January 2022 - 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 the AUA’s 2022 State Advocacy priorities and the new audio-only modifier for telemedicine services.
Register Now: 5th Annual Urology Advocacy Summit in Washington, DC
Registration for the 5th Annual Urology Advocacy (AUA) Summit in Washington, DC from March 14-16, 2022 is open. Join over 170 urologists and patient advocates who have registered by visiting www.AUAsummit.org. Be sure to sign in with your AUA member credentials. We are pleased that all 8 Sections are participating in the “match” program in which the AUA matches up to two residents, fellows, or young urologists that the Section sends. Participant’s names are due to Juliana Nicolini (jnicolini@auanet.org) by January 31.
The AUA Summit will open with keynote speaker Major Garrett. Other key features of the Summit include expanding the urologic workforce, advocating for permanent fixtures to Medicare payment structures, protecting telehealth flexibilities, increasing diversity in clinical trials, prior authorization, and many more topics will be featured at the AUA Summit. We look forward to seeing everyone in Washington, DC in March.
AUA to Host Panel for Medical Students and Patients of Color on February 23
Please join the American Urological Association, Urology Care Foundation, and the Prostate Cancer Impact Alliance for a webinar on the importance of increasing the number of Black and African-American urologists. This webinar will be held on February 23, 2022 from 2:00-4:00 pm ET, encompassing two hour-long panels. Both panels will be recorded and available for later viewing.
In the first panel, Black physicians from R. Frank Jones Urologic Society, Oregon Health and Science University, and SUNY Downstate Health Sciences University, will discuss their journeys in their urologic careers, how culturally competent care shapes patient outcomes, and why Black voices are vitally needed in urology. The goal of the webinar is to introduce Black medical students to the meaningful path they could take if they were to choose a career in urology, and how their presence as Black physicians can make a difference in the lives of their patients.
Register here for the first panel.
In the second panel, Black patients will present their experiences with the medical system, and ways that it can be improved and made more inclusive. The panel will touch on access to care and screenings, community-based outreach, care coordination, and other pressing issues experienced in patient care.
Register here for the second panel.
Audio-Only Modifier Effective January 1
At the September 2021 CPT Editorial Panel Meeting, a new modifier was accepted to describe real-time telemedicine services between a patient and a physician or other qualified health care professional rendered via audio-only. This new modifier became effective January 1, 2022.
Modifier 93 – Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System:
- Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional.
- Urologists utilizing this modifier should ensure the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.
The official release information can be found on the AMA website, here.
Advancing the adoption of telehealth and audio-only visits is an AUA advocacy priority. The AUA believes insurers should cover these telemedicine services at a rate equal to in-person evaluation and management services where appropriate. The AUA further believe insurers should consider telehealth access as a substitute for locally available urologists who can offer the full spectrum of medical and surgical care for urologic disease when creating a network of providers.
Public Comment Opens: The Patient-Centered Outcomes Research Institute (PCORI) Publishes Proposed Research Agenda
The Patient-Centered Outcomes Research Institute (PCORI) has published its proposed Research Agenda for public comment. The Research Agenda will provide the framework for PCORI’s future funding of comparative clinical effectiveness research and other research Initiatives. The AUA previously advocated for continued federal funding of PCORI, which was successful for a period of ten years, through 2029.
The proposed agenda states PCORI will fund research in the following six areas of focus:
- Research that fills patient- and stakeholder-prioritized evidence gaps and is representative of diverse patient populations and settings;
- Research that aims to achieve health equity and eliminate health and health care disparities;
- Research that builds the evidence base for emerging interventions by leveraging the full range of data resources and partnership;
- Research that examines the diverse burdens and clinical and economic impacts important to patients and other stakeholders;
- Research that focuses on health promotion and illness prevention by addressing health drivers that occur where people live, work, learn, and play; and
- Research that integrates implementation science and that advances approaches for communicating evidence so the public can access, understand and act on research findings.
Comments are due January 31.
View the proposed agenda here: https://www.pcori.org/sites/default/files/PCORI-Proposed-Research-Agenda-English.pdf
The AUA Research Advocacy Committee (RAC) will comment on the proposed research agenda by the deadline. Previously, the RAC responded to a Request for Information released by PCORI, on how to better engage patient communities in research studies. The AUA’s comments focused on identifying mechanisms to enhance patient engagement in studies and the development of effective mechanisms for measuring success through greater engagement within patient communities. AUA’s comment letter is available here: https://bit.ly/3tl82ZR
ICYMI: Updates from the AUA Policy & Advocacy Brief blog
AUA Adds Co-sponsors to the Veterans’ Prostate Cancer Treatment and Research Act; Bill Progressing Through the Senate
Senate Veterans’ Affairs Committee Chairman Jon Tester (D-MT) announced plans to include the AUA-supported Veterans’ Prostate Cancer Treatment and Research Act (S. 2720) in an end-of-year/beginning-of-next (2022) omnibus bill. The announcement was part of a December 12th committee hearing on S. 2720. We look forward to sharing with you more as this legislation progresses.
The AUA recently met with staff in the offices of Representatives Jim Banks (R-IN-03) and Mike Levin (D-CA-49), which ultimately led to them supporting and co-sponsoring the House version of the bill.
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 AUA will continue to promote and advance this important measure in numerous ways moving forward. You also can help this key initiative move forward in both chambers by logging onto the AUA’s grassroots alert system and urging your federally elected officials to support these measures by clicking here.
AUA Advocates for Urology Rural Workforce, Seeks Congressional Support for H.R. 944
On December 15, the AUA met with staff in the office of Representative John Curtis (R-UT-03) to discuss co-sponsorship of H.R. 944. 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.
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.
Update: Urology Practice Publishes AUA’s APP Consensus Statement
The ad hoc work group on Advanced Practice Providers’ “Current State of Advanced Practice Providers in Urologic Practice” as a freely accessible article in the AUA Journal, Urology Practice®. The article provides an overview of AUA’s endorsement of this team-based approach: “Supervision/collaboration is a process in which an [advanced practice provider] works with one or more physicians to deliver health care services within the scope of the practitioner’s expertise with medical direction and appropriate supervision as supported by jointly developed guidelines or other mechanisms as indicated by the law of the state in which the services are performed.”
One Voice Against Cancer Annual Meeting (OVAC): Appropriations for Cancer Research Tops Agenda
On January 5, the AUA attended OVAC’s annual meeting. OVAC discussed its appropriations requests for Fiscal Year (FY) 2023, which mirror the efforts of the Research Advocacy Committee in funding for the National Institutes of Health (NIH). OVAC noted they are developing these requests without knowing the FY 2022 funding levels, as no official budget has been passed. OVAC’s goal in FY 2023 is not to increase appropriations requests, but unify the requests across cancer advocacy groups. When those numbers are completed, they will be shared.
National Cancer Institute Director Norman Sharpless, MD, presented on the recent challenges to cancer research presented by the COVID-19 emergency. Dr. Sharpless highlighted major accomplishments in cancer research and noted that the Biden Administration strongly supports cancer research. He is hopeful the COVID-19 emergency will slow and the Administration will be able to make cancer research a priority in 2022 and into 2023.
As a reminder, OVAC is the largest federal cancer advocacy group working on Capitol Hill. The AUA, as a commitment to working with diverse stakeholders on policy when efforts align, is a member of this group.
Below are insurance updates from national insurance carriers. If you have questions about insurer issues, contact Gregory Craig at gcraig@auanet.org.
Aetna
Aetna reviewed its Ablative Procedures for Prostate Cancer Policy with changes to the policy statement and supplementary information, adding:
- Focal thermo-ablative therapy for the treatment of oligometastatic prostate cancer (OMPC) as experimental/investigational
Aetna reviewed its Prostate Cancer Vaccine (Commercial) Policy revising criteria for initial approval of Provenge.
Aetna reviewed its Prostate Cancer Vaccine (Commercial) Policy removing HCPCS code J9228.
Aetna reviewed its Benign Prostatic Hyperplasia (PA Medicaid) Policy with the following changes:
- Added drug-coated balloons as experimental/investigational for the treatment of BPH
- Added codes 0619T, C9769
- Removed code C9747
CGS Administrators
CGS Administrators published its JB and JC DME MAC POE Calendar of Events Webinars, Workshops and More Advisory Meeting Document announcing a new webinar titled “Urological Supplies”, which will take place February 8 virtually from 10:30 a.m. to 12:00 p.m. Register here.
Noridian
Noridian released its new Minimal Residual Disease Testing for Cancer (MolDX) (JF) (A58456) Local Coverage Article (LCA). The article addresses billing and coding guidelines that complement the LCD for “MolDX: Minimal Residual Disease Testing for Cancer” (L38816).
Noridian released its Minimal Residual Disease Testing for Cancer (MolDX) (JF) (L38816) Local Coverage Determination (LCD) from draft policy into future effective policy. The associated response to comments article can be found here.
Noridian reviewed its Prostate Cancer Genomic Classifier Assay for Men with Localized Disease (JF) (A57236) Local Coverage Article (LCA) adding the following CPT/HCPCS code to group 1 codes:
- 0047U – Oncology (prostate), mRNA, gene expression profiling by real-time RT-PCR of 17 genes (12 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a risk score
Noridian reviewed its Prostate Cancer Genomic Classifier Assay for Men with Localized Disease (MoIDX) (JE) (A57372) Local Coverage Article (LCA) adding the following CPT/HCPCS code to group 1 codes:
- 0047U – Oncology (prostate), mRNA, gene expression profiling by real-time RT-PCR of 17 genes (12 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a risk score
WPS Government Health Administrators
WPS Government Health Administrators retired its Prolaris Prostate Cancer Genomic Assay (MolDX) (J05, J08) (A57585) Local Coverage Article (LCA).
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 chendricks@AUAnet.org for more information on any of these issues.
Last week, the AUA Board of Directors approved the State Advocacy Committee’s (SAC) 2022 Priorities. The SAC priorities for this year are as follows:
- Support traditional medical liability reform efforts.
- Promote efforts to support adequate insurance networks.
- Support state efforts to reduce the burden of utilization management tools such as prior authorization and step therapy.
- Support access to prostate cancer screening.
- Support legislation and regulation to maintain the physician led care team.
- Preserve appropriate use of the in-office ancillary services exemption (IOASE) to the federal Stark law and support legislation allowing appropriate participation in alternative payment models.
- Support legislative and regulatory efforts to expand meaningful patient access to telemedicine services.
- Monitor and promote the expansion of the Interstate Medical Licensure Compact in all 50 states.
- Oppose unwarranted statutory or regulatory requirements related to the genitourinary physical examination by licensed and qualified providers. (New)
- Oppose legislation seeking to interfere in the patient-physician relationship. (New)
The State Advocacy Priorities continue to serve as a guide for the AUA’s advocacy efforts at the state level. They do not, however, limit or restrict any policy issues the AUA may consider.
Delaware
Highmark BCBS Delaware
Highmark BCBS Delaware released its new Bulking Agents for the Treatment of Urinary Stress Incontinence and Vesicoureteral Reflux Policy.
District of Columbia
D.C. B. 24-0557 – Co-pay Accumulator
Introduced by Councilmember Mary Cheh (D), D.C. B. 24-0557 seeks to eliminate the practice of excluding the value of any discount provided by a third party from counting towards the insured’s deductible or out-of-pocket maximum. The bill was referred to the Council Health Committee.
Maryland
H.B. 180 – Interstate Medical Licensure Compact
Introduced by Delegate Heather Bagnall (D), H.B. 180 would extend the sunset termination date of the Interstate Medical Licensure Compact eight years and extend to September 30, 2027. The bill was referred to the House Health and Government Operations Committee.
S.B. 167 – Insurance
Introduced by the Senate Finance Committee, S.B. 167 seeks to authorize the insurance commissioner to require a health insurance carrier to provide payment for a claim that has been improperly denied. The bill was referred to the Senate Finance Committee.
New Jersey
Horizon BCBS New Jersey
Horizon BCBS New Jersey revised its Radiation Therapy for Urethral Cancer and Upper Genitourinary Tract Tumors Policy indicating Medicare Advantage products will follow this policy.
Horizon BCBS New Jersey revised its Radiation Therapy for Testicular Cancer Policy indicating Medicare Advantage products will follow this policy.
A.1489 – Pelvic Exams
Introduced by Representative Paul Moriarty (D), A. 1489 seeks to require a health care practitioner to obtain informed written consent to perform an invasive examination from a patient while the patient is under general anesthesia or unconscious. “Invasive examination” includes any visual, tactile, or mechanical inspection of the patient’s reproductive organs or rectal cavity. The bill was referred to the Assembly Health Committee.
A.6155 – Medical Licensure
Introduced by Assemblymember Herb Conaway, Jr. (D), A. 6155 seeks to provide temporary licensure to health care professionals licensed in other states, to assist in the state’s COVID-19 response. The temporary licenses will expire 60 days following the end of the federal public health emergency. The bill was referred to the Assembly Health Committee.
A.2559 – Telehealth ENACTED
Introduced by Senator Vin Gopal (D), S. 2559 seeks to amend state law to require health insurance carriers and Medicaid to reimburse the same as an in-person visit. It also seeks to prohibit health plans from imposing a “place of service” requirement on a New Jersey licensed physician and prohibits restrictions on the platform used to provide telehealth as long as it meets the in-person privacy standards outlined in HIPAA. Governor Phil Murphy signed the bill into law on December 21.
Pennsylvania
Independence Blue Cross
Independence Blue Cross reviewed its Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH) (Medicare Advantage) Policy with the following changes:
- Changed coverage decision for aquablation (water jet-hydrosection) for the treatment of urinary outlet obstruction due to benign prostatic hyperplasia (BPH) from experimental/investigational to medically necessary, along with associated criteria
- Revised criteria for prostatic urethral lift for the treatment of urinary outlet obstruction due to BPH
- Changed coverage decision for code C2596 from experimental/investigational to medically necessary
- Indicated that this version of the policy has a retro-effective date of December 27, 2020
H.B. 2142 – Infertility Treatments
Introduced by Representative Steve Malagari (D), H.B. 2142 seeks to require health insurers to cover infertility treatments with no cost sharing. The bill was referred to the House Insurance Committee.
Virginia
H.B. 81 – Telehealth
Pre-filed for 2022 by Delegate Terry Kilgore (R), H.B. 81 would require the board of health to consult with the Virginia Telehealth Network to develop and maintain the statewide telehealth plan.
H.B. 264 – Telehealth
Pre-filed for 2022 by Delegate Chris Head (R), H.B. 264 seeks to allow the board of medicine to allow a physician licensed in good standing in another state to provide telehealth services during a board of health emergency order, when the purpose is to provide continuity of care to a patient in the state through telehealth if the patient and provider have an established patient-physician relationship.
S.B. 148 – Medical Business
Introduced by Senator Thomas Norment, Jr. (R), S.B. 148 seeks to provide limited immunity to health care professionals during a disaster or local emergency under specific circumstances. The bill was referred to the Senate Judiciary Committee.
S.B. 205 – Certificate of Need
Introduced by Senator J. Chapman Petersen (D), S.B. 205 seeks to create an expedited application and review process for specialized center or clinic or portion of a physician’s office for the provision of outpatient or ambulatory surgery, for services limited to a single specialty. The bill was referred to the Senate Education and Health Committee.
S.B. 243 – Professional Liability Insurance
Pre-filed for 2022 by Senator Dawn Adams (D), S.B. 243 seeks to require a physician to maintain professional liability coverage with limits equal to the current limitation on damages set forth in § 8.01-581.15, the limit on malpractice damages cap which increases every year.
Best regards,
Kathy and the AUA Public Policy & Advocacy Team