Advocacy Successes
Physician Advocacy Successes
Good health policy is made with physicians in the discussion.
MSDC, working with its members, partners, and other organizations, has won major policy victories to help its members practice medicine. Below is a sampling of those victories. Do you want to be a vital part of the next policy victory helping improve the health of the District? Contact us today.
Opioid Policy
- MSDC was added to the opioid fund oversight panel by the Council in its legislation authorizing the oversight body
Scope of Practice
- MSDC supported legislation to ban the sale of flavored electronic smoking devices and restrict the sale of electronic smoking devices.
- Working with a coalition, MSDC added funding to the DC budget to support the hiring of more license specialists to help with the delay in processing medical licenses.
Women's Health
- B24-143, to regulate certified midwives, passed the Council with MSDC's support
Health Equity
- Mayor Muriel Bowser signs into law the Electronic Medical Order for Scope of Treatment Registry Amendment Act of 2019. The eMOST Registry Amendment Act permits the creation of an electronic database of advanced directive wishes for District residents that can be tied into the health information exchange.
- Mayor Bowser signs into law the School Sunscreen Safety Temporary Amendment Act of 2019. The bill permits students to bring and apply sunscreen during the 2019-2020 school year.
- MSDC comments on the importance of funding United Medical Center (UMC) and health facilities in Wards 7 and 8 in the mayor's budget. Those comments are used almost verbatim in CM Trayon White's comments advocating for funding of United Medical Center.
Scope of Practice
- DC Health publishes draft regulations removing the 3 mandatory CME hours for HIV/AIDS awareness and replaces them with a requirement to fulfill 10% of mandatory CME hours with a topic from a public health priority list. DC Health then waived the requirement for 2020.
- The Strengthening Reproductive Health Protections Act of 2020 is signed into law with MSDC support. The bill prohibits government interference in reproductive decisions between a patient and doctor, and prohibits employers from penalizing physicians for practicing reproductive medicine outside of their work hours.
- The Mayor's Commission on Healthcare Systems Transformation releases its final recommendations. One recommendation is for the District to explore options to make providing health care more affordable, including financial relief for higher malpractice insurance rates.
- The Council removes "telephone" from the list of prohibited types of telemedicine to allow physicians and other providers to be reimbursed for telephone telemedicine appointments after MSDC and health community advocacy.
- MSDC worked with the Council to modify onerous language in the Health Care Reporting Amendment Act that potentially would have penalized physicians from seeking help for substance abuse or addiction issues.
Opioid/Drug Policy
- The Department of Health Care Finance (DHCF) waives prior authorization for key medication assisted treatments (MAT) treating substance use disorder patients in Medicaid.
- The Mayor signed into law The Access to Biosimilars Amendment Act of 2019, a top MSDC priority as it would help prescribers to prescribe more cost-effective drugs for patients.
Behavioral Health
- The Behavioral Health Parity Act of 2017, a major priority for MSDC and DCPA, officially becomes law. The legislation requires all health benefit plans offered by an insurance carrier to meet the federal requirements of the Wellstone/Domenici Mental Health Parity and Addiction Equity Act of 2008.
Health Equity
- The District Council passes B22-1001, The Health Insurance Marketplace Improvement Amendment Act of 2018. The bill prohibits the sale of Short Term, Limited Duration health plans and Association Health Plans (AHPs) in the DC Health Benefits Exchange.
Scope of Practice
- DC joins 28 other states in the Interstate Medical Licensure Compact with B22-177 becoming law. The IMLC is designed to ease physician licensure in multiple states.
Women's Health
- The Maternal Mortality Review Committee is established by law. The Committee is responsible for finding solutions to maternal health crisis in the District. District physicians are an important part of this vital committee.
- B22-106, The Defending Access to Women's Health Care Services Amendment Act, becomes law. The act requires insurers to cover health care services like breast cancer screening and STI screenings without cost-sharing.
Opioid Policy
- Right before the Council adjourned for the session, it passed B21-32, the Specialty Drug Copayment Limitation Act. The bill limits cost shifting by payers for prescription drugs.
Behavioral Health
- B21-0007 passes the Council. The Behavioral Health Coordination of Care Amendment Act of 2016 permitted the disclosing of mental health information between a mental health facility and the health professional caring for the patient.
Women's Health
- MSDC was proud to have worked on B21-20. The law requires payers to cover up to 12 months of prescription contraception, advancing women's health and equality.
MSDC Joins Health Associations Asking for Centralize Medicaid Credentialing
On November 19, the Medical Society of DC joined the DC Primary Care Association and other local health associations on a memo arguing for centralized credentialing.
The memo addresses the leadership of the Department of Health Care Finance regarding credentialing of Medicaid providers. Currently in the District a physician or healthcare provider needs to be credentialed by five different entities to ensure they are reimbursed for seeing Medicaid patients. This process leads to delays and gaps in care, leading providers at times to be unable to see certain Medicaid patients and cause offices to do more paperwork.
The memo (see below) asks DHCF to centralize credentialing and points to other states successfully doing just this. In addition the memo asks DHCF to implement credentialing requirements consistent with Maryland that has shown to speed up credentialing.
As local budget challenges continue and federal funding of Medicaid at current levels is unlikely in the future, it is critical that DHCF adopt now improvements to streamline the delivery of care.
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To: Lisa Truitt, Director, Health Care Delivery and Management Association, Department of Health Care Finance
From: Patricia Quinn, VP of Policy and Partnerships, DC Primary Care Association
Justin Palmer, VP, Public Policy & External Affairs, DC Hospital Association
Mark LeVota, Executive Director, District of Columbia Behavioral Health Association
Robert Hay Jr., Executive Vice President, Medical Society of DC
Veronica Sharpe, President, District of Columbia Health Care Association
Kurt Gallagher, Executive Director, DC Dental Society
Ian Paregol, Executive Director, DC Coalition of Disability Service Providers
Re: Recommendation for Centralized Medicaid Provider Credentialing
Date: November 19, 2024
CC: Melisa Byrd, Senior Deputy Director, Medicaid Director, Department of Health Care Finance
Ruth Pollard, President and CEO, DC Primary Care Association
The DC Primary Care Association, our member health centers, and our partners in the health care delivery system including the DC Hospital Association, the DC Behavioral Health Association, the Medical Society of DC, the DC Health Care Association, the DC Dental Society, and the DC Coalition of Disability Service Providers are grateful for the support of the Department of Health Care Finance (DHCF) as we work to solve issues impacting patient access and provider sustainability. As initially described in our February 2023 memo, the process to credential providers for participation in Medicaid managed care networks is burdensome, lengthy, and often opaque. Credentialing delays significantly impact our ability to address current well-documented workforce shortages, and we urge DHCF to take regulatory steps to improve the timeliness and clarity of credentialing process.
In the District, providers must submit documents to no fewer than five separate entities in order to be credentialed by all Medicaid payers. To ease provider burden, DHCF should centralize credentialing, requiring a single standardized process at the District level instead of an individual process with each MCO. Some state examples include:
1. In Ohio, a Managed Care Procurement division of Medicaid runs the Centralized Credentialing program, contracting with Maximus, Inc to serve as a single point of contact (Centralized Verification Organization or CVO) and to develop agreements for delegated credentialing arrangements with health system
2. In North Carolina, a 2018 Centralized Credentialing “concept paper” led to the development of centralized provider enrollment via the NCTracks system. North Carolina reports processing turn-around statistics on their NCTracks website.
3. In Mississippi, providers are credentialed by the Medicaid agency, pursuant to language updated in their 2022 managed care contracts and following 2021 legislation requiring a uniform process.
DCPCA and our partners at DCHA, DCBHA, MSDC, DCHCA, DC Dental, and DC Coalition also recommend that DHCF implement specific credentialing requirements consistent with Maryland’s insurance statute 15-112 that would significantly improve the credentialing process for providers including:
- Requiring notice to providers within 10 days of submission of incomplete applications and steps to remediation
- Requiring notice within 30 days of submission presumptive intent to credential, allowing provisional billing to begin
- Mandating transferal of credentialing status when providers change employer
DHCF has an opportunity to act expeditiously in support of providers facing well-documented post-pandemic workforce and fiscal pressures. We look forward to working in partnership to implement needed changes to the District’s credentialing processes before the close of 2024
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