During the pandemic, AMDA – The Society for Post-Acute and Long-Term Care Medicine was able to raise its profile and attract the attention of policymakers and other stakeholders. In the past year, the organization has continued to make inroads on a variety of issues and to gain advocacy momentum. At PALTC23’s Saturday general session, Milta Little, DO, CMD, the Society’s 2023-2024 president, noted, “We don’t just want a seat at the table. We want to chair committees and lead discussions.” Alex Bardakh, MPP, CAE, the Society’s director of public policy and advocacy, agreed: “Some have said that we’ve been punching above our weight class; but, in fact, this is our weight class.” He added, “If the past two years have taught us anything, it’s that we don’t know what will happen, but we can control how we respond and what actions we take.” The organization did this exceptionally well and demonstrated tremendous resiliency. The Society has been busy during the past year. Its leadership has worked to successfully avert physician and accountable care organization (ACO) participation pay cuts and supported significant increases to nursing facility Evaluation and Management Codes. At the same time, the Society’s 2022–2023 president, Suzanne Gillespie, MD, RD, CMD, was an engaged and valued participant in the White House Roundtable on COVID-19. On the state level, there has been big action. The California state legislature passed a bill requiring all medical directors to be certified. Elsewhere, Massachusetts has introduced legislation to do the same, and other states are working on training requirements and public disclosure laws. Christian Bergman, MD, CMD, chair of the Society’s State Policy & Advocacy Subcommittee, has created work groups focusing on state medical director registers and other public policy issues. “We are employing AMDA’s public policy playbook with sample letters, checklists, and other tools that we can utilize to promote change at the state level,” Dr. Bergman said. Perhaps the biggest news of 2022 was the introduction of H.R. 177, designed to amend Title XI of the Social Security Act to ensure nursing facilities report information on their medical directors. Co-sponsored by Representatives Mike Levin (D-CA) and Brian Fitzpatrick (R-PA), the bill “requires the Centers for Medicare & Medicaid Services to revise regulations so as to specifically require Medicare skilled nursing facilities and Medicaid nursing facilities to report the identity of medical directors and related information.” Mr. Bardakh said, “I would like to urge all you to go to our grassroots advocacy page [https://paltc.org/advocacy] and ask your representatives to support this.” This bill came about partly because of the hard work of two Society members — Dan Haimowitz, MD, FACP, CMD, and Karl Steinberg, MD, HMDC, CMD — who led the way on efforts to get this legislation on the books. This is proof, Mr. Bardakh suggested, of the value of being involved in advocacy efforts. He said, “You can be the next person responsible for change that permeates and affects health care.” In addition to H.R. 177, there is much on the horizon that the Society will be addressing. The expiration of the Public Health Emergency on May 11, 2023. This included the expiration of a three-day stay waiver and the expiration of a waiver around certified nurse assistant (CNA) training. The Society has been working with CMS to look at the possibility of extending the three-day stay waiver and continuing other efforts started during the pandemic that benefit long-term care. Administration implementation of nursing home reform, including the proposed rule on disclosure of nursing home ownership and minimum staffing mandates. Last year, the Society released a position statement on staffing mandates, which said that “AMDA recognizes that while having adequate staffing is critically important, minimum staffing levels should not become a fixed ceiling, as staffing levels based only on resident-to-worker ratios or assumptions that staff availability is an easily fixable variable will not adequately or safely address and meet resident needs.” (Read the full statement at https://bit.ly/3HfNDLN.) Telehealth reimbursement. The Society will be working with CMS on more permanent flexibilities around reimbursement for telehealth use, which is already extended to 2024. Victoria Walker, MD, CMD, chair of the Public Policy Committee, said, “There is still a lot of discussion that needs to happen around telehealth. There will be ongoing discussions about payment for these services.” She observed that while it is common knowledge that telehealth is useful, it doesn’t replace bedside care. Physician Fee Schedule payments and the Quality Payment Program. The Society continues to work to ensure that physicians are paid appropriately for their services in PALTC. Just recently, they expressed support for a bill that would provide annual Medicare Economic Index updates to physician payments. In the Policy Snapshot newsletter, Mr. Bardakh observed, “While there are many other concerns with the Medicare physician payment system that still need to be addressed, this legislation is a great first step toward fixing payment inequities and injecting more financial stability into physician practices, allowing them to invest in new ways of providing care and ultimately [ensuring] that Medicare beneficiaries have access to high-quality care.” Experience with new coding guidelines. Updates to the ICD-10-CM code system for 2023 include 1,176 new billable health care codes for areas such as social determinants of health and dementia. The updated codes, which went into effect on April 1, also include seven code deletions and one revised code. Dr. Walker said, “We are still listening and learning about these and what we can do better and different.” Growing focus on antipsychotic stewardship. As Dr. Walker said, “There is a lot of discussion of psychotropic use and the large proportion of schizophrenia diagnoses in nursing homes.” The agency is concerned that these are associated with increased antipsychotic prescribing in this population. While antipsychotic stewardship is not yet mandated by CMS, more organizations are developing and implementing such programs to help ensure appropriate antipsychotic prescribing and documentation in facilities. Moving Forward. The Society is part of the Moving Forward Nursing Home Quality Coalition. The coalition brings together numerous organizations and individuals to make vital changes in policy and practice through the power of diverse voices. The organization has committees addressing person-centered care, culture change, and care planning; staffing and well-trained workforce; transparency and accountability of finances; financing systems; and systems of quality assurance, quality measurement, and continuous quality improvement. “We are thrilled to have AMDA involved in Moving Forward. We want to know what you would like to do to improve nursing home quality,” said Alice Bonner, PhD, RN, GNP, who is chairing the coalition. Ultimately, creating sustained change, said Timothy Holahan, DO, CMD, vice chair of the Public Policy Committee, “takes a major metropolitan area, not just a village.” He added, “Coming out of the pandemic, we have a voice and can shape public policy. This is a unique opportunity, and we need your help.” Senior contributor Joanne Kaldy is a freelance writer in New Orleans, LA.