The CMS Board of Directors met on Friday, May 16, to take action on maintenance of licensure, proposed clarification of the ACA's 90-day grace period provision, a potential strategic partnership to help with the transition to value-based care, opioid prescribing and dispensing, workers' compensation, the gainful employment requirement, the review of the CMS policy manual, scope of practice, and the strategic plan refresh, among other business. See more on these items below.

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Brent Keeler, MD, chair of the CMS Committee on Maintenance of Licensure, addressed the board. The House of Delegates created the MOL committee in 2011 and charged its members to develop a Colorado-specific MOL framework.

The committee recommends that licensees who are current with meeting MOC requirements of the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA) should be considered to have satisfied CME requirements. All other physicians with an active license under this proposal will be required to fulfill 50 credits/hours of accredited or certified category 1 CME that is relevant to his or her practice during each two-year renewal cycle. The board approved these specifications and will send the proposal to the House of Delegates for consideration at the annual meeting in September.

CMS Immediate Past President Jan Kief, MD, presented information on a rule proposed by the Colorado Department of Insurance to clarify the reporting stipulation in the 90-day grace period that was not addressed in the federal Affordable Care Act. Patients who receive federal subsidies to purchase health insurance plans through the state health insurance exchange have a 90-day grace period for non-payment of premiums. During the first 30 days the health insurer must pay for claims as if the patient were eligible, but in the last 60 days they can suspend claims. If the patient's coverage is cancelled after 90 days because of non-payment of premiums, the insurer may deny all suspended claims for services furnished during the 31-90 day time period. That could leave physicians on the hook for collecting payment for services and imperil access to care.

The ACA requires that the carrier notify the enrollee's physician and other health care providers when a patient enters into the second and third month of the grace period, but the notification requirement is vague and does not indicate when such notification must be made. Kief testified before the DOI on May 1 that the proposed regulation should include language that will ensure providers receive eligibility information from health insurers in a timely manner, and in a manner detailed enough so that providers can anticipate any potential problems. Click here to read more about her testimony.

The board approved the action.

The board agreed to move forward with exploring a collaborative relationship with a company that offers practice tools, resources and solutions to enable CMS members to succeed in accountable care and other payment initiatives. Such a relationship could also involve an ACO or other network arrangement with CMS. The issue has been referred to the CMS Committee on Physician Practice Evolution.

One company that will evaluated early in the process is Health-in-Evolution, Inc. (HIE). HIE is a health care analytics, care management and management services organization specializing in virtual integration. HIE brings the systems and tools developed by its parent companies to physician practices of all sizes to assist them in the transition to value-based medicine. Other companies will also be evaluated.

The board heard a presentation by Lynn Parry, MD, on opioid prescribing and dispensing. The four provider licensing boards - regulating dentists, physicians, nurses and pharmacists - proposed a joint policy on this issue and requested comments from stakeholders. With previous approval by the executive committee, CMS provided comments and revisions that were well received by the four boards.

CMS strongly recommended that the policy not be interpreted or published as a "rule." A "policy" is guidance and a rule has the force and effect of law. CMS supports a policy that is helpful to prescribers and dispensers without establishing a legal or disciplinary grounds for action followed by increased prescriber education. CMS also expressed concern that the proposed policy does not differentiate between chronic, non-malignant pain; cancer-related pain or palliative/hospice care; or short-term acute care situations. CMS recommended that the policy be limited to chronic non-malignant pain or clearly delineate between guidelines for the three types of pain. Click here to read CMS' comments. Click here to read the full draft policy.

Board members approved this action.

Lynn Parry, MD, presented information on partnering on a workers' compensation event, proposed by the CMS Workers' Compensation and Personal Injury Committee (WCPIC). The board approved the recommendation for CMS to partner with Pinnacol Assurance to plan and conduct the "Day of Innovation," a professionally designed and facilitated multi-stakeholder event to identify and explore mutually beneficial system innovations to improve the value propositions of the workers' compensation system in Colorado. CMS will promote this event when details are available.

The board approved a recommendation from ADEMS that CMS support a federal exemption for Rocky Vista University from the proposed U.S. Department of Education "gainful employment" regulation.

The U.S. Department of Education issued a draft rule on the gainful employment proposal earlier this year. The rule proposes holding career-oriented higher education programs (namely for-profit institutions and non-degree programs offered by not-for-profits) accountable for preparing their students to be gainfully employed. These programs, including the osteopathic medical program offered by Rocky Vista University, would have to meet certain metrics around debt-to-earnings ratios and cohort default rates for their students, or risk losing their eligibility to participate in federal Title IV student aid programs.

RVU is the only accredited medical school in the United States that will be subject to the gainful employment regulation and the debt-to-income ratios in the regulation make it mathematically impossible for RVU to comply with this regulation - most medical school graduates leave school with high debt levels, and in fact, no medical school would likely be able to meet the debt-to-income ratios in the regulation.

The CMS Constitution and Bylaws Committee has worked over the past few months to review the CMS policy manual and make one of five recommendations on each policy: Reaffirm, sunset, sunset and replace, refer for expert review, or sunset and move to standing rules. The committee's recommendations will be reviewed by the board before the July board meeting and voted on by the House of Delegates at the annual meeting in September.

The committee has completed its initial review of the policy manual and it is now ready for the board's review. Board members and component societies are encouraged to submit thoughts or concerns to CMS COO Dean Holzkamp, [email protected], by June 10. Click here to read the policy recommendations under the sunset process presented to the board. The board approved the committee's process.

CMS President John L. Bender, MD, led a strategic discussion on scope of practice trends to inquire whether CMS needs to address scope issues in a new way while still serving the will of the membership. After a lengthy discussion, the board took two actions. The first is to ask the CMS Council on Legislation to discuss scope of practice and report back to the board on whether CMS should maintain its current path or change course. The second is to instruct staff to include a scope of practice discussion and/or education at the annual meeting.

The Board of Directors met in January to review the current CMS strategic plan and make recommendations to update the plan to keep pace with demands in medicine. The revised plan was presented to the board on Friday and approved.

• June 7-11, 2014 - AMA Annual Meeting - Chicago, Ill.
• Sept. 19-21, 2014 - CMS Annual Meeting - Vail, Colo.