December 2021 - AUA Public Policy Council Update for MAS
From the Chair
I am pleased to share updates from the AUA Public Policy Council that may benefit your Section members. Our updates include information on our successful advocacy to mitigate a potential 9.75 cut in physician payments under the Medicare Physician Fee Schedule. As a reminder, each Section was invited to participate in the Annual Urology Advocacy Summit’s “match” program to support participation of resident, fellows, and young urologists. The deadline to participate is January 31, 2022. We appreciate your support for growing our urologic bench strength for advocates.
Registration for the 5th Annual Urology Advocacy (AUA) Summit in Washington, DC from March 14-16, 2022 is open. Join almost 140 urologists and patient advocates who have registered by visiting www.AUAsummit.org. Be sure to sign in with your AUA member credentials.
The AUA Summit will open with keynote speaker Major Garrett. Garrett is an American journalist who is chief Washington correspondent for CBS News. He is also the creator and host of The Takeout and The Debrief podcasts. Garrett has reported from the frontlines of the nation’s most pressing news stories for more than 30 years. He breaks down complex hot-button policy issues and is universally recognized as balanced, having worked for the White House teams of both CNN and Fox News.
Other key features of the Summit include a break out networking session entitled “The Power of Advocacy” for our medical students, residents, and fellows and our popular review of the legislative issues we will discuss in our congressional meetings: expanding the urologic workforce, advocating for permanent fixtures to Medicare payment structures, protecting telehealth flexibilities, and increasing diversity in clinical trials. We look forward to seeing everyone in Washington, DC in March.
AUA, House of Medicine’s Advocacy Halts Medicare Cuts
On December 9, the Senate passed S. 610, the Protecting Medicare and American Farmers from Sequester Cuts Act, in an effort to mitigate a number of potentially devastating cuts to Medicare payments for physicians that would have taken effect January 1, 2022. These cuts, which originally totaled a 9.75 percent reduction in Medicare funding, would have had a catastrophic impact on urologists’ ability to provide quality care to their patients. As a result of the passed legislation, which will soon be enacted by President Biden, the Medicare cuts that will go into effect in 2022 now include:
- A 0.75 percent reduction in the Medicare conversion factor (compared to the 3.75 percent cut that would have gone into effect on January 1, 2022);
- No reduction in Medicare funding from January to March 2022, a one percent reduction in Medicare funding from April to June 2022, and a two percent reduction in Medicare funding from July to December 2022, as a result of a statutory budget sequester cut (compared to the full two percent cut for all of 2022 that would have gone into effect on January 1, 2022);
- No reduction in Medicare funding as a result of a statutory pay-as-you-go (PAYGO) cut triggered by the American Rescue Plan (compared to the four percent cut that would have gone into effect on January 1, 2022).
The AUA’s political and policy teams worked closely with the American College of Surgeons and other surgical specialties to support congressional action that would reverse or minimize the cuts. The AUA launched a grass roots campaign urging domestic members to contact their legislators to support taking action to block these Medicare cuts. Hearing from urology and many other physician groups, a congressional “Dear Colleague” letter from Representatives Ami Bera, MD (D-CA-07) and Larry Bucshon, MD (R-IN-08) outlining the breadth of the issue and the need to take immediate action was signed by 245 lawmakers and sent to House/Senate leadership. The AUA also joined other stakeholders in sending multiple letters, including the attached letter, to Congress expressing strong support for S. 610 prior to its passage.
While this congressional action significantly blunts the impact of these Medicare funding cuts, the AUA will continue to advocate for a long-term solution for Medicare funding mechanisms, during a time of continued challenges in providing care to patients resulting from the ongoing COVID-19 public health emergency. The topic will be one of AUA’s asks during the AUA Summit in March 2022.
AUAPAC Meets with Urologist and House Veterans’ Affairs Committee Member
On December 8, AUAPAC met with Representative Greg Murphy, MD (R-NC-03) at a fundraiser hosted by the coalition of Medical and Dental Political Action Committees (MaDPAC). Dr. Murphy is an AUA member and urologist, a member of the GOP Doctors Caucus, and serves on several committees including House Veterans’ Affairs. He is an original cosponsor of the Veterans’ Prostate Cancer Treatment and Research Act (H.R. 4880). In addition, he is a supporter of the Safe Step Act (H.R. 2163), which safeguards step-therapy protocol in specified cases.
To read more about AUAPAC and other candidates the AUA has supported this year, visit www.myauapac.org.
AUA, AMA Urge Biden Officials to Revise Surprise Billing Requirements
The AUA joined the American Medical Association (AMA), state medical associations, and several specialty medical societies in a letter to Secretaries Xavier Becerra, Martin Walsh, and Janet Yellen expressing concerns with certain requirements of the Interim Final Rule (IFR) related to implementation of the No Surprises Act. The act directs independent dispute resolution (IDR) entities to consider the qualifying payment amount (QPA), a rebuttable presumptive reasonable payment for out-of-network physicians engaging in the IDR process and, in turn, places a thumb on the scale in favor of health insurers in contract negotiations.
The joint letter urged the secretaries to instead revise the IFR to conform to the No Surprises Act statutory language. This revision would allow an IDR entity the discretion to consider all the relevant information submitted by the parties to determine a fair out-of-network payment to physicians, without creating a rebuttable presumption that directs an IDR entity to consider the offer closest to the QPA as the appropriate payment amount.
The AUA is committed to ensuring affordable coverage for patients and fair reimbursement for our members. Please contact Ray Wezik, AUA Director of Policy & Advocacy, at [email protected] for a copy of the letter.
ICYMI: Updates from the AUA Policy & Advocacy Brief blog
AUA Promotes H.R. 4880 and S. 2720, the Veterans’ Prostate Cancer Treatment and Research Act; AUA Advocacy Adds Senators Blackburn and Blumenthal to List of Supporters
The AUA continues to meet with Senate and House to garner co-sponsors for the eterans’ Prostate Cancer Treatment and Research Act. H.R. 4880/S.2720 would establish a viable clinical pathway for prostate cancer within the Department of Veterans Affairs for those men who selflessly served this nation in uniform. The House bill’s primary sponsor is Representative and urologist Neal Dunn, MD (R-FL-02), whom the AUA continues to work with in an effort to get the measure passed in Congress. The bill includes a number of original cosponsors and a growing list of 17 supporters. The Senate bill’s primary sponsor is Senator Jerry Moran (R-KS) and has three total cosponsors, including Senator Marsha Blackburn (R-TN), who signed onto the bill on December 7 after the AUA met earlier this month with her staff.
On November 30, the AUA met with staff in the office of Representative Blake Moore (R-UT-01). Representative Moore serves on the House Armed Services Committee and is a member of the National Guard Caucus and the Navy and Marine Corps Caucus. As a result, the staff indicated the congressman will closely review the measure.
On December 7-8, the AUA met with professional staff in the House and Senate Veterans’ Affairs Committees to get a sense of the plan for the for the upcoming calendar year. The bill likely will be included as part of an end-of-year/beginning-of-next omnibus bill. Since the measure has such great bipartisan support, the hope is to get it across the finish line sooner rather than later.
AUA meetings with Representatives Jason Crow (D-CO-06) and Sharice Davids (D-KS-03) ultimately led to them signing on as cosponsors of H.R. 4880. Additionally, Senator Richard Blumenthal (D-CT) signed on as a cosponsor of the Senate bill.
The AUA needs your help in advancing H.R. 4880/S.2720 in both chambers. Log onto the AUA’s grassroots alert system and urge your federally-elected officials to support these measures by clicking here.
AUA Attends ZERO – The End of Prostate Cancer’s Veterans Fly-In
On November 18, the AUA, including Jeffrey Jones, MD, who chairs the AUA Veterans Healthcare Work Group, joined ZERO – The End of Prostate Cancer and Veterans Prostate Cancer Awareness, Inc. for a virtual veterans fly-in. Dr. Jones met with staff in the office of Representatives Al Green (D-TX-09) and John Carter (R-TX-31), as well as Senators Ted Cruz (R-TX) and John Cornyn (R-TX), to garner support for H.R. 4880 and S. 2720, the Veterans’ Prostate Cancer Treatment and Research Act. In total, participants met with nearly 30 lawmakers and/or their staff during the day.
AUA Advocates for Urology Rural Workforce, Seeks Congressional Support for H.R. 944
On November 15-18, the AUA met with staff in the office of Representatives Angie Craig (D-MN-02), Raja Krishnamoorthi (D-IL-08), and Darren Soto (D-FL-09) to discuss co-sponsorship of H.R. 944: Specialty Physicians Advancing Rural Care Act, which is AUA-led legislation to incentivize specialty physicians to practice in rural America.
On December 6-9, the AUA met with staff in the office of Representatives Tony Cardenas (D-CA-29) and Cathy McMorris Rodgers (R-WA-05) to discuss co-sponsorship of H.R. 944. The AUA also met with staff in the offices of Senators Marsha Blackburn (R-TN), Michael Braun (R-IN), and Lisa Murkowski (R-AK) to discuss serving as the Republican sponsor for the Senate companion along with Senator Jacky Rosen (D-NV).
While the AUA continues to meet with legislators to garner cosponsors and support for H.R. 944, we need your help! We are asking domestic AUA members to email or Tweet their federally elected officials and ask them to cosponsor this legislation. Domestic members can easily access this intuitive grassroots action center by clicking here or simply texting AUA to 52886 to get started.
As you know, Representatives David McKinley (R-WV-01) and Peter Welch (D-VT-AL) introduced this legislation in February 2021. It establishes a loan repayment program to encourage specialty medicine physicians to serve in rural communities experiencing a specialty physician shortage. Offices remain receptive to the idea of incentivizing specialists to practice in rural areas while helping patients gain much-needed access to care.
AUA Advocates for Medical Research in Appropriations Letter
The AUA joined the Ad Hoc Group for Medical Research and 314 other organizations urged House and Senate Appropriations Committee Leadership to improve the nation’s health and well-being by investing robustly in the National Institutes of Health (NIH) in Fiscal Year 2022. The groups’ letter asks leadership to provide $46.4 billion for NIH as included in the House-passed appropriations bill. The letter also emphasizes the need for the newly proposed ARPA-H (Advanced Research Projects Agency for Health) to supplement rather than supplant the NIH’s appropriation, a concern shared by the AUA due to the zero sum game approach many in Congress take to research funding. Please contact Kim Nelson, AUA Manager of Policy & Advocacy, at [email protected] for a copy of the letter.
Below are insurance updates from national insurance carriers. If you have questions about insurer issues, contact Gregory Craig at [email protected].
Aetna
Aetna reviewed its Neurogenic Bladder, Selected Treatments (Commercial) Policy removing CPT code 64550.
BCBS Federal Employee Plan
BCBS Federal Employee Plan reviewed its Transurethral Water Vapor Thermal Therapy and Transurethral Water Jet Ablation (Aquablation) for Benign Prostatic Hypertrophy Policy adding an investigational policy statement for transurethral waterjet ablation (Aquablation) as a treatment of benign prostatic hyperplasia.
Noridian
Noridian reviewed its Prognostic and Predictive Molecular Classifiers for Bladder Cancer (MoIDX) (JE A58181 and JF A58187) Local Coverage Article (LCA) removing the following criterion:
- For decipher bladder including, but not limited to, the following: the member has a localized urothelial carcinoma that is AJCC stage I, II, or IIIa; the tumor sample in FFPE is at least 0.5mm in length; member is a candidate for definitive local therapy such as chemotherapy, radical cystectomy, or chemoradiation.
- Indicating that tests for FGFR2 and FGFR3 mutations are covered for members who would otherwise be considered candidates for erdafitinib based on FDA label.
United Healthcare
United Healthcare reviewed its Prostate Services and Procedures (Medicare Advantage) Policy with the following changes:
- Revised applicable coverage guidelines for temporary prostatic stent and prostate rectal spacers placement:
- Indicated HCPCS code L8699 – Prosthetic implant, not otherwise specified, may be used to report UroLift system
WPS Government Health Administrators
WPS Government Health Administrators retired its Prolaris Prostate Cancer Genomic Assay (MolDX) (J05, J08) (A57585) Local Coverage Article (LCA), effective October 28.
WPS Government Health Administrators retired its Prolaris Prostate Cancer Genomic Assay (MolDX) (J05, J08) (A57585) Local Coverage Article (LCA), effective October 28.
WPS Government Health Administrators future retired its Prolaris Prostate Cancer Genomic Assay (MolDX) (L36787) Local Coverage Determination (LCD), effective December 4.
WPS Government Health Administrators retired its Prolaris Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease (MolDX) (J05, J08) (A57586) Local Coverage Article (LCA), effective October 28.
WPS Government Health Administrators retired its Prolaris Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease (MolDX) (L37226) Local Coverage Determination (LCD), effective October 28.
Local and Regional Updates
The following are updates in your Section. The AUA routinely monitors state legislative, regulatory, and insurance policy trends. Please contact AUA State Advocacy Manager Catherine Hendricks at [email protected] for more information on any of these issues.
The following state is in special session: Maryland (December 6-December 31).
The legislative session ended for Pennsylvania (November 30).
New Jersey
- 4201 – Prostate Cancer
Introduced by Senators Linda Greenstein (D) and Vin Gopal (D), S. 4201 seeks to provide cancer screenings for firefighters with all associated costs to be borne by health care benefits plan. The bill was referred to the Senate State Government, Wagering, Tourism and Historic Preservation Committee. Read the bill.
Pennsylvania
Independence Blue Cross
Independence Blue Cross retired its Saturation Needle Biopsy of the Prostate Policy, effective September 10.
Best regards,
Kathy and the AUA Public Policy & Advocacy Team