West Coast Council of Advanced Nursing Practice
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Call to Action

Posted 5 days ago by Andrew Lombardi

1. Medical Care Advisory Committee Meeting

  • This is a request for a new 5-year Section 115 Medicaid Demonstration to implement key provisions of the Live Healthy Act which was passed on March 22, 2024 (SB 7016)
  • Public Document for review: https://ahca.myflorida.com/content/download/25534/file/FL%20Workforce%201115%20Demonstration%20Final%2012.9.24.pdf
  • Key Notes:
    • TEACH Funding Program provides funds to federally qualified health centers, rural health clinics, and community mental health centers or certified community behavioral health clinics to offset the costs of training residents and students to become licensed health care practitioners (up to $75,000 or $100,000 per fiscal year).
    • FRAME Program provides educational loan repayment for APRNs & Autonomous APRNs contingent on 25 hours annually of volunteer primary care services in a free clinic or through another volunteer program operated by the state (up to $75,000 or $90,000 - 25% awarded annually over 4-years).
    • FIRST program makes payments to eligible public teaching hospitals for higher patient care expenses and increased complexity of cases resulting from nursing education.
  • Deadline to comment is 1/25/2025
 
2. The Treat and Reduce Obesity Act (TROA)
  • Review the proposed rule here - https://www.federalregister.gov/public-inspection/2024-27939/medicare-and-medicaid-programs-contract-year-2026-policy-and-technical-changes-to-the-medicare
  • Focus on Section 1.B.4, Part D Coverage of Anti-Obesity Medications and Application to the Medicaid Program
  • Key Notes:
    • The rule does not define obesity by BMI
    • Part D plans can establish criteria for prior authorization. However, these criteria cannot be more restrictive than the prescribing indication criteria.
    • The rule acknowledges obesity as a chronic disease, emphasizing that patients will require ongoing therapy for effective treatment and therefore patients will need continuous coverage for proper treatment.
    • If finalized, the CMS proposed rule:
      • Offers broader coverage of OMs than any amended form of TROA that was being considered by Congress in 2024
      • Provides Medicare coverage of OMs for obesity but not overweight 
      • Also requires similar Medicaid coverage for OMs for obesity
  • Deadline to comment is 1/27/2025 at 5pm EST 
    • Using the link above, there is a green box to the right, "Submit A Public Comment"
    • Include file code CMS-4208-P at the beginning of your comment
    • While lengthy comment letters are not necessary, quality comments are important. Letter content should focus on expressing support for the proposed rule, the need for OM coverage, and possibly additional details - such as why it is important for obesity to be treated like other chronic conditions, why the proposed rule matters to you/your organization or brief personal experiences 
    • Comments will be visible to others, so be mindful of sharing personal information within the comment.