April 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. We encourage you to share these updates with your membership. Our updates include information on agency meetings to discuss urologic research needs and continued advocacy to support the urologic workforce and telehealth.
Mark your calendars for the 6th Annual Urology Advocacy Summit in 2023. The event will be February 27 – March 1, 2023 at the Capital Hilton in Washington, DC. We look forward to seeing you there!
AUA Advances Support for AUA Summit Asks on Workforce, Telehealth and Diversity
On March 29-31, as a follow-up to the 5th Annual Urology Advocacy Summit, the AUA met with staff in the office of Representatives Scott Peters (D-CA-52) and Kathleen Rice (D-NY-04) and Senators Jerry Moran (R-KS) and Tina Smith (D-MN). During the meetings, the AUA reiterated and answered any outstanding questions about the legislative asks from Congressional staff.
In addition, on April 6, the AUA met with staff in the office of Representative Brad Wenstrup (R-OH-02). During the meetings, the AUA reiterated and answered any outstanding questions about the legislative asks from congressional staff. As a reminder, during Hill visits at the AUA Summit attendees requested that members of the House and Senate support easing the specialty physician workforce shortage, make telehealth expansion permanent, diversify clinical trials, and reform the Medicare Physician Fee Schedule.
The AUA will continue to hold additional meetings to help further the AUA’s legislative priorities during the remainder of this Congress.
AUA Meets with NIH Agencies to Discuss Urologic Research Needs
During the week of March 21, Research Advocacy Committee (RAC) members met with representatives from the National Cancer Institute (NCI), National Institute on Aging (NIA), and National Institute of Allergy and Infectious Diseases (NIAID) to discuss AUA urologic research needs and priorities. Led by AUA President Raju Thomas, MD, and RAC Chair Michael Hsieh, MD, PhD, the group advocated on behalf of increased research on racial disparities, resiliency in older adults, and better engagement between the agencies and AUA activities.
NCI Director Ned Sharpless, MD, agreed with the AUA delegation’s emphasis on quality of life issues, stating: “These questions that sit around quality of life and outcomes are tremendously important and can sometimes get swamped by mortality questions, but they’re no less important and should be considered.”
The RAC also met with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) the week of April 18, to discuss a change from T32 to U2C early career investigator awards.
These meetings were held in conjunction with the 2022 Annual Urology Advocacy Summit.
AUA Works to Increase Research Funding for Urologic Diseases
As part of the AUA’s yearly efforts around appropriation funding, the AUA meets with House and Senate Appropriations Committee members in an effort to further urologic-related research done by the National Institutes of Health and the Congressionally Directed Medical Research Programs. The AUA leads an effort, in partnership with Bladder Cancer Advocacy Network (BCAN), to create a Bladder Cancer Research Program within CDMRP to provide a dedicated line of funding for the research around the disease. The AUA supports similar programs already established for prostate and kidney cancer. These programs must be requested each year or risk elimination from the program.
ICYMI: Updates from the AUA Policy & Advocacy Brief blog
HRSA Reopens Reporting Period Due to AUA Request
On March 31, the AUA, along with the American Medical Association (AMA) and 30 other specialty societies, sent a letter to the Health Resources and Services Administration (HRSA) urging them to reopen the Provider Relief Fund (PRF) reporting period for at least 60 days. As a direct result of the AUA’s letter, HRSA has reopened the reporting period. Providers who received more than $10,000 in PRF funds and failed to submit their period 1 reports by the November 30, 2021, deadline will now have until April 22 to submit a late reporting period 1 request. The AUA believes the extra time will allow urologic practices to maximize needed relief funds related to the pandemic. For a copy of the letter, please reach out to the AUA Policy & Advocacy Director Ray Wezik at rwezik@AUAnet.org.
President Biden Releases Fiscal Year 2023 Budget Request
On March 28, President Biden released his fiscal year (FY) 2023 budget request including a proposal for a $4.312 billion increase in discretionary funds for the National Institutes of Health with $4 billion of that for ARPA-H (Advanced Research Projects Agency for Health). This proposal leaves a total increase of just $312 million for all of the NIH’s Institutes/Centers. The President also is proposing a $12 billion increase in mandatory funds for NIH for pandemic preparedness. Additionally, the President requested $430.8 billion for the Centers for Disease Control and Prevention – a significant increase from last year’s appropriation of $389.8 billion. For more information, check out the full breakdown of the President’s budget.
The AUA continues to advocate for increased research funding within the federal government agencies related to urology.
AUA Comments on VA Pilot Program on Graduate Medical Education and Residency
On April 5, the AUA and the Alliance of Specialty Medicine (ASM) convened on a comment letter to the Department of Veterans Affairs (VA) regarding the implementation of the VA Pilot Program on Graduate Medical Education and Residency (PPGMER). The letter applauded the VA’s efforts to ensure that the program reflects the role that specialists serve in meeting the needs of America’s veterans and the attention paid to lack of access to specialty care in the development of the PPGMER placement factors. The VA’s efforts will support national workforce needs while connecting healthcare providers to veterans in communities where increased access is needed most. For a copy of the letter, please contact the AUA Legislative & Political Affairs Vice President Brad Stine at bstine@auanet.org.
AUA Comments on Electronic Prior Authorization RFI
On March 18, the AUA joined the Alliance of Specialty Medicine in a letter to the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) to offer suggestions to improve utilization management processes through the adoption of electronic prior authorization for federally authorized plans, including Medicare Advantage plans.
In the letter, the AUA suggests ONC consider burden reduction policies such as the Improving Seniors Timely Access to Care Act (H.R. 3173/S. 3018) and Safe Step Act (H.R. 2163/S. 464). The letter noted CMS has the authority to implement many of the provisions of the Improving Seniors Timely Access to Care Act, such as the creation of a real-time decision making process for certain routinely approved services and items. The letter is attached for your review.
Utilization management protocols create administrative issues that delay diagnostic and therapeutic treatment in medical specialties such as urology. The AUA remains concerned with federal agencies’ decisions to walk back utilization management proposals that would have alleviated the frustrations that specialties face with prior authorization. The AUA submitted individual comments to ONC on this request that largely echo both the Alliance and the American Medical Association comments around prior authorization. For a copy of the letter or the AUA’s comments, please contact AUA Policy & Advocacy Director Ray Wezik at rwezik@auanet.org.
AUAPAC Participates in Fundraisers for Two Senate HELP Committee Members
On March 23, AUAPAC participated in a fundraiser for Senator Jerry Moran (R-KS), hosted by a coalition of Medical and Dental Political Action Committees known as MaDPAC. Senator Moran serves as Ranking Member of the Senate Committee on Veterans’ Affairs and member of the Senate Health, Education, Labor & Pensions (HELP) Committee. During the fundraiser, Senator Moran expressed the need for continued access to specialty physicians for men and women in the military and civilians in rural America.
Additionally, AUAPAC participated in a fundraiser for Senator Jacky Rosen (D-NV). Senator Rosen serves on the Senate HELP Committee and is a staunch supporter of addressing the impending physician workforce shortage in rural America. During the fundraiser, Senator Rosen expressed her dissatisfaction that America is experiencing a workforce shortage across many sectors. She feels Congress needs to take the necessary steps to reinforce the workforce to help resolve other issues such as infrastructure and access to healthcare.
Below are insurance updates from national insurance carriers. If you have questions about insurer issues, contact Raymond Wezik at rwezik@auanet.org.
Aetna
Aetna reviewed its Ostomy Supplies Policy with the following changes to coding:
- Added HCPCS codes A4436 and A4437
- Removed HCPCS code A4397
Aetna reviewed its Urinary Incontinence Policy updating criteria for InterStim for urge urinary incontinence (UI) and non-obstructive urinary retention.
CGS Administrators
CGS Administrators issued a new version of its Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (J15) (L38378) Local Coverage Determination (LCD).
CGS Administrators issued a new version of its Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (J15) (A57926) Local Coverage Article (LCA).
CGS Administrators issued a new version of its Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (J15) (L38378) Local Coverage Determination (LCD).
CGS Administrators issued a new version of its Laser Ablation of the Prostate (J15) (A56467) Local Coverage Article (LCA).
CGS Administrators issued a new version of its Laser Ablation of the Prostate (J15) (L34090) Local Coverage Determination (LCD).
Cigna
Cigna reviewed its Molecular Diagnostic Testing for Hematology and Oncology Indications Policy with the following changes:
- Updated criteria for somatic pathogenic or likely pathogenic variant genetic testing, tumor profile/gene expression classifier testing, screening and prognostic tests for early detection of prostate cancer, tumor tissue-based molecular assays for detection of prostate cancer, hematologic cancer and myeloproliferative and myelodysplastic disease
- Removed policy statement for solid tumor cancers
- Added codes including 81277, 81314, 81450, 81455, 0235U
- Removed codes including 81545, 0081U, 88299, 88399, 89240
- Revised description for code 81229
First Coast Service Options
First Coast Service Options published it new Rezum Procedure (A59038) (JN) Local Coverage Article (LCA).
First Coast Service Options retired its Rezum System for Use in the Management of Benign Prostatic Hypertrophy Clarification Regarding the System Technology and Correct Billing (A55477) Local Coverage Article (LCA). The article is being replaced with Billing and Coding: Rezum Procedure (A59038) effective March 10.
Humana
Humana revised its Genetic Testing and Liquid Biopsy for Prostate Cancer Policy adding a requirement for pre- and post-test genetic counseling.
Novitas
Novitas reviewed its Rezum Procedure (A55352) Local Coverage Article (LCA) removing the following language from the Coding Guidance section:
- “The claim, in block 19 on the CMS 1500 form (or its electronic equivalent), should indicate that the Rezum procedure was performed.”
Palmetto
Palmetto reviewed its Next-Generation Sequencing for Solid Tumors (MolDX) (JJ, JM) (A57831) Local Coverage Article (LCA) revising the description for HCPCS Code 0244U, due to the 2022 Annual CPT/HCPCS Code Update.
United Healthcare
United Healthcare reviewed its Urinary and Fecal Incontinence Diagnosis and Treatment (Medicare) Policy adding PureWick urine collection system as an approved device with associated guidelines, and HCPCS code K1006.
WPS Government Health Administrators
WPS Government Health Administrators issues a new version of its Testing of Multiple Genes (MoIDX) (J05, J08) (A57880) Local Coverage Article (LCA) with the following changes:
- Under CPT/HCPCS Codes Group 1: Paragraph deleted the verbiage and moved it to the end of the Article Text section.
- Deleted all codes under CPT/HCPCS Codes Group 1: Codes.
- Deleted CPT/HCPCS Codes Group 2: Paragraph, CPT/HCPCS Codes Group 2: Codes, and CPT/HCPCS Modifiers Group 2: Codes.
- Under Article Text added the verbiage: “Refer to Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT) A57772 for CPT/HCPCS Codes that are applicable to this article” after the first sentence.
- Added L36807 MolDX: Molecular Diagnostic Tests (MDT) & associated billing and coding article links under Associated Documents and removed A57878 & NCD 90.2 links.
WPS Government Health Administrators issues a new version of its ProMark Risk Score (L37011) Local Coverage Determination (LCD) with the following changes:
- Under Bibliography changes were made to citations to reflect AMA citation
- Added registered trademark symbol to ProMark throughout the document
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.
Legislative session ended for the following states: Maryland (April 11), Virginia (March 12), and West Virginia (March 12). Virginia is in special session April 4-May 4.
Delaware
S.B. 265 – Insurance
Introduced by Senator Spiros Mantzavinos (D), S.B. 265 requires that third-party cost sharing utilized by enrollees is applied toward the enrollee’s deductibles and any out-of-pocket limits. The bill was referred to the Senate Banking, Business and Insurance Committee.
S.B. 267 – Insurance
Introduced by Senator Spiros Mantzavinos (D), S.B. 267 requires a third-party cost-sharing assistance utilized by patients is applied toward the enrollee’s health insurance deductibles and any out-of-pocket limits. Additionally, the bill defines what constitutes a “cost-sharing requirement” as well as how to calculate the assistance when applying to patient’s deductibles and out-of-pocket limits. The bill was referred to the Senate Banking, Business and Insurance Committee.
District of Columbia
D.C. B 24-0683 – Medical Business ENACTED
Introduced by Councilmember Elissa Silverman (I), D.C. B 24-0683 amends when the ban on non-compete agreements applies from March 16, 2021, to October 1, 2022. Mayor Muriel Bowser (D) signed the bill into law on March 28.
Maryland
CareFirst BCBS
CareFirst BCBCS reviewed its Treatments for Urinary Incontinence Policy removing HCPCS codes E0740, L8603, and L8606.
New Jersey
Horizon BCBS New Jersey
Horizon BCBS New Jersey reviewed its Radiation Therapy for Prostate Cancer Policy with the following changes:
- Coverage decision for SpaceOAR during radiation therapy for prostate cancer from investigational to medically necessary
- Updated Medicare coverage information
- Added CPT code 55874
- Removed HCPCS code C9743
- 3239 – Medical Business
Introduced by Assemblymember Pam Lampitt (D), A. 3239 requires a plaintiff to obtain an affidavit of merit in a malpractice action. The bill was referred to the Assembly Judiciary Committee.
- 3488 – Telehealth
Introduced by Assemblymember Ron Dancer (R), A. 3488 requires a healthcare facility obligated by federal or state law to provide language interpretation services to patients who are not proficient in the English language or patients who are deaf or hard of hearing. The healthcare facility is to provide the required language interpretation services regardless of whether the healthcare facility is engaged in telehealth or in-person treatment. The bill was referred to the Assembly Health Committee.
- 3656 – Medical Business
Introduced by Assemblymember Sterley Stanley (D), A. 3656 revises the requirements concerning the fees charged for professional treatment and billing records reducing the current per-page fee cap of $200 to $50, regardless of the method used to store the record; revises the authorized fee of up to $10 per search for patient treatment and billing records to no more than $20 per request, no search fee is to be charged to a patient requesting their own records. The bill was referred to the Assembly Health Committee.
- 3715 – Medical Business
Introduced by Representative Paul Moriarty (D), A. 3715 places certain limitations on restrictive covenants. Under the bill, an employer may require an employee enter into a restrictive covenant as a condition of employment or with respect to severance pay. A restrictive covenant is enforceable to the extent that it meets the certain requirements. The bill has not yet been referred to a committee.
- 1794 – Insurance
Introduced by Senator Vin Gopal (D), S. 1794 requires a utilization review (UR) entity to make certain disclosures regarding its prior authorization (PA) requirements and restrictions, on its website and in writing; if a UR entity requires PA of a covered service, the UR entity shall make a PA and notify the enrollee and the healthcare provider of the PA within two business days (one business day for an urgent healthcare service) of obtaining all necessary information to make the PA; and prohibits a UR entity from: requiring an enrollee to participate in a step therapy protocol; requiring a healthcare provider first obtain a waiver, exception or other override when deeming a step therapy protocol to not in enrollee’s best interests; or penalizing a healthcare provider for issuing a prescription, performing a procedure or performing a test that may conflict with the step therapy protocol of the carrier. The bill was referred to the Senate Commerce Committee.
- 2253 – Medical Business
Introduced by Senator Nick Scutari (D), S. 2253 revises the requirements concerning the fees charged for professional treatment and billing records reducing the current per-page fee cap of $200 to $50, regardless of the method used to store the record; revises the authorized fee of up to $10 per search for patient treatment and billing records to no more than $20 per request, no search fee is to be charged to a patient requesting their own records. The bill was referred to the Senate Health, Human Services and Senior Citizens Committee.
Virginia
S.B. 148 – Medical Business ENACTED
Introduced by Senator Thomas Norment, Jr., S.B. 148 seeks to provide limited immunity to health care professionals during a disaster or local emergency under specific circumstances. Governor Glenn Youngkin (R) signed the bill into law on April 11.
West Virginia
H.B. 4021 – Student Loans ENACTED
Introduced by Representative Chuck Horst (R), H.B. 4021 amends the Medical Student Loan Program authorizing medical schools to make loans, authorizing the use of special revolving funds for program use, establishing eligibility requirements, setting maximum loan amount, requiring an agreement for persons participating, requiring persons participating to select service commitment area, establishing repayment obligation for those participants who do not satisfy commitment obligation and establishing school reporting requirements. Governor Jim Justice signed the bill into law on March 28.
H.B. 4634 – Medical Licensure ENACTED
Introduced by Representative Paul Espinosa (R), H.B. 4634 provides an application method for persons with a valid license in another state to be licensed in West Virginia and outlines the criteria. Governor Jim Justice (R) signed the bill into law on March 30.
S.B. 25 – Medical Business ENACTED
Introduced by Senator Tom Takubo (R), S.B. 25 seeks to require a health care professional who executes a certificate of merit in a professional liability case shall be subject to deposition by the subject of the certificate of merit. Governor Jim Justice (R) signed the bill into law on March 23.
S.B. 138 – Medical Licensure ENACTED
Introduced by Senator Tom Takubo (R), S.B. 138 seeks to reduce the number of members on the Board of Medicine from 16 to 15. Governor Jim Justice (R) signed the bill into law on March 28.
S.B. 585 – Medical Licensure ENACTED
Introduced by Senator Tom Takubo (R), S.B. 585 would create an administrative medical license category for physicians who do not want to practice clinical medicine. Governor Jim Justice (R) signed the bill into law on March 23.
S.B. 606 – Medical Licensure ENACTED
Introduced by Senator Ryan Weld (R), S.B. 606 requires providers licensed by the Board to report misconduct and provides civil immunity for making good-faith reports. Governor Jim Justice (R) signed the bill into law on March 28.
Best regards,
Kathy and the AUA Public Policy & Advocacy Team