Capitol Hill Report: AAN Members Head to Capitol Hill

April 22, 2013


By Mike Amery, Legislative Counsel, Federal Affairs, (202) 506–7468,

Neurology on the Hill 2013 took place April 22-23.

144 Neurologists Hit Capitol Hill, Demand Fair and Stable Reimbursements

Neurology on the Hill is one of my favorite times of the year. I really look forward to seeing so many AAN members advocating for neurology and for patients. This year, we have 144 AAN members from 43 states heading to the Hill for what should be the best event ever. See who is attending from your state.

Your AAN colleagues will spend two days in DC hearing from key policy makers from the NIH, the Centers for Medicare and Medicaid Services (CMS), and Congress beginning Monday. They will head to the Hill Tuesday, where they are scheduled to visit 241 congressional offices.

The Enhanced Access to Medicaid Services Act

Just in time for Neurology on the Hill, legislation has been introduced in both the House and the Senate to add neurology to the Medicaid “Bump” provision of the Affordable Care Act.

Whether fair or not, the Medicaid Bump was designed to pay primary care physicians billing Medicaid for 2013-14 with Medicare rates for E/M services. CMS expanded the provision through regulation to include all physicians boarded by the American Board of Internal Medicine (ABIM), such as cardiology, oncology, rheumatology, and even sports medicine.

This expansion leaves out neurology as well as psychiatry and OB/GYN simply because these physicians are not boarded by ABIM, which clearly is not fair or good for Medicaid beneficiaries. The Enhanced Access to Medicaid Services Act will fix this inequity and Neurology on the Hill advocates will be on at the Capitol asking for co-sponsors to the legislation. 

This increase in payments can be a big deal depending on the state where you live and practice. For instance, physicians in California, Texas, and New York will see Medicaid payments for E/M services increase more than 100 percent.

The AAN thanks Senate sponsors Amy Klobuchar (D-MN) and Susan Collin (R-ME) as well as House sponsors Steve Stivers (R-OH) and Jim Moran (D-VA).

Tell Your Member of Congress to Get on Board

The AAN will send an action alert on the evening of April 22, 2013 asking you to send a message to your members of Congress urging them to support this legislation. The AAN has a great email program that allows you to send a message in less than a minute. Since the first few weeks of a bill are crucial to building momentum, it is important that all AAN members in the US respond promptly to this AAN Grassroots Network email when it arrives. AAN members can also send a message on

Senator Questions CMS on Behalf of AAN

The AAN has made great progress over the last few years in raising the awareness on Capitol Hill of issues like the Medicaid Bump and the primary care bonus.

For example CMS Acting Administrator Marilyn Tavenner recently appeared for a confirmation hearing before the Senate Finance Committee. At the request of the AAN, Sen. Johnny Isakson (R-GA) asked the following question:

The Patient Protection and Affordable Care Act included several incentive programs for primary care physicians. While I agree that we need to increase the primary care workforce, I have heard concerns from some physician groups that these incentive programs do not adequately account for the need for cognitive care specialists, such as neurologists and rheumatologists. These specialists primarily bill Medicare under evaluation and management (E/M) codes, rather than procedural codes, and are not as highly compensated as the procedural specialties. However, they are ineligible for incentive programs that are specifically targeted to primary care. The March 2013 report of the National Commission on Physician Payment Reform, chaired by former Senate Majority Leader Bill Frist, recommended that physician payment reform should differentiate between E/M codes and procedural codes, rather than between primary care physicians and specialists. Would you agree that efforts to strengthen the primary care workforce should also include cognitive specialties that are similarly facing workforce shortages?

Tavenner generally pledged to work with all physician specialties, but at least our point was made. The AAN thanks Sen. Isakson for looking out for cognitive care physicians.

The Bigger Picture

Of course, getting neurology included in the Medicaid Bump and a mention in a congressional hearing is a small part of a much bigger problem.

The AAN recently submitted a second round of comments regarding a draft plan by the House Energy and Commerce and Ways and Means Committees to permanently repeal and replace the Sustainable Growth Rate (SGR) formula.

Their plan builds on a previous draft released in February which includes three phases: repeal the SGR and provide fixed payment rates for a to-be-determined period; shift from the current fee-for-service system to one that rewards physicians for quality care; and, after a number of years, give bonus payments to doctors who deliver efficient care.

As this and other SGR/physician payment reform plans develop, the AAN will be at the forefront advocate for the value of cognitive care physicians and legislation that recognizes that value.

Advocacy Notes

by Tim Miller, Senior Program Manager, Communications & State Advocacy

  • The AAN signed on to a coalition letter requesting $5 million in FY2014 for the Pediatric Subspecialty Loan Repayment Program.
  • The Academy also signed on to a letter to the US Department of Labor opposing out-of-pocket maximums for certain health group plans.
  • Telemedicine legislation has been abundant in state legislatures this year, with language being introduced that would require private health insurers to cover health care services provided through telemedicine. With legislation recently passing in Arizona and Montana, 19 states now have telemedicine parity laws.
  • Have a Twitter account? Be sure to follow @AANMember and/or #NOH2013 for updates from Monday’s guest speakers and Tuesday’s meetings during Neurology on the Hill.