Priorities and Policies

This bipartisan bill would establish common sense guidelines for appealing step therapy protocols under ERISA health plans. DDNC urges legislators to pass the Safe Step Act in the 118th Congress. Step therapy is one of many “utilization management” or “cost-shifting” tactics employed by third parties to shift costs away from themselves and to the patient, which delays appropriate treatment, increases patient out-of-pocket costs, and drives a wedge between a patient and their health care provider’s decision-making.

The bipartisan HELP Copays Act requires health plans to count the value of copay assistance toward patient cost-sharing requirements.

Patients who are medically stable of a course of treatment should be allowed to continue unless there is a medical reason to change their treatment. We oppose the switching of stable patients from treatment courses for non-medically necessary reasons, as it is both unethical and violates the standard of care. All treatment decisions should remain between the patient and prescribing provider.

Advocate for the passage of legislation that caps out-of-pocket costs (co-payments, coinsurance limits, and prepayment requirements) on specialty drugs so that patients can have real access to affordable medications.

The bipartisan “TROA” allows coverage under Medicare’s prescription drug benefit of drugs used for the treatment of obesity or for weight loss management for individuals who are overweight while improving access to behavioral therapy.

COGI is a member of the Patients & Providers for Medical Nutrition Equity Coalition which is committed to seeing the Medical Nutrition Equity Act (HR 6892) passed by Congress so that all Americans will have access to medically necessary foods.

Many states require coverage of medical nutrition, but coverage is highly variable. The MNEA would require coverage of medically necessary nutrition under Medicaid, the Children’s Health Insurance Program, Medicare, the Federal Employee Health Benefit Program, and private insurance for defined gastrointestinal and metabolic disorders.

The bipartisan “MNTA” extends dietitian access and coverage to individuals with other diseases and conditions, including obesity, eating disorders, cancer, and HIV/AIDS; such services may also be referred by a physician assistant, nurse practitioner, clinical nurse specialist, or (for eating disorders) a clinical psychologist.

This bill provides for Medicare coverage and payment, subject to specified frequency limits, of certain colorectal cancer screening blood-based tests.

Colorectal cancer disproportionately impacts communities of color. Black individuals have the highest incidence and mortality and face lower survival than white individuals. American Indian/Alaskan Natives also have elevated rates and deaths compared to the general population and represent the only racial/ethnic group for whom colorectal cancer mortality rates are not declining. Racial and ethnic minorities are also more likely than white individuals to present with late-stage, incurable disease.

The Colorectal Cancer Caucus is a bipartisan group of Members of Congress dedicated to working collaboratively to increase access to screening, advance biomedical research to ensure more effective lines of treatment, and ultimately find a cure for colorectal cancer. The caucus will help to raise awareness about the challenges faced by the colorectal cancer community among policymakers and their staff as well as work to improve the lives of all patients, survivors, and their loved ones.

This bill removes the requirement that Medicare beneficiaries be seen in person within six months of being treated for mental health services through telehealth. In 2020, Congress permanently expanded access for Medicare patients to be treated in their home and other sites for mental health services. Unfortunately, it also included an arbitrary requirement that would require the patient to be seen in person before they could receive telemental services. The Telemental Health Care Access Act eliminates this in-person requirement so that patients can directly access mental health services via telehealth.

This bill is consistent with how substance use disorder (SUD) telehealth services are covered under Medicare – passed as part of the SUPPORT for Patients and Communities Act in 2018, which eliminated certain requirements for SUD services so patients can access treatment from their home through telehealth.

This bill repeals restrictions that generally prohibit federal payment under Medicaid for services provided in institutions for mental diseases (IMDs) for individuals under the age of 65. (Currently, states may receive payment for such services through certain mechanisms, such as through a Medicaid demonstration waiver.) The bill also requires state Medicaid programs that cover IMD services to improve patient access to outpatient and community-based behavioral health care, expand crisis stabilization services, facilitate care coordination between providers and first responders, and report specified information relating to IMD utilization and costs.

This bill authorizes state and local educational agencies to use Student Support and Academic Enrichment grants to improve mental health services available to students. Specifically, it allows funds to be used for identifying and disseminating best practices for mental health first aid, emergency planning, coordination of services, and telehealth services.