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©2021 MGMA. All rights reserved.
Building Effective State Advocacy
Programs
Claire Ernst, JD
Director
Matt Devino, MPH
Associate Director
MGMA GOVERNMENT AFFAIRS
WASHINGTON, DC
©2021 MGMA. All rights reserved. - 2 -
1. Discuss how to successfully engage state MGMA
members and other stakeholder groups in
advocacy at the state level
2. Identify state advocacy challenges, lessons
learned, and best practices
3. Describe the elements needed to build successful
advocacy programs
Learning Objectives
©2021 MGMA. All rights reserved. - 3 -
1. Welcome
2. How Washington Works
3. Advocacy 101
4. Best Practices
5. Open Discussion & Questions
Agenda
©2021 MGMA. All rights reserved. - 4 -
Welcome to MGMA Advocacy!
Meet the Team
Kelsey Haag, MPH
Associate Director
Anders Gilberg, MA
Senior Vice
President
Claire Ernst, JD
Director Matt Devino, MPH
Associate Director Emily Dowsett
Associate Director,
Public Affairs
Together with State Legislative Liaisons, MGMA advocates on issues affecting
medical groups at the state and national levels.
©2021 MGMA. All rights reserved. - 5 -
Add the MPE: Leaders Conference mobile app to
your device and ask your questions in the chat
Visit mgma.com/mobileapp for more details or
scan the QR code
Ask Your Questions
©2021 MGMA. All rights reserved. - 7 -
Separation of Powers in the Federal Government
The Three Branches
1. Congress (legislative):
• The House and Senate introduce, debate, amend and vote on legislation
• Legislation that passes both chambers with a majority vote go to the executive for
consideration
2. President and the Departments/Agencies (executive):
• Approves or vetoes legislation from Congress
• Creates regulatory rules when necessary
3. Supreme Court (judicial):
• “Checks” the actions of Congress and the Executive when necessary
©2021 MGMA. All rights reserved.
In Congress, What are the Odds?
Is there an upcoming deadline?
Is there a catalytic event?
Did Congress recently
pass a bill in that policy area?
Who controls the
White House?
Is there an election
coming up?
What is the perceived impact of
the legislation?
What will stakeholder
s have to say?
Is the media
pushing it in some
way?
Is it bipartisan?
©2021 MGMA. All rights reserved.
“Washington Speak”: Decoded
Short-term legislation that continues current funding when the gov. fails to agree on budget.
Continuing resolution
Bills that include diverse, unrelated topics.Omnibus package
Special rules allowing budget-related bills to pass with a simple majority.
Reconciliation
“Must-pass” legislation onto which less popular provisions are added.
Legislative vehicle
Series of amendments votes often used as political tactic to slow down passage of a budget bill.
Vote-a-rama
Differences between House-passed and Senate-passed version of the same legislation are worked out.
Conference
©2021 MGMA. All rights reserved.
Congressional Committees
• Congressional committees provide the most intensive consideration of a
proposed measure as well as the forum where the public is given their
opportunity to be heard.
• Each committee’s jurisdiction is divided into certain subject matters and
all measures affecting that area of law are referred to the committee with
jurisdiction.
• Committees with jurisdiction over healthcare issues, including Medicare:
• House Ways & Means Committee
• House Energy & Commerce Committee
• Senate Finance Committee
• Senate HELP Committee
• Membership on the various committees is divided between the two major
political parties.
• Appointments are determined by each party by expertise and seniority.
©2021 MGMA. All rights reserved.
How Rulemaking Works
Regulations come from the 15 federal executive department and agencies, and sub-agencies, including the Department of Health and Human Services (HHS).
Within HHS:
©2021 MGMA. All rights reserved.
Why Is Rulemaking Important?
The law is only the framework
Federal agencies have substantial discretion.
Regulations have the force of law.
Often overlooked by media.
Many reasons why an agency will make a rule:
o Congressional mandate,
o Agency identifies a problem,
o Petition for rulemaking from regulated groups, or from advisory committees or oversight groups within government.
©2021 MGMA. All rights reserved.
How Rulemaking is Supposed to Work
Resource: federal government guide to the rulemaking process
A simplified example of the rulemaking process:
Law is passed
requiring rulemaking
Department issues a
proposed rule
Public Comment
Period
Department reviews
comments, makes
modifications
Department issues final
rule
©2021 MGMA. All rights reserved.
Why Does it Work this Way?
Defining the problem is a challenge
Bound by statuteTimeframes often dictated
by congress
Limited budgets, staff, and technology
Agencies are impacted by
• Organizational structure
• Division of labor
• Culture
• Motives and expertise of individual agency staff
Power grab of another agency
©2021 MGMA. All rights reserved. - 21 -
Advocacy 101: Effectively Lobbying Your Lawmakers
Additional resources are available on the MGMA website:
Write Your Legislator ● State Legislative Liaison Resources
Legislative and regulatory advocacy are efforts to influence the introduction, enactment or
modification of legislation and proposed rulemaking.
©2021 MGMA. All rights reserved. - 22 -
How Can I Influence Decisions?
Successful advocacy is all about relationships and respect
Develop clear “asks”
• Administration
• Congress
• State officials
Know the correct contacts for the issues you’re trying to influence
Recognize the tools at your disposal
Leverage the power of coalitions
©2021 MGMA. All rights reserved. - 23 -
What is an “Ask”?
• Simple/unified message of what lawmakers should do to address issue.
• For example - MGMA’s ask for fair Medicare reimbursement is:
• “Pass legislation that would provide updates to the Medicare physician
payment system that cover the cost of delivering medical services to Medicare
beneficiaries.”
• Put a face to the issue
• Use real world stories to show how the issue affects your practice.
• Give a narrative and use numbers/data to back the narrative up.
©2021 MGMA. All rights reserved. - 24 -
Knowing the Correct Audience: Federal vs. State Issues
MIPS
Alternative Payment Models
Accountable Care
Organizations
Medicare Physician Fee
Schedule
Audits and Appeals –
Recovery Audit Contractors
(RACs)
Medicare Administrative
Contractors (MACs)
Physician Self-referral (Stark)
Rules
HIPAA Privacy Rules and
Procedures
Healthcare Transactions and
Administrative Simplification
ONC Health IT
ICD-10
Physician Open Payments
Veterans Choice Program
Insurance Commissioners
and Commercial Insurance
Regulations
Medicaid and CHIP
Clinician and Facility
Licensing
Prescription Drug Monitoring
Programs
Telehealth Licensure
Requirements
Federal State
©2021 MGMA. All rights reserved. - 25 -
Be Involved: Contacting Congress
Who do I contact?
- For major legislative issues, contact the Washington, DC, office of your federal representatives.
- Each office usually has a health legislative aide (health LA) who focuses on health-related issues.
These staff are likely the target of your advocacy outreach.
- Please feel free to contact the MGMA Government Affairs Department for this information.
- Address all correspondence to the Member of Congress.
How do I contact them?
- Visit mgma.com to find contact information
- MGMA routinely posts grassroots updates with sample letters and updates sent via the
Washington Connection
- Send letters, make phone calls, schedule in-person meetings
©2021 MGMA. All rights reserved.
MGMA.com/CONTACTCONGRESS
- 26 -
Contact Congress
©2021 MGMA. All rights reserved. - 27 -
Be Involved: Influencing the Administration
Submit your own comments at regulations.gov
- Keep letters focused on the proposed rule
- Give feedback on areas that are under an agency’s discretion, not details dictated by statute
- Explain the real-world repercussions of proposals
Provide feedback to MGMA
©2021 MGMA. All rights reserved. - 28 -
How does your state approach advocacy?
• Partnerships and coalitions
• Grassroots
• Stakeholder involvement
• Issue tracking and membership education
• Communication with state legislatures
• Advocacy events (i.e., “Capitol Day” or site visits)
• Other?
©2021 MGMA. All rights reserved. - 30 -
Best Practices
✔ Track state health legislation and regulations that could impact state MGMA members, and keep
state members apprised of these items.
- How?
• via participation in state medical society/association calls and updates;
• signing up for listservs;
• using a state legislation tracking software system
✔ Emphasize the importance of legislative issues within your state MGMA board and provide
updates on legislative and regulatory matters at state board meetings.
- How?
• have a monthly legislative update incorporated into board meetings;
• have a monthly call to share key legislative and regulatory updates;
• create a legislative committee at the state level
©2021 MGMA. All rights reserved. - 31 -
Best Practices
✔ Keep members informed and engaged with advocacy efforts.
- How?
• Forward the Washington Connection
• Provide information on programs/events that can involve/educate members on a particular issue
• Engage in letter writing campaigns, meetings with legislators
✔ Foster communication among state members who are implementing state and federal
requirements in their practices. Facilitate discussions and strategies for how to best approach
challenges.
✔ Create a strategic advocacy plan for your state MGMA.
- If you’ve never done this, reach out to your peers for examples
©2021 MGMA. All rights reserved. - 32 -
Best Practices
✔ Reach out to key state legislators focused on healthcare policy.
- How?
• Schedule a meeting with the lawmaker at their office
• Schedule a site visit
• Write letters
✔Attend developmental conferences.
- Including MGMA national, state medical society events
✔ Leverage your relationship with national MGMA.
- We are here to answer your questions on issues in Medicare, HHS, and other agencies.
-
©2021 MGMA. All rights reserved.
Calls and Meetings with CMS/HHS staff
Discussions
with Congress
Advocacy
statements
and letters
Washington Connection newsletter
Member-benefit
resources
Dedicated
Member
Communities
Washington Update
presentations
Access to GA
experts
Collaboration
with state
MGMAs
Government Affairs
Council (GAC)
Coalition and
consensus
building with
industry partners
Grassroots
advocacy
MGMA Government AffairsADVOCACY “FEEDBACK LOOP”
MGMA Healthcare
Guiding Principles
MGMA Membership Federal
Advocacy
- 33 -
©2021 MGMA. All rights reserved. - 34 -
Remember: Advocacy Matters!
• Lawmakers make decisions that affect you, your patients,
and your practice.
• Voicing your concerns to government is one of the most
important steps to influencing the decisions that affect
your practice.
• Advocacy works!
If you’re not at
the table, you’re
on the menu
©2021 MGMA. All rights reserved.
Thank You!
@ClaireErnstJD
Claire Ernst, JD
Director
MGMA GOVERNMENT AFFAIRS
WASHINGTON, DC
[email protected] | 202.293.3450
Matt Devino, MPH
Associate Director
MGMA GOVERNMENT AFFAIRS
WASHINGTON, DC
[email protected] | 202.293.3450
@matt_devino