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Capitol hill report: CONGRESS ENACTS BILL WITH KEY ADVOCACY WINS

December 23, 2022

Overview of Consolidated Appropriations Act, 2023

This week Congress enacted a $1.7 trillion spending bill for fiscal year (FY) 2023. This legislation impacts a number of priorities the AAN has championed throughout the 117th Congress, including mitigating the looming cliff to Medicare reimbursements, extending telehealth flexibilities beyond the public health emergency, providing historic levels of funding for medical research, and ensuring high-quality neurologic care for American veterans. This legislation is extensive, consisting of more than 4,000 pages. Due to this, only the key health care policies that most impact AAN members are summarized here:  

Medicare Payment

  • Congress eliminated three-quarters of the scheduled 8.5-percent Medicare reimbursement reduction, resulting in a net 2-percent reduction in payments for 2023. This mitigation for 2023 is comprised of 2.5 percent from the extension of short-term relief originally enacted in 2021 plus a waiver of the 4-percent PAYGO sequester cuts. Congress also extended the incentive payment for participation in eligible Medicare Alternative Payment Models, but at a reduced rate of 3.5 percent. While the AAN recognizes that any cuts to Medicare reimbursement continue to threaten practices and patient access to care, this lesser reduction remains a hard-fought victory for neurology. But we will not let up on the pressure in 2023 with the new Congress to ensure that our practitioners receive appropriate reimbursement for their care and expertise.

Telehealth

  • Medicare telehealth flexibilities, including audio only, have been extended two years, through December 31, 2024. This action matches the request of the AAN and the telehealth community, eliminating the risk of an immediate and sudden cliff after the conclusion of the public health emergency. The AAN will advocate for permanent action in the next Congress.

Improvements to the FDA

  • This package includes AAN-supported reforms to the FDA Accelerated Approval pathway to ensure that novel treatments that address critical unmet medical needs can continue to be moved through the approval process quickly while also addressing the necessity for their timely and comprehensive post-approval study.
  • The AAN has supported efforts aimed at enhancing diverse enrollment in clinical trials, including those focused on Alzheimer's disease. This legislation includes guidance and support in these efforts, such as workshops to disseminate best practices and instruction on decentralized trials, among other requirements.
  • Provides $2 million in new money to boost the FDA neuroscience program, which the AAN supported.

Appropriations

  • Each health care and medical research program prioritized by the AAN received at least stable funding for FY23, with most programs receiving significant increases. This included:
    • National Institutes of Health: $47.459 billion, an increase of $2.5 billion from FY22
    • National Institute of Neurologic Disease and Stroke: $2.814 billion, an increase of $203 million
    • BRAIN Initiative: $680 million, an increase of $60 million from FY22
  • The bill also includes specific language providing an additional $5 million for the expansion of Headache Centers of Excellence and up to $4 million to support expansion of Parkinson’s Disease Research, Education and Clinical Centers and multiple sclerosis centers.

Workforce

  • The bill provides federal funding for 200 new Graduate Medical Education (GME) slots, half of which are devoted to psychiatry-focused specialties. This is the second time Congress has expanded federal funding for GME in recent years, after decades of no investment.
  • The bill reauthorizes the Conrad 30 Waiver Program for the remainder of fiscal year 2023.

Prior Authorization Reform

  • The Academy recognizes that the administrative burden in the prior authorization process continues to place an unnecessary burden on practices and providers, leading to delays in patient care. AAN is a member of the Regulatory Relief Coalition, a group that served as a lead stakeholder in developing the Improving Seniors’ Timely Access to Care Act, a bill that would codify provisions that would streamline prior authorization in Medicare Advantage. While this legislation was not included in the final package this year, it is important to note that CMS released a proposed rule that closely aligns with this legislative text. The Academy will continue to work with Congress in 2023 to ensure that work continues to reduce unnecessary administrative burden.