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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Coverage and Delivery Expansion

Coverage Expansion | Demonstrations and CMMI | HIT | Patient Care Quality

The Affordable Care Act (ACA) calls for new programs and initiatives that will transform how healthcare is delivered. Innovative pilot programs specified in the legislation, such as accountable care organizations (ACOs), are currently being implemented. The ACA also created the Centers for Medicare and Medicaid Innovation (CMMI), which is tasked with developing and funding demonstration projects to improve the quality of care for patients. CMMI launched programs such as the Pioneer ACO, Bundled Payments for Care Improvement, and the Health Care Innovation Challenge.

The ACA also establishes new requirements for health insurance coverage. Starting in 2014, consumers and small businesses will be able to purchase coverage through state-level exchanges. These exchanges will offer insurance options, aid consumers in selecting plans, and coordinate eligibility for premium tax credits. Also in 2014, Medicaid will expand to cover those at or below 133 percent of the federal poverty level.

Related: Geographic Variation | Inpatient Prospective Payment System

News and Updates

CMS Finalizes Coverage of Next Generation Sequencing Tests

March 23, 2018

The Centers for Medicare and Medicaid Services (CMS) March 16 announced it will cover Next Generation Sequencing (NGS) tests for patients with advanced cancer. The decision finalizes many aspects of the proposed National Coverage Decision (NCD) issued Nov. 30.

AAMC Joins Community Letter Opposing ‘Right to Try’ Legislation

March 16, 2018

The AAMC March 12 joined 85 organizations in a community letter opposing the latest version of the Trickett Wendler, Frank Mongiello, Jordan McLinn, and Matthew Bellina Right to Try Act, legislation that would create a secondary pathway for accessing investigational therapies outside of clinical trials that would remove Food and Drug Administration (FDA) approval and consultation.

AAMC Comments on Association Health Plan Proposed Rule

March 9, 2018

The AAMC March 5 submitted comments on the Department of Labor’s (DOL) proposed rule on association health plans (AHPs).

AAMC Signs Community Letter Questioning Anthem Payment Policies

March 9, 2018

The AAMC March 5 signed a hospital community letter to Anthem asking the insurer to abandon coverage policies for outpatient imaging and emergency care services that could diminish access to care.

AAMC Submits Comment Letter on Extreme and Uncontrollable Circumstances Rule

February 23, 2018

The AAMC submitted a Feb. 20 comment letter to the Centers for Medicare and Medicaid Service (CMS) supporting the agency’s decision to establish extreme and uncontrollable circumstances policies for the Shared Savings Program that will apply to accountable care organizations (ACOs) impacted by events, such as Hurricanes Harvey, Irma, Maria, and California wildfires.

On Government Affairs

Testimony and Correspondence

External Resources