Without congressional action before the end of the year, Medicare providers are set to face up to a 10% reimbursement cut. The Association for Clinical Oncology (ASCO) encourages its members to contact their lawmakers and urge them to address the cuts now.
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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On November 1, 2022, the Centers for Medicare & Medicaid Services (CMS) released its final rule for the calendar year (CY) 2023 Medicare Physician Fee Schedule and updates to the Quality Payment Program. CMS also released its final rule for the CY 2023 Hospital Outpatient Prospective Payment System the same day. The Association for Clinical Oncology (ASCO) is still assessing the rules, but based on a preliminary analysis, key provisions for the cancer care community are included here.
On October 13, 2022, Department of Health and Human Services (HHS) Secretary Alex Azar extended the COVID-19 Public Health Emergency (PHE) declaration, on the day it was set to expire, for an additional 90 days. The PHE is now set to expire January 13, 2023.
On October 6, 2022, the definition of information blocking is expanding to include the entire scope of the definition of Electronic Health Information (EHI)—including, electronic protected health information (ePHI) that is or would be in a Designated Record Set (DSR). Practices may want to review and assess their information blocking compliance policies and procedures and contact their EHR vendors to find out how they are preparing to assist practices in meeting the deadline.
In a step towards addressing one of multiple pending Medicare physician payment cuts, Representatives Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) introduced the Supporting Medicare Providers Act (H.R. 8800), which would increase the conversion factor to 4.42%, effectively putting the Medicare physician fee schedule cut on hold for a year. The new legislation also includes language that says lawmakers and the Department of Health and Human Services should work to promote and reward value-based care, as well as safeguard timely access to high-quality care by advancing health equity and reducing disparities. The Association for Clinical Oncology supports this effort to provide short-term stability and urges Congress to pass the bill before the end of the year.
UPDATE: On September 14, 2022, the House of Representatives passed the Improving Seniors’ Timely Access to Care Act (H.R. 3173) by voice vote on the House floor. The bill now moves to the Senate. This remains a critical moment when your Senators need to hear your support for this legislation. Please ask them to pass this bill into law—it takes seconds using the ACT Network.
The American Society of Clinical Oncology (ASCO) issued a new position statement on Medicare billing for split or shared (split/shared) evaluation and management (E/M) services. The statement summarizes ASCO’s concerns about changes to split/shared E/M services and makes recommendations to better align Medicare coding for E/M services with the care that beneficiaries with cancer need.
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 Inflation Reduction Act extends Affordable Care Act (ACA) tax credit subsidies, allows Medicare to negotiate prescription drug prices, places inflationary caps on price increases for Medicare Part B and Part D drugs, and limits Medicare beneficiaries’ out-of-pocket spending on Part D prescription drugs.
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 July 27, 2022, the House of Representatives passed the Advancing Telehealth Beyond COVID–19 Act of 2021 (H.R.4040). The bill—which was introduced by Representatives Liz Cheney (R-WY-AL) and Debbie Dingell (D-MI-12)—would extend telehealth flexibilities for two years, through the end of 2024.
Specifically, the legislation would:
ASCO is continuing to collaborate with State Affiliates and outside stakeholders to raise awareness and facilitate implementation of the CLINICAL TREATMENT Act, which requires all states and territories to cover and reimburse routine costs of care for treating a Medicaid enrollee who is participating in a qualifying clinical trial.
The U.S. House of Representatives passed its comprehensive legislation to reauthorize the Food and Drug Administration (FDA) user fee agreements, including the Prescription Drug User Fee Act (PDUFA), the Generic Drug User Fee Act (GDUFA), the Biosimilar User Fee Act (BsUFA), and the Medical Device User Fee Act (MDUFA). ASCO is pleased that several of the Association’s priorities were included in the final House-passed bill.
Proposals to reauthorize the Food and Drug Administration (FDA) user fee agreements include several ASCO priorities, including those that would increase diversity of clinical trials and strengthen the accelerated approval process.
From April 4-8, U.S. members of the Association for Clinical Oncology (ASCO) participated in the 2022 ASCO Week of Action, which was held in conjunction with the Association’s annual Advocacy Summit. During the Week of Action, advocates from across the country sent a record 920 letters to Members of Congress through ASCO’s ACT Network urging them to take action on important policies to improve access to high-quality, equitable care for people with cancer.