Prior authorization is harming individuals with cancer according to new survey results from the Association for Clinical Oncology (ASCO). The survey found that prior authorization delays necessary care, worsens cancer care outcomes, and diverts clinicians from caring for their patients.
ASCO in Action provides the latest news and analysis related to critical policy issues affecting the cancer community, updates on the Association for Clinical Oncology’s ongoing advocacy efforts, and opportunities for members and others in the cancer care community to take action.
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The Internal Revenue Service (IRS) recently finalized policy changes that make health care coverage more affordable for approximately one million individuals by fixing the so-called “family glitch.” The new policy updates the interpretation of the “affordability” of health insurance plans and allows eligible families to receive tax credits to buy more affordable insurance through an Affordable Care Act (ACA) exchange if employer coverage is too costly.
Medicare providers are facing significant reimbursement cuts starting January 1. The 2023 Medicare Physician Fee Schedule proposal jeopardizes the financial stability of many oncology practices by proposing a cut to the Medicare conversion factor of approximately 4.5%. Urge Congress to pass important changes that will provide practices with short-term fiscal stability, while simultaneously laying the foundation for long-term payment reforms.
The Centers for Medicare & Medicaid Services (CMS) released a Request for Information seeking public comment on various aspects of the Medicare Advantage (MA) program as CMS works toward establishing more equitable, high-quality care in MA. The Association for Clinical Oncology (ASCO) submitted a response to the agency on a variety of issues including health equity, expanding access to coverage and care, promoting person-centered care, and supporting sustainability and affordability. Some of the issues addressed in ASCO’s comments are summarized here.
UPDATE: On August 7, 2022, the Senate passed the Inflation Reduction Act (IRA), a broad climate, tax, and healthcare reconciliation bill, 51 to 50. Healthcare provisions in IRA will extend Affordable Care Act (ACA) premium tax credits, allow Medicare to negotiate prescription drug prices, place inflationary caps on Medicare Part B and Part D drugs, and cap out-of-pocket spending on prescription drugs for Medicare beneficiaries. The House of Representatives will reconvene on August 12 to consider and vote on the legislation--which is expected to pass--after which President Biden will sign the bill into law.
On June 27, 2022, the Centers for Medicare & Medicaid Services (CMS), through its Center for Medicare & Medicaid Innovation (CMMI), announced a new, voluntary oncology payment model, the Enhancing Oncology Model (EOM).
The Centers for Medicare & Medicaid Services released the Patient Protection and Affordable Care Act 2023 Notice of Benefit and Payment Parameters final rule. The rule finalizes regulatory changes in the individual and small group health insurance markets and establishes parameters and requirements issuers need to design plans and set rates for the 2023 plan year. The rule also aims to improve enrollment policies for qualified health plans offered on the federal Marketplace to ensure consumer access to quality and affordable coverage and to advance health equity.
The Association for Clinical Oncology (ASCO) submitted comments in response to the Centers for Medicare & Medicaid Services’ (CMS) Patient Protection and Affordable Care Act 2023 Notice of Benefit and Payment Parameters proposed rule.