CNS March 2023 Legislation Update – Steve Cattolica

UnitedHealthcare and HCSC Accept NBPAS Certification

One week until Conference and Legislative Day

The team discusses their upcoming meeting on April 30th at the Citizen Hotel

CNS Reviews Bills and Votes on Measures of Support or Opposition

Quick recap The team discussed the financial implications of transportation for people with epilepsy and proposed potential solutions, including allocating a dollar from truck registration towards retraining or local transportation budgets. They also discussed healthcare policies, particularly a bill aiming to align the standards of administering life-saving medicines to people with seizures in adult day centers with FDA standards. Lastly, they discussed the risks of head injuries in children playing tackle football and the potential for introducing a bill to raise awareness about the impact of head injuries on children's brain development. Next steps Selim to send conference information to Sean Porter. Selim to create or coordinate creation of a formal invitation for the legislative reception on May 1st. Johanna to contact Sean Porter about potential legislation sponsorship and discuss the epilepsy transportation issue. Stella to write a letter to the NFL praising them for flag football and encouraging them to promote safety in youth football. Johanna to resubmit the full CMA resolution documents, ensuring all content fits within the submission guidelines. Selim to contact the Governor's office and healthcare representatives to invite them to speak at the May 1st legislative day. Johanna to attend the CMA legislative day on May 21st, arriving the night before. Jeff to attend the CMA legislative day on May 21st. Legislative team to continue pursuing the head injury bill with potential sponsors. Johanna to follow up with Michelle Rodriguez's office about attending the May 1st reception and potentially meeting with the team. Summaries Transportation Funding for Epilepsy Patients Johanna discussed the financial implications of transportation for people with epilepsy, suggesting that those who cannot drive due to their condition should receive a portion of the taxes paid by those who can drive. She proposed a potential solution of allocating a dollar from the registration of 18-wheeler trucks towards retraining or budget for local transportation departments. Steve agreed with Johanna's points about the funding and taxation system, but expressed concerns about the feasibility of taxing truck drivers due to their strong union. The conversation ended with Stella and Nick joining the conversation. Healthcare Policy Discussion and Support Selim, Dr. Stella Legarda, Dr. Joanna Rosenthal, and Steve Cattolica met with Nick, a legislative representative, to discuss healthcare policies. They expressed support for a bill, Assembly Bill 369, which aims to align the standards of who can administer life-saving medicines to people with seizures in adult day centers with FDA standards. They also discussed the possibility of Nick's office giving a talk about the bill at their upcoming conference in Sacramento. Additionally, they mentioned a previous bill, the Levine Bill, which they supported and was recently passed. Addressing Tackle Football Risks in Children Johanna and Stella discussed the risks of head injuries in children playing tackle football, particularly in the developing brain. They mentioned a bill that partially went through last year, which required parents to sign a waiver acknowledging the risks. They also discussed a study by Boston University's CTE Center, which found that 100% of professional football players under 30 had chronic traumatic encephalopathy (CTE). Stella suggested that the National Football League should prioritize long-term brain health in children and proposed a joint resolution between the House and Senate to create an age limit for tackle football, similar to other contact sports. Addressing Head Injuries and Epilepsy In the meeting, Johanna, Stella, and Nick discussed the possibility of introducing a bill to raise awareness about the impact of head injuries on children's brain development and the subsequent challenges faced by those affected. They agreed that the bill should be the primary focus, with a resolution as a fallback option. Nick committed to discussing the idea with his team and superiors, acknowledging the challenge of securing funding in the current budget deficit. The team also discussed the potential for job training programs and transportation assistance for individuals with epilepsy who lose their driver's licenses. The conversation ended with the understanding that the issue is underserved and needs to be addressed. Bill Language and Legislative Session Nick agreed to follow up on the ideas discussed with his team and send the bill language to Stella for support. Johanna reminded Nick of a February 21st deadline for new legislation and asked about the number of bills his department was sponsoring. Nick clarified that they were limited due to the shortened session and the new member's role. Johanna proposed an invitation for Nick's department to attend the legislative session on May 1st and visit the office in the Capitol. Nick agreed to this and provided Selim with the scheduler's email. Steve expressed his appreciation for the bill and the progress it aimed to achieve. State Funding and Project Income Johanna and Stella discussed the challenges of generating income for their projects and the need to approach the state for funding. They also discussed their interactions with the Principal Consultant on the Senate Transportation Committee, Melissa White, who advised them against asking for money, suggesting instead to extend the service to the population. Johanna expressed her belief that they could find a workaround and generate income from the state, while Stella emphasized the importance of presenting their goals clearly and avoiding the perception of asking for extra money. They agreed to continue their efforts and to invite the legislative assistant to a meeting to further discuss their plans. Youth Sports Concussion Prevention Efforts Stella, Johanna, and Selim discussed the committee's legislative efforts, particularly focusing on concussion prevention in youth sports. They agreed on the need for a joint resolution between the House and the Senate to limit contact sports for under-12s, rather than a bill. They also discussed the potential for using the legislation as a bargaining chip with the NFL. Johanna mentioned that she had sent letters to the NFL and other organizations, and Stella suggested writing a letter to the NFL praising their adoption of flag football. The team also discussed the importance of Selim speaking up in meetings, as he has a strong understanding of the legislative process. Lastly, they planned to invite representatives from the Governor's office to their upcoming legislative day. Epilepsy Medication and Transportation Discussion Johanna, Stella, Jeff, and Selim discussed various topics, including epilepsy medication, transportation for epilepsy patients, and potential legislation. Stella mentioned a bill she was involved with last year, which allowed school personnel to administer epilepsy medication to students. Johanna suggested a new approach to claw back some of the money epilepsy patients pay for transportation they can't use. Jeff agreed, stating that it wouldn't cost much for transportation agencies to provide free transportation for epilepsy patients. They also discussed the possibility of bringing the issue to a state level, as opposed to individual municipalities. Selim asked about reaching out to Sean Porter, and Johanna agreed to do so. Lastly, they discussed the upcoming CMA resolutions and the possibility of attending a legislative day on May 21st.

Legislative Committee Meeting Minutes Here is a summary of the meeting: Steve C: Set up a May 1 meeting with the governor’s office Health staffer. Start a template letter for staffers to present. Start a template letter to write to the DOJ regarding MOC, to co-author with Bob and Stella. Selim: Contact offices of representatives to request 15-minute meetings on May 1. Sign the organization onto CapitolTrack, with Jeff and Stella covering the monthly charge until Robyn Treasurer takes over. Organize Capitol visits to member offices with Johanna. Jeff K: Contact the CMA chief lobbyist to discuss closer cooperation on health bills on May 1. Contact Rebekah about resurrecting the youth tackle bill. Contact Ramos of Appropriations to discuss the $2M budget and also reach out to the Surgeon General. Find a speaker for an update on neuromuscular disease for the program meeting on Tuesday. Stella: Send a letter invitation to Ravindra Chandrashekh to speak on May 1 about MOC and its negative impact on patient care. Work with Johanna on the May 1 agenda, tentatively including: 8:00 -8:15 AM: "Making the Sausage" with Garrett Jansen 8:15 to 8:30 AM: "Working Together" with a CMA lobbyist 8:30 -9:00 AM: presentations about each BIll Concussion Epilepsy Prior auth and UR 10:00 AM: Questions part of the team visits offices, anyone else can stay for AAN and General neurologist MOC 11:30 AM: Lunch break 1:00 pm - 2:30 PM: Capitol tour 3:00 PM: Break 3:30 PM - 6:30 PM: CNS Reception Request an AAN speaker to discuss the need for general neurologist training emphasis while at Neurology on the Hill. Johanna: Add the need for general neurologist training emphasis to the survey. Add other items to the survey. Prepare meeting minutes with Dorian.

ABMS Maintenance of Certification (MOC) is a proprietary continuing education product that to date has no high-quality evidence that it improves patient care. The cost and burden associated with MOC remains a significant factor driving physicians out of medicine. Key Takeaways • ABMS's MOC program is criticized for lacking evidence of improving patient care and contributing to physician burnout and exit from practice. • MOC is effectively mandatory due to its integration into national credentialing systems, despite being labeled as voluntary. • Surveys show most physicians view MOC as unnecessary and financially motivated, with little clinical value beyond existing CME requirements. • The MOC program exacerbates physician shortages, impacting patient care access, especially in Healthcare Professional Shortage Areas. Editor's note: 2024 has been a year of innovation in primary care, from advancements in artificial intelligence to the growing role of value-based care. As we close out the calendar year, our "Best of 2024" series highlights Medical Economics' coverage of the past year's health care trends that have paved the way towards better patient care. The largest board certification organization in the United States, the American Board of Medical Specialties (ABMS), recently announced a record-breaking number of ABMS-certified physicians in the United States – 988,737 out of 989,323 physicians to be exact – easily cementing its monopoly status for its physician certification enterprise. Amidst their highly profitable business model is a significant, but little known, driver that is exacerbating burnout and hastening the exit of physicians from clinical practice. ABMS Maintenance of Certification (MOC) is a proprietary continuing education product that to date has no high-quality evidence that it improves patient care. The cost and burden associated with MOC remains a significant factor driving physicians out of medicine. READ THE FULL ARTICLE HERE

Legislative Committee Meeting Minutes Here is a summary of the meeting:  The UAPD, celebrating 52 years in business and present in six states, primarily consists of MDs, NPs, mid-levels, and some dentists. George Osborne, hired by Dr. Weinmann over 20 years ago, attended the meeting. Two UAPD-sponsored bills were signed by the governor, but SB636, despite multiple attempts over 20 years, remains vetoed. Private sector doctors can join UAPD for an annual fee of $477. The governor signed AB310, addressing data collection disparities between private and public sector services. LA County doctors, with about 1,200 members, considered a strike last year. UAPD successfully introduced AB2889 to remove punitive sanctions for unlawful strikes. The state is hiring private doctors over civil service ones, leading to a disparity in pay. Current bills include one from Assemblywoman Baines and another from Dr. Joaquin Arrambula, an ER doctor. Dr. Weber, a pediatrician from San Diego, is also involved. The supervision of NPs has been a long-standing issue, with full autonomy at the county level but not at the state level. The UAPD is concerned about scope creep and the increasing roles of mid-levels. Psychiatry needs more doctors, and there is a high turnover due to term limits. The Medical Board, now more political, is seen as disciplining doctors rather than supporting them. Dr. Klingman discussed the need for supervision of NPs. Johanna raised concerns about Medicare privatization and lack of oversight. Dr. Klingman suggested a union for private doctors. Specialists face billing challenges, and Blue Cross and Blue Shield are accused of defrauding Medicare. Hospitals are losing money and closing. The Workers Compensation doctors are exempt from duty of care. The UAPD is considering a lawsuit for discrimination and working with the California Chamber of Commerce. The idea is to involve Public Employees in Workers Compensation cases. Newsom, seen as healthcare-friendly, will be replaced in 2026. The UAPD's agenda includes engaging neurologists in the legislature and addressing issues like drug expenses and transportation for epilepsy patients. Prior authorization for neurology should involve independent neurologists, and there are concerns about the cost and effectiveness of prior authorizations. The UAPD is considering a referendum on concussions.

The September 19, 2024, LEDGE meeting focused on addressing challenges in physician board certification and advocating for increased choice among certification boards. The discussion, led by Paul Matthews, centered on empowering physicians to select from multiple recertification options, emphasizing the need for competition to improve the healthcare system.  Summary of LEDGE Meeting Minutes (September 19, 2024) The September 19, 2024, LEDGE meeting focused on addressing challenges in physician board certification and advocating for increased choice among certification boards. The discussion, led by Paul Matthews, centered on empowering physicians to select from multiple recertification options, emphasizing the need for competition to improve the healthcare system. 1. Main Topic: Physician Choice in Certification ◦ Discussion led by Paul Matthews emphasized advocating for physician options among certification boards (AOA, ABPN, NBPS). ◦ The goal is to address the lack of competition in the certification space, arguing that physicians deserve multiple recertification choices. ◦ Highlighted the existing precedent: AAN endorses multiple boards (e.g., UCNS and ABPN for Neurocritical Care). 2. Action Plan and Contributors: ◦ Letter Drafting: A key strategy is to draft a letter co-signed by state neurological societies, spearheaded by Dorian , Stella , and Johanna . ◦ The letter will articulate unified support for board certification options, targeting the AAN and CMA. ◦ Paul Matthews suggested leveraging media outlets like Practical Neurology and Neurology Reviews, with potential support from Allan Rapaport, to publicize efforts. 3. Next Steps: ◦ Initial focus on collaboration with the Massachusetts Neurology Society and California Neurology Society . ◦ October 2024 is a target to engage with the California Medical Association (CMA) to build broader support. ◦ Use CMA’s House of Delegates to push for rule changes, as most delegates are reportedly sympathetic. 4. Challenges: ◦ Steve Holtz pointed out that the CMA's historical focus on surgeons and generalists limits their attention to neurology issues. ◦ Holtz emphasized prioritizing state society endorsements to "build the armory" before approaching broader entities like the AAN. 5. Key Recommendations: ◦ Garner letters of support from additional state neurology societies to create national momentum. ◦ Engage with organizations like the United Council of Neurological Subspecialties (UCNS) , already endorsed by AAN, as potential allies. ◦ Address independent boards such as the American Board of Clinical Neurophysiology and Neurodiagnostic Medicine as part of broader coalition-building efforts. 6. Conclusion: ◦ The consensus is that a coordinated, state-led initiative is crucial for influencing national organizations like the AAN. ◦ Paul Matthews stressed the importance of making the letter widely known to generate visibility and pressure that cannot be ignored.