition of the CPT-4 and to update values of the selected codes can be viewed at our website at www.ica.state.az.us.

The 2011 Physicians’ and Pharmaceutical Fee Schedule is effective October 1, 2011 through September 30, 2012 and will be posted on the website on September 1, 2011.


Posted on July 5, 2011

AHCCCS EHRs Incentive Payment Program Update

The AHCCCS electronic Provider Incentive Program (e-PiP) web site for Arizona Medicaid EHR incentive payments will open for Registration to all Medicaid Eligible Providers (EPs) and Eligible Hospitals (EHs) on Monday July 25th, 2011.

The ePIP web site will be then be open for Adopt/Implement/Upgrade (AIU) Attestation activities for all Eligible Professionals (EPs) and Eligible Hospitals (EHs) on Thursday September 1, 2011.

Please check the AHCCCS EHRS Incentive Program web page http://www.azahcccs.gov/HIT/default.aspx - it will be updated with final provider toolkits and worksheets as they are ready.

Posted on May 31, 2011

CMS Announces Proposed Rule on Electronic Prescribing Incentive Program

Providers Offered Flexibility in Adopting E-Prescribing

On Thursday, May 26, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for the Electronic Prescribing Incentive Program, which will allow more flexibility to providers who are adopting electronic prescribing systems. This program, in conjunction with the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, give providers new options and incentives to use health IT to improve care for their patients, which can improve patient health and lower costs.

The Electronic Prescribing Incentive Program today announced proposals for new flexibilities to help providers phase in the use of e-prescribing technology. This program provides financial incentives, including payment adjustments beginning January 1, 2012, for eligible providers to encourage e-prescribing. The proposals announced today would provide exemptions from the payment adjustment for providers who plan to participate in the program but who face certain barriers to using e-prescribing systems or meeting program requirements that may be beyond their control.

For more information and detailed fact sheets on both the e-prescribing proposed rule and the EHR incentive payments, please visit: http://www.cms.gov/apps/media/fact_sheets.asp. CMS’ proposed rule on electronic prescribing is available for public review and comment today at http://www.ofr.gov/OFRUpload/OFRData/2011-13463_PI.pdf with the comment period closing on July 25, 2011.

Posted on May 16, 2011

ACO Webpage Goes Live

Section 3022 of the Affordable Care Act requires the Centers for Medicare and Medicaid Services (CMS) to establish a shared savings program on Jan. 1, 2012, that would:

  • Aim to supply better care for individuals
  • Provide better health outcomes for patients
  • Lower per capita costs
  • Encourage investment in healthcare infrastructure

To participate in the shared savings program, eligible providers, hospitals and suppliers may create or join an Accountable Care Organization (ACO). An ACO encourages providers of services and suppliers to create a new type of health care entity that agrees to be held accountable for improving the health and experience of care for individuals and improving the health of populations while reducing the rate of growth in health care spending.

You can find more information on ACOs on the AOA's new webpage at http://osteopathic.org/inside-aoa/development/practice-mgt/accountable-care-organizations/Pages/default.aspx. Be sure to check their ACO webinar on this page in days to come!


Posted on April 26, 2011


As part of the recently enacted budget, the Arizona Legislature adopted Governor Brewer's Medicaid Reform Plan which restores funding of previously covered transplants for adults that were eliminated effective October 1, 2010. Retroactive to April 1, 2011, AHCCCS will once again cover the following transplants for members 21 years of age and older:

  • Pancreas-after-kidney transplants
  • Liver transplants in patients with Hepatitis C
  • Allogeneic unrelated hematopoietic cell transplants
  • Heart transplants in patients with non-ischemic cardiomyopathies
  • Lung transplants
  • Heart-lung transplants

This legislation does not affect transplants that were not covered for adults prior to October 1, 2010, including pancreas only transplants, partial pancreas transplants and pancreas islet cell transplants. Those transplants remain non-covered consistent with AHCCCS policies. In addition to the medically necessary transplants covered for adults, AHCCCS continues to cover all medically necessary, non experimental transplants for members under the age of 21 years as required by EPSDT.

Coverage criteria for restored transplants will be the same as the criteria in place prior to October 1, 2010. Physicians with patients they believe meet the criteria for any AHCCCS covered transplant should contact the AHCCCS health plan in which the patient is enrolled to refer the patient for transplant evaluation.

For more information, please see the AHCCCS website at: http://www.azahcccs.gov/reporting/legislation/sessions/2010/BenefitChanges.aspx#transplantRestoration


Posted on January 20, 2011

House Votes to Repeal Healthcare Reform Legislation

By a vote of 245-189, the House of Representatives voted to repeal the new healthcare reform law, a long-expected action that is seen as largely symbolic since leaders of the Democratic-controlled Senate have vowed to block repeal.

The vote was preceded by a day and a half of debate on the measure, known as the "Repealing the Job-Killing Health Care Law Act." The two-page bill would repeal the Affordable Care Act (ACA) -- signed by President Obama in March 2010 -- and all other laws changed by the reform law "as if such Act had never been enacted." It would also repeal the healthcare provisions in the companion bill, known as the reconciliation act, that altered some parts of the main law.


Posted on December 10, 2010

Congress Enacts One-Year Fix to Medicare Physician Payments

Cuts for 2011 Stopped

The House and Senate have approved legislation preventing implementation of a 24.9% cut in Medicare physician payments scheduled to take effect on January 1, 2011. The “Medicare and Medicaid Extenders Act of 2010” (H.R. 4994) extends current Medicare payment policies for 12 months, expiring on December 31, 2011. The enactment of H.R. 4994 marks the 5th time this year that Congress has enacted legislation preventing cuts in Medicare payments for physicians.

In addition to preventing cuts in physician payments, H.R. 4994 extends several provisions set for expiration on December 31. Most notably of those provisions, is a 12 month extension of the floor of 1.0 for the “work” geographic practice cost indices or GPCI for all geographic regions. This provision is important to most rural communities and states and provides equity in payments in relation to larger urban areas.

Additionally, the legislation provides $200 million to the Centers for Medicare and Medicaid Services (CMS) to process and pay claims filed during 2010 that are eligible for higher payments as a result of changes in legislation.


Posted on November 30, 2010

Congress Passes 31-day Extension on Medicare Pay Cuts

The House of Representatives has approved the “Physician Payment and Therapy Relief Act of 2010.” The bill was approved by the Senate on November 18. Once signed by the President, the bill will extend current Medicare physician payment policies for an additional 31 days – thus preventing implementation of the scheduled 23% cut in payments for physicians participating in the Medicare program. Congress must take action prior to adjournment to prevent a 25% cut scheduled for January 1, 2011.


Posted on November 22, 2010

Register now for AOA/AMA Webinar on Medicare Participation

Thursday, December 2 @ 6:30pm Eastern

What are your options when it comes to participation in the Medicare program? Do you have questions about what it means to be a participating or non-participating physician in the Medicare program? Do you have questions about what it means to “opt-out” of the Medicare program?

Given the current instability in Medicare physician payments, we want you to clearly understand what your options are and how those different options impact your practice and your patients. How they impact other Medicare incentive payments such as the Primary Care/General Surgery bonus, PQRI, Electronic Prescribing, and the new Electronic Health Records.

The AOA has arranged for our members to be able to participate in a special AMA webinar on Medicare Participation. The webinar will take place on Thursday, December 2 at 6:30pm eastern. The webinar will feature presentations on Medicare participation options and their potential impact on your practice and patients. There will be a question and answer session where you can ask specific questions related to your current and/or future participation in the Medicare program. To register, go to: https://cc.readytalk.com/cc/schedule/display.do?udc=o0vb1hmijhzh.


Posted on November 19, 2010

Senate Approves Legislation to Prevent 23% Cut; Focus Shifts to House

On November 18, the Senate approved legislation that prevents implementation of the scheduled 23 percent reduction in Medicare physician payments through December 31. The legislation extends the current 2.2 percent payment rate for 31 days at a cost of $1 billion. The House had already adjourned by the time the Senate approved the bill. Therefore the House will consider the bill upon their return November 29 or 30.

Additionally, Congressman Dingell, Waxman, Pallone, and Stark have introduced a 13 month physician payment proposal. This proposal likely will be the focus of House deliberations in December.

Posted on November 11, 2010

AOMA hosts a Health Care Reform Panel at it's Fall Seminar

American Osteopathic Association (AOA) President Karen Nichols, D.O. from Arizona, AHCCCS Medical Director Marc Leib, M.D.,J.D. and Mutual Insurance Company of Arizona’s CEO James Carland, M.D. gave presentations on the impact of the national health care reform laws on physicians practices , Medicaid, and the medical professional liability. Dr. Nichols stated that the AOA gave a letter of “measured “support for HR 3200 because 70% of the AOA’s priority issues were included in the bill and will be implemented by March 31, 2011 The AOA House of Delegates in which Arizona has 13 Delegates determines this policy. There was a quote from one of the presenters that “if you are not at the table, you will be on the menu.”

Dr. Nichols went into greater detail about the Medicare Physician Fee Cuts and reallocation of Graduate Medical Education (GME). Their presentations are linked below:

Dr. Carland's Presentation
Dr. Leib's Presentation
Dr. Nichols' Presentation



Posted on July 14, 2010

Final Rule for Meaningful Use of Electronic Health Records Just Released!
Arizona Health-e Connection to Launch Series of In-Depth Meetings Across State on New Rule

On July 13, the Centers for Medicare & Medicaid Services (CMS) issued the Meaningful Use Final Rule for electronic health records (EHRs). The final rule defines the criteria that healthcare providers must meet to reach Meaningful Use and outlines payment methodologies for the Medicare and Medicaid incentive programs.

The Arizona Regional Extension Center, led by Arizona Health-e Connection (AzHeC) in collaboration with key partners (ASU’s Department of Biomedical Informatics, Health Services Advisory Group and the Purchasing & Assistance Collaborative for Electronic Health Records) is part of a $634 million ARRA/HITECH initiative to establish HIT Regional Extension Centers nationwide to assist primary care providers in adopting and becoming Meaningful Users of EHR systems. Arizona’s Regional Extension Center recognizes there are many challenges Arizona providers face and is committed to addressing those challenges when it opens its doors to begin assisting providers in early fall 2010.

In the coming weeks, the Regional Extension Center program will offer a series of statewide regional Meaningful Use meetings to provide in-depth information on the new rule. Meetings will be held in Flagstaff, Phoenix, Tucson and Yuma and are specifically geared toward healthcare providers and other healthcare professionals that will be impacted by Meaningful Use, although anyone is welcome and encouraged to attend. Please look for details soon!
The final rule, along with a number of summary resources on the final rule, are posted on AzHeC’s Website.

Learn More

  • Visit the AzHeC Website
  • Read Arizona’s Regional Extension Center: An Opportunity to Make Healthcare Higher in quality and Lower in Costs through Adoption of Electronic Health Records, an AzHeC Issue Paper
  • Sign-up to receive regular Regional Extension Center updates—please email ehr@azhec.org (subject line: Sign-up for REC updates)
  • Attend one of the Regional Meaningful Use meetings taking place in Flagstaff, Phoenix, Tucson and Yuma—Look for details soon!

Posted on June 25, 2010

House Agrees to Six Month Payment Fix Proposed by Senate

On Thursday, June 25, the House of Representatives approved a six-month Medicare physician payment bill 417-1.  The Senate approved the bill late last week.  The short-term fix, which would restore Medicare payment cuts that took effect June 18, was a last-minute addition to the House floor schedule Thursday afternoon.  Once enacted by the President, physicians participating in the Medicare program will receive positive payment updates through November 30, 2010.

Posted on June 18, 2010


Senate reaches Medicare physician payment deal, House scheduled to vote next week

The Senate passed legislation on Friday, June 18th via a unanimous consent agreement blocking the 21.3 percent cut to Medicare physician payments until Nov 30. The House of Representatives must also vote on the matter and is expected to do so next week. If this bill becomes law, medical practices will receive a 2.2 percent increase to Medicare physician payment for claims with dates of service of from June 1 through Nov. 30.

Posted on June 16, 2010

Senate Fails to Enact Medicare Payment Fix

The United States Senate has failed to override a budget point of order on HR 4213, the American Jobs and Closing Tax Loopholes Act (HR 4213). This legislation would have helped preserve access to physicians for millions of Americans in Medicare until 2014 by preventing the impending 21.2% Medicare physician payment cut and replacing it with at least 1% positive updates until a permanent fix to the Sustainable Growth Rate formula could be found. With the Senate's failure to override the point of order, the bill will be scaled back dramatically, including rolling back the Medicare physician payment provisions. The American Osteopathic Association (AOA) now anticipate that the Senate will seek a freeze for six to seven months. We will keep AOMA members apprised of further developments.


CMS Delays Implementation of 21.3% Cut

Claims will continue to be held through June 17th

The Centers for Medicare and Medicaid Services has released the statement below regarding the Medicare physician fee schedule. Please note that the date for processing claims reflecting the 21% cut is now Friday, June 18.

The 2010 Medicare Physician Fee Schedule

The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010. At this time, Congress is debating the elimination of the negative update that took effect June 1, 2010. The Centers for Medicare & Medicaid Services (CMS) is hopeful that Congressional action will be taken within the next several days to avert the negative update.

To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers paid under the MPFS, CMS had instructed its contractors on May 27th to hold claims for services paid under the MPFS for the first 10 business days of June (i.e., through June 14, 2010). This hold only affects MPFS claims with dates of service of June 1, 2010, and later.

Given the possibility of Congressional action in the very near future, CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18.

This action will facilitate accurate claims processing at the outset and minimize the need for claims reprocessing if Congressional action changes the negative update. It also should minimize the provider and beneficiary burdens and costs associated with reprocessing claims.

We understand that the delayed processing of Medicare claims may present cash flow problems for some Medicare providers. However, we expect that the delay, if any, beyond the normal processing period will be only a few days. Be on the alert for more information regarding the 2010 Medicare Physician Fee Schedule Update.


FTC extends deadline for Red Flags Rule

The American Osteopathic Association (AOA), the American Medical Association (AMA) and the Medical Society of the District of Columbia (MSDC) filed a lawsuit in federal court last week seeking to prevent the Federal Trade Commission (FTC) from extending identity theft regulations to physicians.


The complaint, prepared by the Litigation Center of the AMA and State Medical Societies, targets the contentious "Red Flags" Rule, which requires creditors to implement safeguards against identity theft. The medical societies charge that the FTC's rule exceeds the powers delegated to it by Congress and that its application to physicians is "arbitrary, capricious and contrary to the law."


At the request of Congress, the FTC has now delayed the enforcement of the "Red Flags" rule until December 31, 2010; the Red Flags rule was scheduled to go into effect on June 1. For more information on the delay, visit the FTC website. http://www.ftc.gov/opa/2010/05/redflags.shtm


Congress Adjourns without Ensuring SGR Cut is Prevented

The U.S. House of Representatives has approved the "American Jobs and Closing Tax Loopholes Act" (H.R. 4213), which includes Medicare physician payment provisions. The House considered the Medicare physician payment policy as an amendment to the underlying bill. The SGR amendment was approved 245-271. Fifteen Republicans voted for the amendment and 15 Democrats voted against the amendment. The vote on the complete package was 215-206.

The Medicare physician payment provisions provide a 2.2% positive payment update for 2010 and a 1% positive payment update for 2011. The formula would revert to current law in 2012.

Since the Senate has adjourned for the Memorial Day recess, they will not consider the bill until June 7 at the earliest. This means that the 21% cut will be implemented on June 1. The Centers for Medicare and Medicaid Services (CMS) has announced that they will - as allowed under current law - hold all claims for 10 business days. This affords the Senate additional time to enact H.R. 4213 and prevent the payment of claims reflecting the 21% cut.


Health Care Reform Enacted

On Sunday, March 21, 2010, the U.S. House of Representatives approved by a vote of 219 – 212 the Patient Protection and Affordable Care Act (PPAC) (H.R. 3590). President Obama signed the bill into law on Tuesday, March 23, 3010
The Senate approved the Health Care and Education Affordability Reconciliation Act of 2010 (H.R. 4872) by a vote of 56 – 43 on March 25, 2010 by a vote of 56-43.
Changes for patients:

  • Health care coverage will be extended to an additional 32 million Americans which dramatically increases access to care.
  • Health insurance plans will be required to offer dependent coverage for adult children through the age of 26 years.
  • If children have been accepted for coverage, or are already covered, the insurer cannot exclude payment for treating a particular illness. The full protection for children and adults with preexisting conditions will begin in 2014. (This is new information).
  • Medicare beneficiaries will receive $ 250 to cover expenses for medications to close the gap or donut hole whereby the beneficiaries previously had to pay their own drug costs.

Changes affecting physicians
Chart Developed by American Osteopathic Association Department of Government Relations

Issue Description of New Policy Effective Date(s)
Medicare Physician Payment Congress will address the sustainable growth rate formula in separate legislation this summer. Currently, physician payments are frozen at 2009 levels through March 31.  
Primary Care Bonus Payments All primary care physicians will be eligible for a 10% bonus in Medicare payments. To qualify, at least 60% of the physicians total Medicare charges must be comprised of office, nursing home, and home care visits. 2011 - 2016
General Surgery Bonus
General surgeons who perform major procedures in a health professional shortage
area will be eligible for a 10% bonus payment for those services. Major procedure is
defined as any service with a 10 or 90 day global payment.
2011 - 2016
Medicaid Payments Raises Medicaid payments for evaluation and management (E&M) services to at least 100% of Medicare payment rates. 2013 - 2014
Geographic Payment
Establishes the “floor” on the work geographic practice cost indice (GPCI) at 1.0 for all localities for 2010. Medicare will begin making a separate adjustment for the practice expense portion of physician payments in 2010 and 2011. Increases the practice expense GPCI adjustment for physicians in North Dakota, Montana, South Dakota, Utah and Wyoming to the national average beginning in 2011. 2010
Medical Liability Reform The Secretary of Health and Human Services (HHS) is authorized to award five-year demonstration grants to states to develop, implement and evaluate alternative medical liability reform initiatives, such as health courts and early offer programs. Medical liability protections under the Federal Tort Claims Act (FTCA) are extended to officers, governing board members, employees, and contractors of free health clinics. 2011
Community Health Centers Funding for Community Health Centers increases by $11 billion to assist in providing care to uninsured and underinsured individuals. 2011
 Prevention and Wellness  Medicaid will be required to cover tobacco cessation services for pregnant women beginning in 2010. Cost-sharing for preventive services is eliminated in Medicare and Medicaid programs beginning in 2011. Medicare payments for these preventive services will be increased to 100 percent of payment schedule rates. Health plans are required to provide a minimum level of coverage without cost-sharing for preventive services beginning in 2010. 2010
Mental Health Incentive
Medicare will increase payments for psychotherapy services by 5%. 2010
Administrative Simplification  National rules will be implemented to standardize and streamline health insurance claims processing requirements. 2013 - 2016
Insurance Reforms Insurers are prohibited from denying coverage to children who have pre-existing conditions. Insurers are prohibited from placing lifetime limits on how much they pay out to individual policyholders and from rescinding coverage except in the case
of fraud. Adult dependent children up to the age of 26 are eligible for coverage under their parents or legal guardians’ insurance policies.
 Medicare Prescription Drug
Medicare beneficiaries whose prescription expenses reach the so-called Medicare Part D coverage "doughnut hole" ($2,700 to $6,150) in 2010 will receive a $250 rebate. 2010
Coverage Mandates – Employers Employers with more than 50 employees, with a minimum of one full-time employee, which receives a premium tax credit, are required to offer health insurance coverage to their employees or face penalties. Employers with 50 employees or less are exempt from this requirement. 2014
Coverage Mandate – Individuals Most individuals are required to either purchase health care coverage or demonstrate
coverage through their employer or other program or face penalties.
Medicaid Expansion Low-income individuals under the age of 65 and at or below 133% of the federal
poverty level ($29,327 for family of four) are eligible for Medicaid coverage.



Banner Health CEO Comments on Health Cuts

Arizona Osteopathic Medical Association
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