The  Accelerating Kids Access to Care Act (H.R. 1509, S. 752) requires states to establish a process through which qualifying out-of-state providers may temporarily treat children under Medicaid and the Children’s Health Insurance Program (CHIP) without undergoing additional screening requirements.

Specifically, states must establish a process through which qualifying out-of-state providers may enroll for five years as participating providers to treat individuals under the age of 21 without undergoing additional screening requirements.

A qualifying out-of-state provider (1) must not have been excluded or terminated from participating in a federal health care program or state Medicaid program; and (2) must have been successfully enrolled in Medicare or a state Medicaid program based on a determination that the provider posed a limited risk of fraud, waste, or abuse.

• The  Accelerating Kids Access to Care Act (H.R. 1509, S. 752)

  Specifically, states must establish a process through which qualifying out-of-state providers may enroll for five years as participating providers to treat individuals under the age of 21 without undergoing additional screening requirements.

  A qualifying out-of-state provider (1) must not have been excluded or terminated from participating in a federal health care program or state Medicaid program; and (2) must have been successfully enrolled in Medicare or a state Medicaid program based on a determination that the provider posed a limited risk of fraud, waste, or abuse.

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The bipartisan Help Ensure Lower Patient (HELP) Copays Act (S.864, 119th Congress) eliminates barriers to treatment for patients ensuring that they can afford the necessary and life-saving medications prescribed by their doctors.

The legislation requires health plans to count the value of copay assistance toward patient cost-sharing requirements. This would bring much-needed relief to vulnerable patients by ensuring that all payments— whether they come directly out of a patient’s pocket or with the help of copay assistance—counts towards their out-of-pocket costs.

Specifically, plans must apply third-party payments, financial assistance, discounts, product vouchers, and other reductions in out-of-pocket expenses toward the requirements.

The Improving Seniors’ Timely Access to Care Act (H.R. 3514, S.1816) is bipartisan legislation designed to streamline and modernize the prior authorization process within Medicare Advantage plans.

Key provisions include establishing an electronic prior authorization standard to streamline approvals, reduce the amount of time a health plan is allowed to consider a prior authorization request, require MA plans to report on their use of prior authorization and the rate of approvals and denials, and encourage MA plans to adopt policies that adhere to evidence-based guidelines.

Accessia Health is joining the broader patient advocacy community in calling on Congress to pass the Safe Step Act (H.R. 5509). This popular bipartisan legislation seeks to protect patients from dangerous and disruptive step therapy and fail first protocols but needs to be passed into law before the end of 2024.

Step therapy, sometimes referred to as ‘fail first’ or ‘step protocol,’ has severe consequences for patients who need care. Step therapy is a prior authorization practice where insurers require approval before covering a treatment or medication and where insurers implement tiered treatment pathways for medical conditions. Ideally, step therapy is designed to help curb unnecessary medical use and serves as a cost-management strategy.

The Safe Step Act aims to reform step therapy protocols in health plans. Although step therapy protocols aim to reduce barriers to care according to some providers, they also can create administrative burdens to medical practitioners and patients in maintaining continuity of care. The Safe Step Act would not ban step therapy; however, it would require group health plans to provide exceptions for any medication step therapy protocols. The exceptions included in the legislation include when: 

• An otherwise required treatment has been ineffective; 
• Such treatment is expected to be ineffective and delaying effective treatment would lead to irreversible consequences; 
• Such treatment will cause or is likely to cause an adverse reaction to the individual; 
• Such treatment is expected to prevent the individual from performing daily activities or occupational responsibilities; 
• The individual is stable based on the prescription drugs already selected; and 
• There are other circumstances as determined by the Employee Benefits Security Administration.