March 2020 - AUA Public Policy Council Update for MAS
I am pleased to share updates from the AUA Public Policy Council that may benefit your Section members. Our updates include information on recently introduced federal bills on veteran’s prostate cancer care and the workforce shortage. We also highlight important updates on state advocacy in Arizona relating to a Kidney Health and Cancer Awareness Month Proclamation.
2020 AUA Summit: New Dates Confirmed
The AUA is pleased to announce the 2020 Annual Urology Advocacy Summit has been rescheduled and will now take place from August 31 to September 2, 2020 at the Hyatt Regency Capitol Hill in Washington, DC.
For those that were originally planning to attend, we have transferred your registration to the new dates. In the coming weeks, we will share additional information regarding hotel and travel, along with information to help you easily engage your lawmakers on the issues most important to you and your practice.
If you are able to attend, no further action is needed at this time. However, if you are not able attend, please email LegistlativeAffairs@AUAnet.org to cancel your registration.
We appreciate your commitment and flexibility and look forward to seeing you in Washington, DC later this year!
COVID-19 Pandemic: CMS to Relax Medicare Telemedicine Requirements
With the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) relaxed their requirements on reimbursing Medicare telehealth services. Here is the CMS announcement on telehealth services, the Medicare Telemedicine Provider Fact Sheet and Medicare Telehealth Frequently Asked Questions (FAQs). See more information on coronavirus disease at the AUA Information Center and what urologists should know about the telehealth changes.
Veterans Health/Prostate Cancer Care: AUA-led Bill to Create Clinical Pathway and a Comprehensive Prostate Cancer Care Program for Veterans Introduced
On March 5, Congressmen Neal Dunn (R-FL-02) and Joe Cunningham (D-SC-1) introduced H.R. 6092, Veteran’s Prostate Cancer Treatment and Research Act, a long-awaited bill that would establish a national clinical pathway for prostate cancer, a comprehensive standardized system of treatment for veterans and establishes a real-time registry to track patients’ progress. The bipartisan bill also creates a national prostate cancer care program with recommendations on the use of transformative innovations, research and uniform clinical data designed in collaboration with disciplines across the public and private sector to guide evidence-based care for veterans. Read the AUA press release.</p”>
As you have been previously informed, the AUA, specifically the AUA Veterans Health Workgroup, has been working closely with urologist Rep. Neal Dunn, MD (R-FL-2) and Rep. Cunningham (D-SC-1) and their staff for nearly a year to develop this legislation, and it will be a major focal point of the upcoming AUA Summit. Read more about H.R. 6092.
The AUA will begin a strategy to build awareness and congressional support for this important legislation moving forward. If you have any questions or are interested in learning how to promote H.R. 6092 with your legislator, please contact Quardricos Driskell at QDriskell@AUAnet.org.
Urology Workforce Shortage: Bill to Create Student Loan Forgiveness Bill Introduced in the House
On February 18, Congressmen David McKinley (R-WV-1) and Peter Welch (D-VT-AL) introduced a long-awaited bill that would help to address the workforce shortage of specialty physicians in rural America (H.R. 5924). This bipartisan legislation would create a student loan repayment program for specialty physicians that practice in rural communities for a minimum of six years. While student loan forgiveness programs exist through agencies like the National Health Service Corps, none of them are open to specialty care physicians such as urologists.
As you have been previously informed, the AUA has been working closely with Rep. McKinley and his staff for nearly a year to develop this legislation, and it will be a major focal point of the upcoming Annual Urology Advocacy Summit. To read more about H.R. 5924, please click here.
The AUA will now begin a strategy to build awareness and congressional support for this important initiative moving forward. If you have any questions or are interested in learning how to promote H.R. 5924 with your legislator, please contact Joshua Webster at JWebster@AUAnet.org.
Below are insurance updates from national insurance carriers.
Amerigroup Real Solutions, Anthem, BCBS Georgia, BlueChoice HealthPlan of South Carolina, Empire BCBS, Healthlink, Simply Healthcare, Unicare
The Surgically and Minimally Invasive Treatments for Benign Prostatic Hyperplasia (BPH) medical policy has been reviewed and updated with the following changes to criteria, coding, and supporting information:
- Revised coverage decision for the following procedures from medically necessary to not medically necessary: transurethral radiofrequency needle ablation, also called transurethral needle ablation; and water-induced thermotherapy, also called thermo urethral hot-water therapy.
- Revised coverage decision for transurethral convective water vapor thermal ablation from investigational and not medically necessary to medically necessary in members with prostate volume less than 80 mL.
- Added waterjet tissue ablation as a medically necessary procedure.
- Added the following requirement for transurethral incision of the prostate: the member’s prostate volume is less than 30 mL.
- Removed procedures that are considered investigational and not medically necessary for all genitourinary conditions other than benign prostatic hyperplasia.
- Added the following medically necessary CPT code:
- 0421T Transurethral waterjet ablation of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included when performed)
- Added the following medically necessary HCPCS code (effective 01/01/2020):
- C2596 Probe, image-guided, robotic, waterjet ablation
- Revised the following CPT codes from medically necessary to not medically necessary:
- 53852 Transurethral destruction of prostate tissue; by radiofrequency thermotherapy [when specified as RF needle ablation, RF TUNA, RFNA]
- 53899 Unlisted procedure, urinary system [when specified as transurethral destruction of prostate tissue: by water-induced thermotherapy (WIT)]
- Revised the following CPT code from investigational and not medically necessary to medically necessary when criteria are met:
- 53854 Transurethral destruction of prostate tissue; by radiofrequency generated water vapor thermotherapy
Amerigroup Real Solutions, Anthem, BCBS Georgia, BlueChoice HealthPlan of South Carolina, Community Connect Health Plan, Empire BCBS, Healthlink, Unicare
The Sacral Nerve Stimulation (SNS) and Percutaneous Tibial Nerve Stimulation (PTNS) for Urinary and Fecal Incontinence; Urinary Retention medical policy was reviewed and updated with the following additions to coding and supporting information:
- 0587T – Percutaneous implantation or replacement of integrated single device neurostimulation system including electrode array and receiver or pulse generator, including analysis, programming, and imaging guidance when performed, posterior tibial nerve
- 0588T – Revision or removal of integrated single device neurostimulation system including electrode array and receiver or pulse generator, including analysis, programming, and imaging guidance when performed, posterior tibial nerve
- 0589T – Electronic analysis with simple programming of implanted integrated neurostimulation system (e.g., electrode array and receiver), including contact group(s), amplitude, pulse width, frequency (Hz), on/off cycling, burst, dose lockout, patient-selectable parameters, responsive neurostimulation, detection algorithms, closed-loop parameters, and passive parameters, when performed by physician or other qualified health care professional, posterior tibial nerve, 1-3 parameters
- 0590T – Electronic analysis with complex programming of implanted integrated neurostimulation system (e.g., electrode array and receiver), including contact group(s), amplitude, pulse width, frequency (Hz), on/off cycling, burst, dose lockout, patient-selectable parameters, responsive neurostimulation, detection algorithms, closed-loop parameters, and passive parameters, when performed by physician or other qualified health care professional, posterior tibial nerve, 4 or more parameters
BCBS Illinois, BCBS Montana, BCBS New Mexico, BCBS Oklahoma, BCBS Texas, HCSC, HealthSelect Texas Employees Group Benefits Program
BCBS has released a draft policy for Prostatic Urethral Lift with the following proposed changes to criteria and supporting information:
- Revised medically necessary indication from “lower urinary tract symptoms due to benign prostatic hyperplasia” to “moderate-to-severe lower urinary tract obstruction due to benign prostatic hyperplasia.”
- Added the following medical necessity criteria: prostate anatomy demonstrates normal bladder neck without an obstructive or protruding median lobe; member has had appropriate testing to exclude diagnosis of prostate cancer; and member does not have a known allergy to nickel, titanium or stainless steel.
- Removed the following medical necessity criteria: age 45 years or older; International Prostate System Score (IPSS) ≥ 13; and surgical intervention is indicated.
- Revised medical necessity criterion regarding previous treatment; clarified that the member should have persistent or progressive lower urinary tract symptoms despite medical therapy (e.g., α1 -adrenergic antagonists maximally titrated, 5α-reductase inhibitors, or combination medication therapy maximally titrated) over a trial period of no less than 6 months, or is unable to tolerate medical therapy.
- Revised medical necessity criterion regarding prostate gland volume; removed language stating volume should be based on ultrasound imaging.
- Revised medical necessity criterion that requires no active urinary tract infection; removed the descriptor “active;” added requirement of no urinary retention or recent prostatitis (within past year).
- Changed policy title to Prostatic Urethral Lift.
Read the complete update. (Click the link and search for “Prostatic Urethral Lift” in the search bar.)
You can view the latest insurance updates from the AUA. For the week of March 16, 2020, click here. For the week of March 9, 2020, click here. For the week of March 2, 2020, click here. For the week of February 24, 2020, click here.
Local and Regional Updates
The following are updates in your Section. Please contact AUA Executive Vice President Kathleen Shanley at KShanley@AUAnet.org for more information on any of these issues.
HB 852 – Urological Procedure Awareness
On March 3, Maryland House Delegate Erek Barron HB 852 (D) introduced HB 852. This bill specifically requires the state of Maryland to cover a digital rectal exam and a PSA test for men between 40 and 75 years old and men who are at high-risk of developing the disease.
As a reminder, the AUA collaborated with ZERO – The End of Prostate Cancer , Chesapeake Urology and MedChi: The Maryland State Medical Society in formally endorsing the bill. The AUA also sent a support letter to all Health and Governance Operations Committee members prior to the hearing. Lastly, the AUA also sent out a grassroots alert to more than 430 Maryland urologists – urging them to phone, tweet and write their state legislators to support HB 852. The legislation now awaits further consideration by members of the full House. Read the bill.
AB 5508 – Urological Procedure Awareness
On June 6, Assemblymember Andrew Zwicker (D) introduced AB 5508. This bill revises the law requiring health benefits coverage for certain contraceptives (including male sterilizations). AB 5508 was signed by Governor Phil Murphy (D) and is effective on April 16, 2020. Read the bill.
Horizon BCBS New Jersey
Horizon BCBS NJ has updated its gene expression profiling and protein biomarkers for prostate cancer management medical policy to reflect following changes to supporting information:
- Added the following CPT code:
- 81542 – Prostate oncology, mRNA, microarray gene expression profiling
- Updated literature review with a search through October 8, 2019; revised rationale section.
HR 778 – Urological Procedure Awareness
On February 28, Representative Donna Bullock (D) introduced HR 778. This bill designates the week of June 15 through 21, 2020, as “Men’s Health Week” in Pennsylvania. HR 778 was referred to the House Health Committee and awaits consideration. Read the bill.
SB 172 – Balance Billing
On February 14, Senator Barbara Favola (D) introduced SB 172. This bill prohibits balance billing for emergency medical services. On March 5, SB 172 passed the House and is eligible to be sent to Governor Ralph Norman (D). Read the bill.
ICYMI: Updates from the AUA Policy & Advocacy Brief blog
Research Advocacy Efforts: Urology-Specific Funding Requests in the Congressionally Directed Medical Research Program
The AUA supported a request entailing a $10 million increase in funding for kidney cancer within the Department of Defense’s (DoD) Congressionally Directed Medical Research Program (CDMRP). Advocacy organizations including the AUA, are supporting a line item of $50 million to ensure there is a continual and consistent funding increase that ensures treatment innovations continue to improve patient quality of life. As background, kidney cancer was allocated an independent line item within the CDMRP for the first time in Fiscal Year (FY) 19 for of $20 million. In FY 20, the allocation was increased to $40 million.
The AUA, in collaboration with the research advocacy community, submitted an Appropriations request letter to Representatives Ruppersberger (MD-07-D), Harris (MD-01-R) and Cartwright (PA-08-D). The letter promotes research funding for bladder cancer in the Department of Defense (DoD) Congressionally Directed Medical Research Program (CDMRP) and requests Members of Congress to allocate a $10 million line item for Bladder Cancer in FY 21.
Prior Authorization: AUA, Coalition Support of House Legislation; CMS Responds to AUA, AMA
On February 27, the AUA, in conjunction with the Regulatory Relief Coalition (RRC), met with staff in the offices of Reps. Jamie Herrera Beutler (R-WA-03), John Katko (R-NY-24) and Rick Allen (R-GA-12) to educate them on the Improving Seniors’ Timely Access to Care Act (H.R. 3107). The bill – sponsored by Reps. Suzan DelBene (D-WA-01), Mike Kelly (R-PA-16), Roger Marshall, MD (R-KS-01), and Ami Bera, MD (D-CA-07) – would protect patients from unreasonable Medicare Advantage plan requirements that needlessly delay or deny access to medically necessary care (more information can be found here). Cosponsorship of this legislation will be one of the four congressional “asks” during the Annual Urology Advocacy Summit later this month.
As a reminder, the RRC, of which the AUA is an active member, is a coalition of 10 national physician specialty organizations advocating for a reduction in Medicare program regulatory burdens to protect patients’ timely access to care and allow physicians to spend more time with their patients.
The Centers for Medicare & Medicaid Services (CMS) has responded to an American Medical Association-led (AMA) letter cautioning the agency on limiting its prior authorization reforms to automation. The agency’s February 21 letter points out that CMS has been holding listening sessions regarding this issue. CMS also stated that will support the security of electronic health records to address concerns that protections are needed to prevent plans from inappropriately accessing patient information. CMS also has been working to implement tests of the Da Vinci standards in order to understand the costs and timeline for the technology solutions.
The AUA joined the AMA and more than 75 medical societies in addressing CMS’ Patients Over Paperwork initiatives to tackle the challenging issue of prior authorization in September 2019. Both letters are attached.
AUAPAC Update: AUAPAC Attends Event for Physician-Congressman; Hosts Event for West Virginia Representative
On February 26, AUAPAC, in conjunction with its colleagues in the Alliance of Specialty Medicine, attended its second fundraiser this cycle for Rep. John Joyce, MD (R-PA-13). Dr. Joyce is a physician freshman member of Congress and prior to taking office in 2019, served as a dermatologist for more than 25 years in rural Pennsylvania. He has supported numerous issues during his brief time in office, including cosponsoring H.R. 3107 – legislation to streamline prior authorization in the Medicare Advantage program.
On February 27, AUAPAC hosted a fundraiser for Rep. David McKinley (R-WV-01) that was attended by 10 other representatives from the physician and dental community. Rep. David McKinley is a member of the House Energy & Commerce Committee, enthusiastically supports research funding for the National Institutes of Health, and is championing legislation that would create a student loan forgiveness program for specialty physicians that choose to practice in a rural area (H.R. 5924). This was the second fundraiser this cycle that AUAPAC was involved in for the Congressman.
State Advocacy Update: Maryland Prostate Cancer Screening Bill Moves Forward, AUA Advocacy Leads to Arizona Proclamation on Kidney Health and Cancer Awareness Month
Maryland Prostate Cancer Screening Coverage Bill Passes First Committee
On March 3, HB 852, by Maryland House Delegate Erek Barron (D-24), passed the House Health and Government Operations Committee. HB 852 specifically requires the state of Maryland to cover a digital rectal exam and a PSA test for men between 40 and 75 years old and men who are at high risk of developing prostate cancer.
As a reminder, the AUA collaborated with ZERO – The End of Prostate Cancer , Chesapeake Urology and MedChi: The Maryland State Medical Society in formally endorsing the bill. The AUA also sent a support letter to all Health and Governance Operations Committee members. Lastly, the AUA also sent out a grassroots alert to more than 430 Maryland urologists – urging them to phone, tweet and write their state legislators to support HB 852. The legislation now awaits further consideration by members of the House. We will continue to keep you updated as this bill moves forward.
AUA Receives Arizona Kidney Health and Cancer Awareness Month Proclamation from Governor
This week, the AUA received a proclamation from Arizona Governor Douglas Ducey declaring March 2020 as Kidney Health and Cancer Awareness Month. This proclamation raises awareness on Kidney Health and encourages patients with diabetes and hypertension to be regularly screened for kidney disease. For a copy of the proclamation, please contact Andrea Oh at firstname.lastname@example.org.
Takeaways: First Friday Clinician Outreach Meeting, February 7, 2020
The top takeaways from the Centers for Medicare & Medicaid Services (CMS) February Clinician Outreach Meeting include Open Payments Program updates, updated Medicare coverage guidelines related to acupuncture for chronic low back pain, and stakeholder feedback on ways to improve the Claims Appeals Process. Read more here.