and I just fell in love with advocacy efforts and we're blessed also to have Camille Bonta who has been the longtime face of ASGE in DC with us today. So this next topic on advocacy efforts is near and dear to my heart and I'm very happy to invite up Molly MacDonald who has been Fight Colorectal Cancer's Director of Advocacy since 2019. She oversees Fight CRC's advocacy and policy initiatives at the local, state, and federal levels. Ms. MacDonald formerly worked for Winning Strategies Washington which is a government relations firm in Washington, DC. She also spent more than five years working in the US House of Representatives for Congressman Leonard Lance of New Jersey, the Fighting Seventh District, right? Senior member of the House Energy and Commerce Committee. Molly was his senior health policy advisor working on medical research, public health, drug development, and health coverage issues. Molly, welcome. I am so thrilled to be here today and thank you for ASGE for having me and for hosting this and to having such a great focus and putting all these resources and energy towards the follow-up colonoscopy. So I'm gonna talk a little bit today about the advocacy efforts that Fight Colorectal Cancer and many other groups have been working towards around the follow-up colonoscopy. So for those of you who aren't familiar, Fight Colorectal Cancer is a national patient advocacy organization dedicated to the colorectal cancer community. We provide patient support and educational materials. We support research efforts. And then of course, my area of expertise is we do state and federal policy and advocacy efforts. So I'm gonna start with just a little bit of background, particularly around our state-based advocacy efforts. So at the end of 2019, we launched our Catalyst State-by-State Advocacy Program, which was really aimed at supporting coalitions at the state level who are working to advance policy, increasing access to colorectal cancer screening. So when we launched this program, the focus was really on ensuring coverage for colorectal cancer screening beginning at age 45, which at the time was pre-USPSTF change. And then also removing out-of-pocket costs for follow-up colonoscopy after a positive noninvasive test. So through this program, we provide funding and technical assistance to state coalitions to help them advance their policy work. So to date, we've funded 12 states. Two of our grantees are in the room. Whitney Jones and his crew in Kentucky worked on their pharmacy protocol with some help from the Catalyst Program. And then Stoney Anderson and his crew in California was able to pass legislation removing out-of-pocket costs for follow-up colonoscopy, as well as working to get a colorectal cancer screening measure in Medicaid. So it's been a really exciting process to work with the Catalyst Program and to build it out. We really, to some of the earlier comments, we really work with states to determine what's most helpful for them and what is most needed in their states. But we work with them on building coalitions. They go through a really robust action planning process at the outset to determine who are the stakeholders that need to be in the room in order to advance this policy change. What are the steps in the process? Who is going to execute them? And then we do a lot of sharing across grantees. So learning best practices from one another, what worked, what didn't work. And we've also leveraged the great work of other organizations. So we have a Catalyst Advisory Council that includes CDC, the American Cancer Society, Cancer Action Network, and the Prevent Cancer Foundation. We also were able to start and build the Catalyst Program thanks to an unrestricted grant from Exact Sciences. And they've been an incredible partner in letting us really run with this and grow to have additional folks as part of this process. So again, this is just sort of an overview of the Catalyst states are the ones that have the gold star on them, but also areas where there are states where legislation around follow-up colonoscopy has passed at the state level. And so I wanted to kind of give this timeline overview around some of the different sort of pieces of this puzzle. So as I think it was Fola alluded to earlier, the policy change can be challenging because insurance is regulated in many different places. And so it's not like one policy changes everyone's plan. So I did include on here the Medicare loophole bill. So this was a bill at the federal level around ensuring that if a patient went in for a screening colonoscopy and a polyp was detected and removed, that they would not wake up with a surprise bill. That was first introduced in 2012 and took about eight years to actually get signed into law. So policy can move slowly, but also to some of the other points earlier today too, once it's actually signed into law, then begins a whole other set of work to make sure that people actually know about it and that it's effectively being implemented. So that bill was focused on Medicare, but for commercial plans for almost 10 years, they've had to cover that colonoscopy if the polyp was removed. But I heard from a patient just a couple of months ago that they got pushback from their insurer on that. So we definitely still have work to do. But over the course of the last several years between 2015 and 2022, a number of states, as I said, advanced legislation to remove that out-of-pocket costs for follow-up legislation. So those bills primarily impacted state-regulated health plans and some impacted Medicaid as well. But then we really saw some really exciting movement in last year, in 2022. So working closely with the American Cancer Society, Cancer Action Network, and AGA, we for several years had been engaging with CMS as well as what we fondly call the Tri-Agencies. So it's a group of federal agencies, the Department of Labor, the Department of HHS, and the Department of Treasury that routinely put out guidance to commercial plans around what they need to cover and kind of how they can stay compliant with the Affordable Care Act. So in January of 2022, the Tri-Agencies came out with guidance to commercial plans saying that they needed to cover that follow-up colonoscopy without out-of-pocket costs. And then CMS followed suit a couple of months later in July. So this is just kind of the little snippet from the Tri-Agency guidance. So again, it was released in January in 2020 and began implementation in 2023. So I put this on here because this is what it looks like when you pull it up. It's an FAQ document. It's a PDF. It's very hard to find if you're just Googling this on the Internet. It's not necessarily really widely disseminated. I'd be curious to hear from the insurers in the room if they received this document and how. But so, you know, we really obviously celebrated this win and seeing this new guidance, but we quickly began thinking about, okay, how does this actually get into the right hands? And similar with CMS. So again, this is just kind of getting to that point that though we've had these incredible policy wins, gaps still exist. So based on the state coverage, the commercial plan guidance and CMS guidance, that covers ACA-compliant plans, Medicare, Medicaid expansion population. It's unclear whether that also captures traditional Medicaid population. It can kind of vary based on the state, and we don't really have a great sort of landscape assessment as to where various states are with their traditional Medicaid population. If anyone has that or wants to fund a study, call me. And then, of course, grandfathered plans and, of course, the uninsured, these don't apply to. So now looking to implementation. So I was really excited with the last panel because it sort of teed this up perfectly, but we at FightCRC, you know, kind of thinking about all the great wins that we've seen around follow-up colonoscopy, we really wanted to think about that next step of implementation. And so to many of the points made earlier, we were thinking through first, who are the key audiences that need to know about this policy change? And how can we develop a resource for them and get it into the right hands so that people understand what is now covered, what it means for them, and any additional information they might need? So this is just sort of a snippet of what the resource looks like. It's about three pages total, and we worked really hard to get it as short as possible. And we're looking to actually do some smaller versions of this as well that can be kind of like a pocket card or rack card type size as well. But so we focused on patients, health insurers, and physicians, but to an earlier point, also sort of that coder and billing department because it's not often the physician that's going and, you know, doing the coding, but other folks in their office. So we worked closely with AGA on this resource. I am not a coding expert. I don't, I won't pretend to be. But we knew that that was an important part of this process, and that was so often what we were hearing was a challenge, was, you know, knowing what the codes and modifiers needed to be and when they needed to be, you know, used. And even still, we've heard feedback from folks who are hesitant to make any changes in how they're coding. They're very, you know, they don't want to be dinged for, you know, fraud. So it's been, you know, we've sort of struggled to kind of get through to folks on that, on the coding side of things, too. And we've actually, we've done some research. There's a handful, or outreach, I should say. There's a handful of coding trade associations, membership organizations that we've tried to engage to say, hey, we have this resource. We would love for you to share this with your members. Most of them are like, we're cool. Thank you. But so if anyone has any connections there, also call me. But we're working on a journal article for one of them that hopefully will be accepted and kind of get this information out. So this is a QR code that takes you to our landing page that has all of the resources. So we do have different resources for those three audiences that I mentioned. We also have developed this poster that could go in a physician's office. It describes the follow-up coverage change up at the top here, but it's also sort of a broader kind of screening resource that can be used. I'll also add that we, down at the bottom here, you can see it's co-branded with AGA, but we've also, we will co-brand with anyone who wants to do it. So we recently co-branded with Vermonters taking action against cancer. So a group in Vermont that saw the resource and felt it would be helpful to have their brand on it and to help build trust in their local community. So we're more than happy to co-brand and continue to get this resource out there. We have been meeting with different organizations, again, to kind of help get this disseminated, get folks to put it on their websites, to send it out to their membership. And so we're hoping to, you know, continue to get it out into the world. We also, we, Fight Colorectal Cancer has a partnership with Komodo Health. So we're able to do a mailing to about 2,200 physician offices, primarily primary care and OBGYN, who we had identified as low prescribers of non-invasive tests. So that went out a couple of weeks ago. So we're hoping to get some good uptake from that as well. So a few other things I just wanted to note in terms of looking ahead. I think several months ago, as I imagine many of you heard, there was a court case, is a court case in Texas that puts the preventative services provision of the Affordable Care Act in question. There is a stay on the case now. So we're safe for the time being, but should that preventative services benefit be struck down, that would undo not only all the great work that's been done around the follow-up colonoscopy, but, you know, the change to 45, anything that was post ACA. So it's definitely something that we're watching closely. And like I said, could have a really big impact. Obviously, Janava gave a great presentation on the CRCCP program. I don't need to go over it any further, but I just wanted to include that here as well. That's something that FightCRC routinely advocates on, you know, working to increase funding for the colorectal cancer control program. And I think is obviously a key piece of, you know, increasing access to colorectal cancer screening, particularly among underserved communities. Thank you.

colorectal cancer screening

out-of-pocket costs

policy changes

underserved communities

preventative services provision