April 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 success with the National Cancer Institute’s updated K08 Award percent requirements.
We also share registration information on the Virtual Annual Urology Advocacy Summit.
Registration for Virtual Annual Urology Advocacy Summit Launched
Make plans now to join the AUA in July when we bring Washington, DC to you with the Virtual Annual Urology Advocacy Summit! The month of July will feature several advocacy-related events, including a Virtual Hill Day on July 21 that will provide direct opportunities to connect with key federal lawmakers and their staff on the topics impacting your practice and patients. The AUA Summit’s keynote speaker is Ashish Jha, MD, MPH – the Dean at Brown University’s School of Public Health. Featured on MSNBC and CNN, Dr. Jha is a world authority on the COVID-19 pandemic, so he brings unique insights to topics currently impacting healthcare and the future of healthcare in a post-COVID world.
The event is free to all domestic AUA members. Register today!
NCI Reduces K08 Award Percent Effort Requirements – Thanks AUA for Valuable Input
On April 14, the National Cancer Institute (NCI) officially changed their rules to allow K08 applicants to apply for awards at 50% effort. The AUA received the follow response from NCI Center for Cancer Training Director Oliver Bogler:
“I particularly appreciate that you gathered input from across your organization and included it in your reply…. Your response informed the decision to make the changes outlined in the recently published NOT-CA-21-054. NCI will now allow surgeon-scientist applicants to reduce the percent effort required for conducting research career development on a K08 award below 75% (nine person-months), but no lower than 50% (six person-month).”
This has been part of a long standing and ongoing effort within the AUA to work with federal research institutions to offer feedback on award mechanisms to ensure the conduciveness of urologic research.
On February 11, the AUA responded to the National Cancer Institute (NCI) Request for Information (RFI) from on lowing percent efforts from 75% to 50% within the Mentored Clinical Scientist Research Career Development Awards (K08). Based on an AUA survey, with more than 200 AUA member respondents, the AUA advocated for a reduction of the percent effort to 50%. Currently, many applicants do not attempt to apply for these grants because their institutions will not allow them to spend 75% of their time in the lab and only 25% in clinic.
The lowering of the percent effort to 50% will allow more surgeon-scientist to apply, and to address major needs in moving research discoveries forward into clinical practice.
AUA Continues Series of Virtual Meetings with Freshman Lawmakers
The AUA continued its series of meetings with first-year lawmakers in the U.S. House of Representatives. The goal is to introduce urology and the AUA’s top advocacy initiatives, such as addressing physician workforce shortages, enhancing access to prostate cancer screening, expanding access to telehealth services and increasing federal research funding. Over the past few weeks, the AUA specifically met with staff in the offices of Representatives Randy Feenstra (R-IA-04), Andrew Garbarino (R-NY-02), Bob Good (R- VA-05), Nancy Mace (R-SC-01), Lisa McClain (R-MI-10), Matt Rosendale (R-MT-At Large), Marilyn Strickland (D-WA-10) Mariannette Jane Miller-Meeks (R-IA-02), Nikema Williams (D-GA-05), Young Kim (R-CA-39), and Michelle Steel (R-CA-48).
AUA Telehealth Task Force Meets Senate Staff on CONNECT Act
On April 2, members of the Urology Telehealth Task Force met virtually with healthcare policy staff from the office of Senator Brian Schatz (D-HI) on the reintroduction of the Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act (CONNECT) Act. Public Policy Council Chair Dr. Eugene Rhee and Urology Telehealth Task Force Chair Dr. Aaron Spitz highlighted payment parity for telehealth services, the continuation of audio-only telehealth visits beyond the public health emergency and the elimination of the originating site requirement as the primary policy initiatives supported by the AUA. Senator Schatz’s staff was very receptive to those issues and expressed support for inclusion in the upcoming legislation.
A previous version of the CONNECT Act introduced in 2019 during the last Congress contained sections to loosen the originating site requirement, but was limited in scope. With the onset of the pandemic, proposed telehealth legislation has dramatically changed due to the obvious benefits now enjoyed by patients no matter their location. Congress and the Centers for Medicare & Medicaid Services continue to discuss what provisions require legislation, and what issues the agency can regulate under current law.
ICYMI: Updates from the AUA Policy & Advocacy Brief blog
AUA Interviews Representative David McKinley on Student Loan Forgiveness Bill
On March 30, the AUA released a special edition of the AUA Inside Tract podcast. It is an interview between former AUA Holtgrewe Legislative Fellow, Joshua Langston, MD, and Representative David McKinley (R-WV-01), sponsor of the rural physician student loan forgiveness bill. The podcast also highlights that it is a special edition of the AUA Inside Tract, as part of the Policy & Advocacy Resident Workgroup’s efforts to educate residents and fellows on advocacy issues important to urology.
You can listen to the podcast by clicking the following link: https://www.auanet.org/podcast/aua-advocacy-update-for-march-30-2021
AUAPAC Attends Fundraiser for Representative from Kentucky
On March 23, AUAPAC participated in a virtual fundraiser for Representative Brett Guthrie (R-KY-02). Earlier this year, Congressman Guthrie was appointed as the Ranking Member of the House Energy & Commerce Subcommittee on Health. The Health Subcommittee has jurisdiction on AUA-championed legislation such as the U.S. Preventive Services Task Force Transparency and Accountability Act and the specialty physician student loan forgiveness bill (H.R. 944). Representative Guthrie also championed the AUA-supported urotrauma legislation from original introduction through passage as part of the Fiscal Year 2016 National Defense Authorization Act.
For more information on AUAPAC activities, please visit www.MyAUAPAC.org.
AUA Hosts Congressional Briefing on Prostate and Kidney Cancer Research Funded Through Department of Defense (DOD)
The AUA, KidneyCAN and ZERO: The End of Prostate Cancer jointly hosted a congressional briefing to educate and raise awareness about the Kidney Cancer Research Program (KCRP) and Prostate Cancer Research Program (PCRP), as well as ensure robust and sustained funding for these urologic programs. The March 16 briefing targeted members of Congress and congressional staffers.
As part of the briefing, the following panel of experts shared their experiences and the important work conducted through the Congressionally Directed Medical Research Programs (CDMRP):
- Dr. Scott K. Swanson, President, AUA Board of Directors and urologist at Mayo Clinic
- Representative Rosa DeLauro (D-CT-03), Chair, House Committee on Appropriations
- Dr. Carolyn Best, Director of Research, AUA
- Mr. Anthony Minter, prostate cancer patient and Consumer Reviewer for PCRP
- Dr. Hyung Kim, Director of the Cedars-Sinai Academic Urology Program, Associate Director of Surgical Research in the Samuel Oschin Comprehensive Cancer Center and KCRP peer reviewer
- Dr. Brandon Manley, Genitourinary Oncologist at Moffitt Cancer Center, and recipient of multiple KCRP awards.
As background, the CDMRP originated in 1992 via a Congressional appropriation, through the Department of Defense, to foster novel approaches to biomedical research. These programs focus on military medical research, cancer research and other disease- and injury-specific research. All the programs managed by CDMRP share the common goal of filling gaps in research by funding high impact, high risk and high gains projects that lead to improvements in patient care, breakthrough technologies and resources for clinical benefit.
A recording of the briefing can be found here.
Below are insurance updates from national insurance carriers. If you have questions about insurer issues, contact Ray Wezik at firstname.lastname@example.org.
Aetna reviewed its Benign Prostatic Hyperplasia Medical Policy clarifying that Rezum system is also known as convective radiofrequency transurethral water vapor therapy, and removing HCPCS code C9747.
BCBS Federal Employee Plan
BCBS Federal Employee Plan reviewed its Botox Prior Authorization (PA) Criteria adding neurogenic detrusor overactivity as an approved indication and the following approval criteria:
- For prior-approval and renewal, 5-17 years of age
- For prior approval and renewal, patient must have the following:
- For prior approval and renewal, neurogenic detrusor overactivity (NDO)
- For prior-approval, inadequate response or intolerance to an anticholinergic
- For prior-approval and renewal, no dual therapy with other botulinum toxins
CGS Administrators retired its Genomic Health Oncotype DX Prostate Cancer Assay (MoIDX) (J15) (L36206) Local Coverage Determination (LCD) stating this LCD is being retired because the information in this policy has been incorporated within the new LCD for Prostate Cancer Genomic Classifier Assay for Men with Localized Disease (MoIDX) (L38303).
CGS Administrators retired its Oncotype DX Genomic Prostate Score (MolDX) (L37354) Local Coverage Determination (LCD) stating that this LCD is being retired because the information in this policy has been incorporated within the new LCD for “Prostate Cancer Genomic Classifier Assay for Men with Localized Disease” (MoIDX) (L38303).
CGS Administrators reviewed its Prostate Cancer Genomic Classifier Assay for Men with Localized Disease (MoIDX) (J15) (A58371) Local Coverage Article (LCA) adding the following CPT code:
- 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
Humana reviewed its Fluorescence In Situ (FISH) for Noncancer Indications Policy removing the policy statement for Y chromosome microdeletion analysis in men with nonobstructive azoospermia or severe oligozoospermia (less than 5 million sperm/mL) prior to assisted reproductive technologies (when not contractually excluded).
Humana reviewed its Laboratory Analysis for Prostate Cancer Policy removing general criteria for genetic and pharmacogenomics tests to be applied when disease- or gene-specific criteria are not available on a medical coverage policy.
Humana has updated their Botox policy with changes to criteria and indications.
- Humana has added neurogenic detrusor overactivity in members 5 years of age and older as a medically necessary indication with the following criteria:
- The member has had previous treatment, contraindication, or intolerance with one muscarinic receptor antagonists (e.g., oxybutynin, trospium).
- The following limitations apply to Botox (onabotulinumtoxinA) when used in the treatment of urinary incontinence:
- Acute urinary tract infections and/or acute urinary retention
- Use of botox (onabotulinumtoxinA) in combination with other anticholinergic agents
- Humana amended language for urinary incontinence usage from “with two formulary muscarinic receptor antagonists” to “with two muscarinic receptor antagonists”.
- Criteria for Botox utilization for urinary incontinence now reads: “The member has had previous treatment, contraindication, or intolerance with two muscarinic receptor antagonists (e.g., oxybutynin, trospium)*.”
- Asterisk notifies that this does not apply to Medicare medical requests.
Palmetto retired its Oncotype DX Genomic Prostate Score (MolDX) (JJ, JM) (A56285) Local Coverage Article (LCA) stating this article is being retired because the information in this article has been incorporated within the article for “Prostate Cancer Genomic Classifier Assay for Men with Localized Disease” (MoIDX) (A58343).
Palmetto retired its Oncotype DX Genomic Prostate Score (MolDX) (JJ, JM) (L37262) Local Coverage Determination (LCD) stating that this LCD is being retired because the information in this policy has been incorporated within the LCD for “Prostate Cancer Genomic Classifier Assay for Men with Localized Disease” (MoIDX) (L38292).
Palmetto retired its Oncotype DX Prostate Cancer Assay (MolDX) (JJ, JM) (L36153) Local Coverage Determination (LCD) stating that this LCD is being retired because the information in this policy has been incorporated within the new LCD for “Prostate Cancer Genomic Classifier Assay for Men with Localized Disease” (MoIDX) (L38292).
Palmetto reviewed its Prostate Cancer Genomic Classifier Assay for Men with Localized Disease (MolDX) (JJ, JM) (A58343) Local Coverage Article (LCA) adding the following CPT code:
- 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.
United Healthcare reviewed its Prostate Surgery (Commercial and Commercial West) Medical Policy adding documentation requirements section, including requirements for the following procedures:
- Transurethral ablation
- Cryoablation of the prostate
- Surgical – radical prostatectomy
- Prostatic urethral lift
United Healthcare reviewed its Biofeedback Therapy for the Treatment of Urinary Incontinence (NCD 30.1.1) (Medicare Advantage) Policy removing CPT code 90911.
United Healthcare reviewed its Molecular Oncology Testing for Cancer Diagnosis, Prognosis, and Treatment Decisions (Value & Balance Exchange) Policy revising examples of not medically necessary cancer panels adding ExoDX Prostate IntelliScore (EPI).
United Healthcare reviewed its Prostate Services and Procedures (Medicare Advantage) Policy revising guidelines for fluid jet system for treatment of benign prostatic hyperplasia (BPH) revising language to indicate LCDs/LCAs exist for all states/territories and compliance with these policies is required where applicable and removing default guidelines for states/territories with no LCDs/LCAs.
WPS Government Health Administrators
WPS Government Health Administrators retired its Bladder Tumor Marker FISH Billing and Coding Guidelines Update (MolDX) (A56332) Local Coverage Article (LCA) effective February 25.
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. In addition, check out our interactive map on the AUA State Advocacy Webpage for the most updated information on bill status.
State Legislative Trends
- Pennsylvania Seeks to Add Criminal History Requirement to Interstate Medical Licensure Compact Law and Define Supervision of Anesthesia Care;
- Virginia Enacts Two Telehealth Laws – the AUA continues to support the full expansion of telehealth services post the current public health emergency and, on a national level, has met with the Centers for Medicare & Medicaid Services (CMS) to urge the adoption of audio-only visits; and
- West Virginia Introduces Telehealth Reimbursement Parity Bill.
State Session Calendar
Legislative sessions ended for Virginia (March 1); Maryland (April 9); and West Virginia (April 10).
Independence Blue Cross
Independence Blue Cross reviewed its Molecular Diagnostics Attachment B (Medicare Advantage) Supporting Coverage Document removing policy content and associated coding for services including Urovysion Bladder Cancer Kit.
Independence Blue Cross reviewed its Molecular Diagnostics Attachment C (Medicare Advantage) Supporting Coverage Document removing HCPCS codes S3721 – Prostate cancer antigen 3 (PCA3) testing.
H.B. 912 – Medical Licensure
Introduced by Representative Steve Mentzer (R), H.B. 912 seeks to define the qualifications required for a non-anesthesiologist physician to supervise anesthesia care. Supervision is defined as under a qualified physician’s direction and control and the qualified physician is immediately available to provide assistance and direction regardless of whether the physician is in the room for the procedure. The bill was referred to the House Professional Licensure Committee. Read the bill.
S.B. 444 – Interstate Medical Licensure Compact
Introduced by Senator Lisa Boscola (D), S.B. 444 seeks to amend state law to require applicants for a medical license under the Interstate Medical Licensure Compact Act to submit to a criminal history background check conducted by the state police. The bill was referred to the Senate Committee on Consumer Protection and Professional Licensure. Read the bill.
H.B. 1987 – Telehealth (ENACTED)
Introduced by Delegate Dawn Adams (D), H.B. 1987 seeks to amend state law to allow for reimbursement of audio-only telehealth Medicaid services. Governor Ralph Northam (D) signed the bill on March 24. Read the bill.
S.B. 1338 – Telehealth (ENACTED)
Introduced by Senator George Barker (D), S.B. 1338 seeks to amend state telehealth law to allow for audio-only reimbursement. Governor Ralph Northam (D) signed the bill on March 24. Read the bill.
H.B. 3182 – Telehealth
Introduced by Representative Larry Rowe (D), H.B. 3182 seeks to require insurers to provide benefits for telemedicine treatment and evaluation services at the same rate for the same in-person medical services. The bill was referred to the House Banking and Insurance Committee. Read the bill.
Kathy and the AUA Public Policy & Advocacy Team
Kathleen Zwarick Shanley, PhD, CAE, ACC
American Urological Association
Chief Policy Officer & Executive Vice President, Public Policy and Advocacy
1000 Corporate Boulevard
Linthicum, MD 21090