Success in Kentucky: Step Therapy Reform
Following successes in both Arkansas and Louisiana during previous years, CSRO continued its leadership and investment of resources in the area of step therapy reform and looked to Kentucky as a target for its efforts this year.
Kentucky was one of the first states in the country to reform the use of step therapy protocols early in the 2010’s. Since that time, insurer tactics and clinical practice have evolved such that stakeholders felt updates to the law were necessary to ensure the legislature’s original intent was maintained.
As a result, CSRO lead a coalition of patient and provider organizations supporting Kentucky SB 140, which would update Kentucky’s step therapy statute to allow providers additional clinical scenarios under which they are able to override a step therapy protocol, expand the law to include the state’s Medicaid population, and streamline other process details.
We are excited to report success: SB 140 was signed into law by the Governor on March 17 after receiving unanimous support in both the House and Senate - thank you to all of the rheumatologists and partners in Kentucky who advocated for this bill! The law will go into effect for plans issued or delivered on or after January 1, 2023, becoming the strongest law to date in the country. 
Stay tuned for recourses from CSRO to help guide the application and utilization of this new law.
RA Cost Measure Development: CSRO Seeks Improvements
This week, CSRO provided feedback to Acumen, CMS’ contractor responsible for developing episode-based cost measures, on a measure concept for rheumatoid arthritis (RA). CSRO previously weighed in with concerns and suggested improvements during “Wave 4,” when an RA resource use measure concept was first proposed. Building on those comments, the coalition provided additional feedback to address anticipated challenges with cost measure development and discuss innovations in disease management that may reduce treatment expenditures.
Specifically, CSRO reiterated the importance of capturing medications covered under both Part B and Part D to ensure a level-playing field and avoid penalizing physicians based on the treatment needs of their patients. CSRO also highlighted various tools that are helpful in assessing disease activity and guiding treatment decisions, emphasizing the importance of relying on the clinicians' expertise and judgement and shared decision-making approaches in determining when it is best to employ those tools. 
Finally, the coalition stressed that any cost measurement in RA must not have an adverse impact on practice patterns nor discourage treatments that best meet the needs of the patient.
That's a Wrap: 2022 Fellows Conference
CSRO was in San Francisco last week with rheumatology fellows from around the country for our annual Fellows Conference, providing the next generation of rheumatologists with practical career tips and insights not typically taught in academic training.
Thank you to all of our speakers for sharing your insights and expertise! Recordings from this year's event will be available soon

2022 Fellows Conference Sessions:
  • So You Want to Go into Private Practice? Rheuminations
  • Herbert S. Baraf, MD, FACP, MACR
  • Choosing a Career Path Panel: Truths About Becoming a Rheumatologist
  • Panelists: Erin Arnold, MD, FACR; Amish Dave, MD, MPH; Sheetal Desai, MD, MSEd
  • Moderator: Gary Feldman, MD
  • Incorporating Telemedicine in Rheumatology Practice
  • Alireza Meysami, MD, CPE, RhMSUS, FACR, FACP
  • Insurance 101
  • Gregory Schimizzi, MD
  • Anatomy of a Lawsuit
  • James Haliczer, Esq
  • Early Career Financial Management
  • James Dahle, MD, FACEP
  • Work-Life Balance Panel: Truths About Becoming a Rheumatologist
  • Panelists: Kostas Botsoglou, MD; Lianne Gensler, MD; Ekaterini Zapantis, MD
  • Moderator: Grace Wright, MD, PhD, FACR
  • Physician Employment and Contracts
  • Steve McCoy, Esq
  • Important Issues in Coding
  • Jean Acevedo, LHRM, CPC, CHC, CENT, AAPC Fellow
Spotlight: CSRO's Rheum for Action Column
The 'transparency gap' within the healthcare system is becoming increasingly apparent, with a lack of transparency evident at every level of care. CSRO President Dr. Madelaine Feldman discusses how a new law, the Consolidated Appropriation Act (CAA), may help to eliminate that gap in the latest edition of Rheum for Action, CSRO's advocacy column produced in partnership with Rheumatology News.

Read more about the causes of this gap and how the CAA may help (PDF available here).
Legislation Around the Country
What's Happening in the States
CSRO tracks legislative activity relevant to the rheumatology community and their patients. Check out the list below to see the status of CSRO priority bills from the past two weeks. For a full status report on all the bills CSRO tracks, click here.

Be sure to check out our interactive legislative map tool for additional information about current policy in your state. Plus, don't forget to add your state to your email profile here to receive state-specific updates and action alerts via email.
Accumulator Programs
  • B24-0557: Follow up hearing scheduled for 6/27/22 
Rebate Pass Through 
  • AB 2942: Referred to Committee on Health 
White Bagging 
  • SB 958: Set for hearing on 4/6/22 
Accumulator Programs 
  • SB 1480: Died in Banking and Insurance Committee 
  • HB 1063: Died in Finance and Facilities Subcommittee 
Step Therapy 
  • SB 730: Substituted HB 459, read a second time. 
  • HB459: Approved by the Senate 
White Bagging
  • SB 748: Died in Banking and Insurance Committee 
Accumulator Programs 
  • SF 2231: Placed on calendar for unfinished business  
  • HF 2384: Passed the House unanimously, introduced in the Senate, attached to SF 2231
Rebate Pass Through 
  • SF 2231: Placed on calendar for unfinished business  
  • HF 2384: Rebate pass through language removed on amendment, passed the House unanimously, introduced in the Senate, attached to SF 2231
Step Therapy 
  • SB 140: Signed into law by the Governor 
White Bagging 
  • HB 457: Passed the full House, introduced in the Senate, referred to Appropriation and Revenues Committee 
Accumulator Programs 
  • S.644: Approved by committee 
  • H.1053: Approved by committee
Accumulator Programs
  • SF 2136: Referred to Health and Human Services and Finance Policy 
  • HF 3611: Referred to Commerce, Finance, and Policy 
MINNESOTA (continued)
Non-medical Switching 
  • SF 131: Re-introduced
  • HF 58: Committee report to adopt and re-refer to Health and Finance Policy 
  • HF 4266: Introduced and referred to Commerce, Finance, and Policy Committee  
Rebate Pass Through
  • SF 4007: Introduced and referred to Commerce and Consumer Protection, and Finance and Policy Committees 
Accumulator Programs 
  • LB 767: Approved by the Governor 
Accumulator Programs 
  • HB 135: Re-referred to the Rules and Reference Committee 
Rebate Pass Through
  • SB 1324: Approved unanimously by the Senate 
  • HB 4087: Approved unanimously by the House 
Step Therapy
  • HB 677: Action deferred in Finance, Ways, and Means Subcommittee to 3/30/22 
  • SB 1310: Recommended for passage with amendments, referred to Senate Finance, Ways, and Means committee 
White Bagging 
  • HB 2233: Action deferred in Insurance subcommittee 
  • SB 2459: Action deferred in Senate Commerce and Labor Committee 
Accumulator Programs
  • SB 5610: Delivered to the Governor 
Accumulator Programs
  • SB 215: Failed to pass pursuant to Senate rules 
  • AB 184: Failed to pass pursuant to Senate rules 
White Bagging 
  • AB 718: Failed to pass pursuant to Senate rules 
  • SB 753: Failed to pass pursuant to Senate rules 
Please visit the CSRO website for other news and updates, and do not hesitate to contact us with any questions at
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