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Prior Authorization and Marijuana and Surprise Billing, Oh My!

Prior Authorization and Marijuana and Surprise Billing, Oh My!

MSMS Board of Directors tackles administrative burdens, substance use, and price setting at meeting

Wednesday, July 17, 2019

During the mid-summer meeting of the Michigan State Medical Society (MSMS) Board of Directors, the Board discussed the latest information in regards to Health Can't Wait, a coalition of patients, physicians, and health care providers dedicated to putting Michigan patients first and ending delays in patients' access to health care. Below are some additional highlights from last week's meeting:

  • Michigan Department of Licensing and Regulatory Affairs Presentation. Haley Winans, Senior Analyst, and Amber Daniels, Department Analyst, provided a timely summary on the Michigan Automated Prescription System. They reviewed statistics on prescription numbers as well as the patient and provider reports. MSMS Board members expressed concerns on how MAPS analytics is being used to initiate investigations. As the speakers were not able to address all of the questions associated with these valid concerns, MSMS has requested a meeting with appropriate leadership at the Michigan Department of Licensing and Regulatory Affairs (LARA), including the Director of LARA on this and other licensing matters. 
  • CMS Region V Meeting. In May, the Centers for Medicare and Medicaid Services (CMS) hosted the Region V annual in-person meeting in Chicago. The meeting provided MSMS the opportunity to network and learn more about upcoming CMS programs and policies. MSMS continues to stress the need for more alignment and simplification among federal, state, and commercial payer quality initiatives, as well as the importance of physician input during the design, decision-making, and roll-out of new initiatives.
  • Blue Cross Blue Shield of Michigan UpdateMSMS attended the BCBSM Professional Provider Relations Advisory Committee (PPRAC) quarterly meeting earlier this month. This is a Board level committee which included presentations on utilization management, provider delivered care management, pharmacy strategy, and their new risk-based contract product. Of note, Marc D. Keshishian, MD, BCBSM Vice President and BCN Senior Vice President and Chief Medical Officer, presented on utilization management programs in BCBSM and BCN. When prompted, Doctor Keshishian stated that BCBSM/BCN intends to implement gold carding for all prior authorizations. This represents a change in BCBSM policy.  MSMS will continue to follow-up on criteria and implementation dates.
  • Annual Scientific Meeting. The 154th Annual Scientific Meeting (ASM) is schedule for Wednesday, October 23 through Saturday, October 26, 2019, at the Sheraton Detroit Novi in Novi. Watch for more information.
  • Marijuana Policy Action Agenda. The MSMS Board of Directors adopted the following action agenda to help prioritize MSMS regulatory and legislative advocacy regarding adult use marijuana:
  • MSMS advocates that any labeling of marijuana products include warnings that make clear the content, potency, as well as the known safety and health risks, based on the best available scientific evidence.
  • MSMS advocates for prohibiting the use of marijuana in public places.
  • MSMS advocates for funding of more research to determine the consequences of long-term marijuana use, especially among youth, adolescents, pregnant women, and women who are breastfeeding. Research should:
  • Be conducted pursuant to valid research protocols, including properly controlled clinical studies of adequate size and duration;
  • Explore how legalization impacts existing and emerging mental health and substance use issues facing communities; and
  • Be vetted by independent evaluators with backgrounds in the health 
  • MSMS supports sanctions on sellers for misrepresenting health benefits of marijuana.
  • MSMS supports dedicating a substantial portion of tax revenue from marijuana sales toward public health purposes, including substance use prevention and treatment program, marijuana-use educational campaigns, and public service announcements, rigorous research on the health effects of marijuana and public health surveillance efforts.
  • MSMS advocates for funding for ongoing surveillance to determine the impact of marijuana legalization and commercialization on public health and safety (e.g., emergency department visits and hospitalizations, impaired driving rates, traffic fatalities and injuries, unintentional exposures, crimes related to use/intoxication, impact on high-risk populations, etc.)
  • MSMS encourages the adoption of legal and regulatory tools to monitor and stem illegal activity related to marijuana.
  • House Bills 4459 and 4460 -- Legislation to address surprise, out-of-network bills. The Board voted to oppose HBs 4459-4460. The discussion focused on the problems with price setting as HB 4459 and the merits of the New York model were raised. Staff shared that they are working in close collaboration with the Michigan Health and Hospital Association and other physician specialty groups to form a united front to offer alternative language. Part of the strategy will include requesting that the state wait until Congress acts, which could be as soon as December.
  • House Bills 4607-4608, Lyme Disease Legislation. Introduced by Representative Karen Whitsett (D-9), the bills would require that physicians and providers order certain tests and provide written materials specific to Lyme disease; and that the Department of Health and Human Services develop a standardized procedure for the “diagnosis and treatment of Lyme disease.” The Committee discussed amending the recommendation to include opposition to House Bill 4603, which would codify an already existing requirement to report Lyme disease to the state within 24 hours, imposing a civil fine when a physician fails to do so. The Board voted to oppose HBs 4607-4608.
  • Electronic Prescribing of All Prescriptions Update. MSMS updated the Board on the legislative developments related to the mandate to electronically prescribe all prescriptions, including controlled substances. It was shared that the Senate Health Policy committee recently approved substitutes to the bill with a 9-0 vote and that the House Health Policy committee had yet to take a vote. MSMS continues to work with leadership in the Senate, as well as House staff to adopt changes to the bills that align the state with the federal requirements and tie implementation to when the federal government actually imposes its requirement under Medicare Part D.

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