September 2016 - NASPGHAN has been working with Congress over the past few years to address the troubling insurance coverage gaps for medically necessary foods across the U.S. health system. The latest efforts focused on TRICARE, the health care program of the U.S. Department of Defense (DoD) Military Health System, have begun to bear fruit.
The Senate and the House passed their respective versions of the 2017 National Defense Authorization Act (NDAA) this Spring. Both of these bills — to varying extents — address access to medically necessary foods for TRICARE beneficiaries. A conference committee of select members of both the House and Senate Armed Services Committees was named in July to resolve differences between the two bills.
NASPGHAN is leading an informal coalition of physician groups, patient advocates, and children’s hospitals asking lawmakers to include the Senate bill’s legislative language requiring TRICARE to cover medically necessary foods for digestive and inherited metabolic disorders. This language covers a specific group of diseases of the digestive system that affect pediatric populations, including inflammatory bowel disease (IBD), Crohn’s disease, ulcerative colitis, short bowel syndrome, inherited metabolic disorders, and eosinophilic disorders.
Comparatively, the House version of the NDAA bill asks the DoD to investigate the adequacy of the current coverage policy for medically necessary foods.
Differences between the Senate and House versions of the NDAA are unlikely to be resolved in September, which means that negotiations will linger through the November elections until a lame duck session of Congress.
NASPGHAN members are encouraged to keep up the grassroots pressure heading into November.
September 2016 - NASPGHAN has endorsed the Crohn’s and Colitis Foundation of America’s (CCFA) position statement on biosimilars. The endorsement comes on the heels of the Food and Drug Administration’s approval of a second biosimilar, Celltrion’s Inflectra, for the treatment of adult patients and pediatric patients (ages six years and older) with moderately to severely active Crohn’s disease who have had an inadequate response to conventional therapy; and adult patients with moderately to severely active ulcerative colitis who have had an inadequate response to conventional therapy.
Praveen Goday, MD, Chair of NASPGHAN’s Nutrition Committee, and Ann Scheimann, MD, MBA, were invited to the White House on Wednesday, October 28, 2015 to attend a meeting on primary prevention and child health. The meeting was convened to “bring together medical providers, insurers and health professionals who have made progress towards providing more comprehensive primary prevention approaches, addressing childhood obesity and improving child health.” This meeting was associated with First Lady Michelle Obama’s Let’s Move! campaign and development of the White House Task Force on Childhood Obesity Report that will be released in May 2016.
White House staff was very interested to hear about physician use of the 5-2-1-0 pediatric patient and family education program and its variants, highlighted in the meeting by Dr. Goday. Dr. Goday also mentioned the worrisome trends in pediatric liver disease and the importance of early diagnosis and treatment. Dr. Scheimann stressed that support for telemedicine and the increased coverage of psychology and registered dietitian services was critical. Dr. Scheimann also highlighted GIKids.org as a great resource that provides easy-to-understand information about the treatment and management of pediatric digestive conditions for children and parents. While the Let’s Move campaign has focused largely on obesity prevention, NASPGHAN is hopeful that the First Lady’s campaign will also address barriers to treatment of obesity and associated medical conditions.
White House staff said they found the meeting very beneficial and will help to inform the May 2016 Report and as they work to build lasting momentum for the First Lady’s Let’s Move campaign. Staff promised to most immediately focus efforts to capitalize on the President’s Promise Zones Initiative; to make resources available for successful obesity prevention pilot programs; and to push for increased coverage of telemedicine. White House staff also hopes insurers will recognize the importance of providing coverage for preventative services aimed at obesity. White House staff noted they would brief the First Lady on the meeting and would follow up with NASPGHAN and the other participants later this year.
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November 2015 - Across medicine and child populations, there is a severe shortage of pediatric subspecialists to treat children with conditions ranging from severe gastrointestinal problems and pediatric arthritis to seizure disorders, autism, mental illness and behavioral conditions. America’s child and adolescent population currently totals some 75 million individuals, with about four million children joining these ranks yearly. NASPGHAN has been working to convince federal lawmakers to pass the “Ensuring Children’s Access to Specialty Care Act of 2015” (H.R. 1859), a bill that would provide for the participation of pediatric subspecialists in the National Health Service Corps (NHSC) program. Importantly, H.R. 1859 would ensure that relevant pediatric subspecialty training sites and programs meet eligibility criteria.
Momentum for passage of H.R. 1859 has picked up in the House of Representatives as a bipartisan group of 32 members, many in the important committees of jurisdiction, have agreed to co-sponsor the legislation. And there is word that a Senate version of this bill will be introduced soon as stakeholder meetings in the upper chamber, including meetings attended by NASPGHAN members in October, on this issue have been effective. NASPGHAN will continue to work with a group of stakeholders, including the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Juvenile Rheumatoid Arthritis Foundation, to push for passage of this key legislation.
Contact your Representative today and ask him/her to cosponsor H.R. 1859.
In a January 2015 letter to the National Institutes of Health (NIH), NASPGHAN offered its support to proposed change in NIH policy that would allow one Institutional Review Boards (IRBs) of record for multi-site research. In its letter, NASPGHAN noted the single IRB requirement will be particularly beneficial for advancing research into rare pediatric diseases of the digestive system because inclusion of multiple centers is often required to amass the required number of study subjects for meaningful research. NASPGHAN also emphasized the importance that the single IRB of record have expertise in pediatric research when studies involve children.
In March 2015, NASPGHAN and the American Society for Gastrointestinal Endoscopy (ASGE) submitted joint comments to the National Institutes of Health (NIH) on proposed changes to ClinicalTrials.gov, a Web-based resource that provides health care professionals, researchers, and the public with access to information on publicly and privately supported clinical studies.
On April 14, 2015 Congress sent to President Obama a bill that will extend the Children’s Health Insurance Program (CHIP) for two additional years. Without congressional intervention, funding for the program would have run out on Sept. 30, 2015. The President has said he will sign the bill.
On December 17, 2014 NASPGHAN Research Committee Chair Neera Gupta, MD, MAS traveled to the National Institutes of Health (NIH) campus for a meeting with Griffin Rodgers, MD, MACP, Director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The meeting was part of a new collaborative effort by nearly 40 stakeholder organizations (Friends of NIDDK coalition) to become better advocates for NIDDK funding.
While Congress is prone to missing deadlines or averting financial crises at the eleventh-hour, a panel of expert witnesses in December told members of the U.S. House of Representative’s Energy and Commerce Subcommittee on Health that state governments are counting on Congress to act to make sure funding for the Children’s Health Improvement Program (CHIP) does not run out on Sept. 30, 2015.
On October 31, the Centers for Medicare and Medicaid Services (CMS) published the 2015 Medicare Physician Fee Schedule final rule, in which it finalized new payment rates for upper endoscopy services. In November 2014, CMS assigned interim final values to all upper gastroenterology endoscopy codes, which resulted in cuts averaging 11 percent, with cuts for endoscopy services much more severe. In the 2015 final rule, CMS finalized the values and increased the physician work values of some of the codes. While almost half of all codes received an increase in relative value units (RVUs), most increases were nominal at between 0.02 and 0.16 of an RVU higher than the 2014 interim RVU values. For example stent procedures saw nominal increases, but the work RVUs for highly complex procedures, including endoscopic ultrasound, and injection and banding of esophageal varices, were finalized with low valuations.