ACC's advocacy priorities for 2024 focused on establishing sustainable Medicare payment practices, fostering care transformation and optimization, bolstering the clinician workforce now and for the future, and championing access to care for all.

Guided by these policy themes, the ACC tracked key issues and implemented sound advocacy strategies to secure significant victories to benefit both cardiovascular clinicians and patients.

1. Progress on Long-Term Medicare Reform

The ACC continues to push for legislative solutions to foster long-term, sustainable Medicare payment reform, strongly supporting the Strengthening Medicare for Patients and Providers Act (H.R. 2474), which would provide an inflationary update to the physician fee schedule (PFS) equal to the Medicare Economic Index.

Bills have also been introduced in both the U.S. House of Representatives and the U.S. Senate to increase the budget neutrality threshold from $20 million to $53 million.

The ACC submitted formal comments to the Centers for Medicare and Medicaid Services (CMS) in September voicing its opposition to the continued cuts to the PFS conversion factor.

The comments also touched on telehealth policy, new atherosclerotic cardiovascular disease codes, global payment policy accuracy and the transition in the Merit-based Incentive Payment System (MIPS) toward MIPS Value Pathway reporting.

2. Growing Bipartisan Support For Prior Authorization Bill

The Improving Seniors' Timely Access to Care Act (S. 4532/H.R. 8702), a bill to provide common sense prior authorization reforms in Medicare Advantage programs, has secured majority bipartisan support with 59 co-sponsors in the Senate and 229 in the House.

ACC State Chapters also saw major victories in streamlining prior authorization processes and reducing administrative burden, including in Maryland, where the Chapter advocated for and successfully passed a bill to prevent insurance companies from abusing existing prior authorization laws by requiring clinical justification for coverage decisions.

ACC's New Jersey Chapter also helped pass significant prior authorization reform in the state. The new law requires insurers to publicly disclose prior authorization requirements and information such as clinical criteria and approval and denial statistics on their websites.

3. Telehealth Flexibilities For Cardiac Rehabilitation

The Sustainable Cardiopulmonary Rehab Services in the Home Act (H.R. 1406/S. 3021), an ACC-priority bill that would allow cardiac and pulmonary rehabilitation services to be furnished via telehealth at a patient's home under Medicare, was included in the Telehealth Modernization Act (H.R. 7623), which passed the House Energy and Commerce Committee. The ACC continues to prioritize making telehealth flexibilities permanent to increase access to these services.

By submitting formal comments to CMS, the ACC successfully advocated for the extension of direct supervision of cardiac rehabilitation via telehealth and permission for practitioners to use their office address rather than their home address when providing telehealth services from their home through 2025.

4. Bolstering the Clinician Workforce

A paper led by Senate Finance Committee Chair Ron Wyden (D-OR) has outlined potential Graduate Medical Education (GME) policy expansion, calling for an overall increase in the number of Medicare-supported slots and strategies to increase slots to specialties and geographic areas that have the greatest need.

The ACC supports the Resident Physician Shortage Reduction Act (H.R. 2389/S. 1302), which would add 14,000 Medicare-supported GME slots, and has gained nearly 200 bipartisan co-sponsors in the House.

5. Championing Access to Care For All

ACC Advocacy continues to champion access to care for all through legislative efforts to expand AED access in schools. On the federal level, the Access to AEDs Act (H.R. 2370/S. 1024) has secured growing bipartisan support, with 115 House co-sponsors and additional Senate backing.

ACC State Chapters also continue to prioritize access to AEDs, working in tandem with the National Football League's Smart Heart Sports Coalition. ACC Chapters have been pivotal in passing comprehensive AED Access legislation in seven states this year, including Georgia and Tennessee.

Other legislative victories include the passage of the Cardiomyopathy Health, Education, Awareness, Research and AED Training in the Schools (HEARTS) Act of 2024 (H.R. 6829) in the House, which now awaits Senate consideration.

The Congenital Heart Futures Reauthorization Act (H.R. 7189) was signed into law in November. This critical legislation extends federal funding for congenital heart disease research, surveillance and awareness initiatives through 2029.

6. Impact of ACC Legislative Conference 2024

ACC Legislative Conference 2024 brought together ACC members from across the nation to learn more about ACC policy priorities and meet with their members of Congress to advocate on behalf of the cardiovascular community.

More than 470 cardiovascular clinicians attended this year, participating in more than 250 meetings with lawmakers and their staff. Following the conference, ACC Advocacy saw a 30% increase in signatories for the Medicare payment relief letter circulating in the House.

Looking to get involved? Don't miss ACC Legislative Conference 2025, taking place Oct. 5-7 in Washington, DC.

7. HeartPAC: Forging Connections With Lawmakers

ACC Advocacy has been preparing for the new Congress by connecting with candidates who have experience in the health care space and on health policy at the state level through HeartPAC.

In the 2024 election, over 93% of HeartPAC-supported congressional candidates won their races, and 96% of HeartPAC funds supported winning campaigns. HeartPAC will continue to support congressional champions of cardiovascular care, ensuring that issues like bolstering the clinician workforce, advancing prior authorization reform and maintaining critical telehealth flexibilities are prioritized. Learn more at HeartPAC.org.

8. Noncompete Reform in the States

Noncompete and restrictive covenant legislation was prominent in several state legislatures in 2024, with multiple states attempting to ban these agreements for health care professionals. The ACC Maryland Chapter won a long, hard-fought battle by passing H.B. 1388, severely restricting most noncompete agreements.

Additionally, ACC Chapters in Florida, New York, Oregon and Pennsylvania focused their advocacy efforts on eliminating these agreements. Pennsylvania was the only other state to successfully pass noncompete restrictions this legislative session.

9. The Transition to Value-Based Care

The ACC remains dedicated to promoting the transition to value-based care for cardiovascular patients, holding its sixth annual Value-Based Care in Cardiology Forum on Dec. 5.

The Forum gathered clinicians, health systems, payers and other stakeholders to facilitate the implementation of models that prioritize high-quality care, inspiring meaningful discussions, innovative ideas and practical examples of collaboration between primary care and cardiology through incentive-based arrangements.

10. Expanding Payer Coverage

The ACC joined the Heart Rhythm Society in leading a joint letter encouraging energy-agnostic coverage for ablation, emphasizing the importance of clinician discretion in patient selection. Major national payers including Aetna, Cigna and Elevance Health increased their coverage in response.

The ACC also joined a multisociety letter advocating for appropriate coverage for IVUS and atherectomy used to treat peripheral artery disease in lower extremities. Policy changes followed from Aetna, Humana and prior authorization vendor EviCore.

Keywords: Cardiology Magazine, ACC Publications, ACC Advocacy, Medicare, Health Policy, Telemedicine, Health Services Accessibility