On March 12, 2024, the AOA participated in a roundtable convened by the Biden Administration to discuss the steps the Department of Health and Human Services (HHS), Biden-Harris Administration, and healthcare stakeholders are taking in response to the cyberattack on Change Healthcare. Meeting participants included leadership from the White House and HHS, as well as chief executives from major health plans, select physician societies, and associations representing hospitals, pharmacies, and other providers. During the meeting, AOA Chief Executive Officer Kathleen Creason emphasized the challenges osteopathic physicians across the country are experiencing as they try to maintain their practices and provide care to their patients.
The AOA asked the Biden administration to require plans to:
1. Waive utilization management (UM) measures to prevent disruptions to patient care;
2. Prohibit plans from retroactively denying claims based on eligibility or lack of UM approval; and
3. Require that plans extend claims submission deadlines to ensure payment for services rendered during the disruption.
Change Healthcare provides clearinghouse services to support a broad range of electronic transactions in healthcare. As noted by an HHS letter to stakeholders, “Change Healthcare, owned by UnitedHealth Group (UHG), processes 15 billion health care transactions annually and is involved in one in every three patient records.” The disruption has significant implications across the health care ecosystem for activities including e-prescribing, provider claims submission and processing, pharmacy claims transactions, and payment. While solutions have been developed to largely restore some activities, such as e-prescribing and pharmacy claims, claims and payment transactions for physicians and other providers continue to be significantly disrupted.
Many physician practices continue to go without or with very limited revenue, and the outage will have disproportionate impacts on small and independent practices, as well as those in rural and underserved communities, who are already grappling with limited resources, thin margins, and payment challenges.
HHS has taken several steps to support physicians and other providers during the Change Healthcare disruption, including making advanced payments available to Medicare Part A and B providers via the Change Healthcare/Optum Payment Disruption (CHOPD) accelerated payments program; issuing guidance to Medicare Advantage, Medicare Part D, Medicaid, and CHIP plans urging them to grant flexibilities to providers for utilization management and claims submission; and coordinating with other federal agencies to take additional appropriate responses. However, more must be done to ensure the survival of physician practices who are entering a fourth week of limited revenue.
During the roundtable, HHS made clear that all health plans accepting federal funds, including MA, Part D, Medicaid managed care, and CHIP plans, should be providing flexibility and advanced payments to providers. The AOA will continue to advocate with the Biden Administration and health plans, and share resources with members.
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