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Legislative Updates

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  • 17 Feb 2023 8:30 AM | Katy Monaco (Administrator)

    The Association for Clinical Oncology (ASCO) submitted comments in response to the Centers for Medicare & Medicaid Services (CMS) Contract Year 2024 Policy and Technical Changes to the Medicare Advantage (MA) and Medicare Prescription Drug Benefit Programs proposed rule. ASCO’s comments focus heavily on the proposed changes to prior authorization in the MA program in addition to enhancing health equity and other updates to the Part D drug benefit program.

    > Read more

  • 17 Feb 2023 8:27 AM | Katy Monaco (Administrator)

    Both chambers of the United States Congress are working on a top health care priority for the session—protecting patients from high out-of-pocket drug costs and pharmacy benefit manager (PBM) practices that could reduce access and adherence to treatments.

    In the Senate, Senators Maria Cantwell (D-WA) and Chuck Grassley (R-IA) recently introduced the Pharmacy Benefit Manager Transparency Act of 2023 (S.127), legislation that would incentivize fair and transparent PBM practices, prohibit unfair or deceptive pricing practices, and mandate transparency. The Association for Clinical Oncology (ASCO) endorses this timely legislation and will continue to work with bill sponsors to shed light on opaque PBM practices that can negatively impact individuals with cancer.

    Read more

  • 01 Feb 2023 10:24 AM | Katy Monaco (Administrator)

    On January 30, 2023, President Biden announced the COVID-19 Public Health Emergency (PHE) will end on May 11, 2023. This announcement comes after the Department of Health and Human Services (HHS) Secretary Xavier Becerra extended the PHE earlier in January.

    During the PHE, the Centers for Medicare & Medicaid Services (CMS) temporarily approved several telehealth flexibilities. The Omnibus that passed at the end of 2022 extended these telehealth flexibilities for two years; they are set to expire December 31, 2024.

    While the Association for Clinical Oncology has been advocating for permanent extension of telehealth flexibilities, the two-year extension allows Congress time to study how telehealth is being used, create parameters to avoid abuse, and identify a way to pay for the permanent expansion.

  • 13 Jan 2023 11:23 AM | Katy Monaco (Administrator)

    On January 11, the Department of Health and Human Services (HHS) Secretary Xavier Becerra extended the COVID-19 Public Health Emergency (PHE) declaration. The PHE is now set to expire on April 11, 2023.

    During the PHE the Centers for Medicare & Medicaid Services (CMS) temporarily approved a number of telehealth flexibilities. With the Omnibus that passed at the end of 2022, these telehealth flexibilities were extended for two years, and are set to expire December 31, 2024.

    Read more

  • 22 Dec 2022 1:25 PM | Katy Monaco (Administrator)

    Lawmakers unveiled their long-awaited $1.7 trillion government funding package on Dec. 20, 2022. As of publishing, it seems likely that a vote on final passage in the U.S. Senate will occur at some point today or tomorrow, with a final up-or-down vote in the House of Representatives taking place ahead of the December 23 government funding deadline.

    The information below is focused on notable Medicare and Medicaid policies and is not reflective of every policy or funded program.


    ·    Medicare Physician Payment Reductions: The omnibus package will reduce expected reductions to Medicare reimbursement for physician services over the next two years. Accordingly, the omnibus increases the Medicare conversion factor by 2.5 percent for 2023 and 1.25 percent for 2024. Watch for a new fee schedule in your area. Will this delay claims in the New Year? I guess we have to wait and see.

    ·    Alternative Payment Model (APM) Bonuses: Currently, Advanced APMs can only earn the 5 percent payment incentive through the end of 2022. (There is a two-year lag between performance and payment years.) After this, there will be a "gap year" between the expiration of the bonus payments and the restart of modest (cheap) annual conversion factor updates, leaving less incentive for providers to participate in an Advanced APM in 2023. To address this, the omnibus provides a one-year bonus for providers who are part of APMs – but rather than keep that bonus at 5 percent, the bill lowers the bonus to 3.5 percent. The bill also extends the current freeze on participation thresholds for qualification for the APM bonuses for an additional year.

    ·    PAYGO: The omnibus halts the looming statutory Pay-As-You-Go (PAYGO) sequestration in 2023 and 2024. It may be back in 2025. PAYGO requires that mandatory spending and revenue legislation not increase the federal budget deficit over a 5-year or 10-year period. Should such legislation be enacted without offsets, the Office of Management and Budget (OMB) is required to implement sequestration, or across-the-board reductions, in certain types of mandatory federal spending. The Congressional Budget Office (CBO) estimated that a Statutory PAYGO sequester in fiscal year (FY) 2022 resulting from the American Rescue Plan Act of 2021 passage would cause a 4 percent reduction in Medicare spending or cuts of approximately $36 billion.

    ·    Telehealth: The omnibus continues Medicare's expanded access to telehealth by extending COVID-19 telehealth flexibilities for an additional two years through Dec. 31, 2024. The bill also extends through calendar year 2024 the flexibility to exempt telehealth services from the deductible in high-deductible health plans (HDHPs) that can be paired with a Health Savings Account (HSA). Hooray!!!!

    ·    PAMA: The omnibus delays for one year pending payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA).

    ·    Separate OPPS Payment for Non-Opioid Packaged Treatments: The omnibus provides a separate (capped at 18 percent) Medicare payment, from 2025 through 2027, for non-opioid treatments that are currently packaged into the payment for surgeries under Medicare's Outpatient Prospective Payment System (OPPS).

    ·    Lymphedema treatment. The final package folds in provisions of the Lymphedema Treatment Act, which expands Medicare coverage for lymphedema-related pressure garments. The new coverage will go into effect in 2024 and could affect more than 3 million Medicare beneficiaries.

    ·    CBO Part D Data Authorization: Authorizes the CBO to access prescription drug payment data, including rebate and direct and indirect remuneration (DIR) data, under Medicare Part D.

    ·    Acute Hospital Care at Home Waivers: The omnibus will extend the waivers by two years until the end of 2024. CMS has approved more than 250 hospitals to participate in the acute hospital care at-home program.

    ·    Sequester Extension and Other Offsets: The package would extend sequestration for the first six months of FY 2032 to help offset the package cost. The sequester policy would also smooth out the sequester cuts in later years and keep the Medicare sequestration percentages at 2 percent for FY 2030 and FY 2031. Hopefully, we will all be retired by then.


    ·    The Children's Health Insurance Program (CHIP): The omnibus extends funding for CHIP for two years through FY 2029. The omnibus also requires children to be provided with 12 months of continuous coverage in Medicaid and CHIP, effective January 1, 2024.

    ·    Modifications to Postpartum Coverage Under Medicaid and CHIP: The bill makes permanent a state option to allow states to continue to provide 12 months of continuous coverage during the postpartum period in Medicaid or CHIP.

    ·    Medicaid Redeterminations Transitioning From Medicaid FMAP Increase Requirements: Under the Families First Coronavirus Response Act, each state was eligible for a 6.2 percentage point increase in its Federal Medical Assistance Percentage (FMAP) if it met several conditions. Among these was the institution of a continuous enrollment policy for Medicaid beneficiaries, States could not remove individuals from Medicaid rolls until the end of the COVID-19 public health emergency (PHE). Now, the omnibus lets states start Medicaid redeterminations (eligibility checks) at the beginning of April, even if the PHE is still in effect. Please verify your Medicaid patients or dual eligibles during that period.

    ·    Medicaid Funding for U.S. Territories: The omnibus extends Puerto Rico's higher federal Medicaid match of 76 percent through FY 2027 and permanently extends a higher federal Medicaid match of 83 percent for American Samoa, the Commonwealth of the Northern Mariana Islands, Guam and the U.S. Virgin Islands.

    ·    340B: In the accompanying report language, Congress directed HRSA, which oversees the 340B program, to provide a briefing to Congress on actions taken to safeguard 340B covered entities’ “lawful access” to discounted drugs. Over the past several years, 18 drug manufacturers have ended discounted pricing to 340B hospitals with regard to contracted pharmacies. In response, HRSA exercised its authority to refer these companies to the Office of the Inspector General to impose civil monetary penalties. Several drug companies then filed lawsuits challenging the government’s authority to enforce penalties against them. This just goes on and one and this provision is kind of toothless.

    There is much, much more in this bill. To view it, go to this site.
  • 29 Aug 2022 8:32 AM | Katy Monaco (Administrator)

    On August 25, the Centers for Medicare & Medicaid Services (CMS) issued a final rule indefinitely delaying the start of the Radiation Oncology (RO) Model. CMS will establish new start and end dates for the model through future rulemaking, which may also modify the model’s design. CMS will propose a new start date for the model at least six months prior to the proposed date.

    According to CMS, the delay was finalized due to the amount of operational resources required for the agency and RO model participants to prepare to implement the model and a lack of stakeholder support for the model unless specific changes are made. Read more

  • 04 Aug 2022 1:55 PM | Katy Monaco (Administrator)

    On July 27, 2022, the House of Representatives passed the Advancing Telehealth Beyond COVID–19 Act of 2021 (H.R.4040). The bill, which was introduced by Representatives Liz Cheney (R-WY-AL) and Debbie Dingell (D-MI-12), would extend telehealth flexibilities for two years, through the end of 2024.

    Specifically, the legislation would:  • remove geographic and originating site restrictions • expand providers who can offer telehealth service—including physician assistants, nurse practitioners, and others  • allow Medicare reimbursement of telehealth services provided by physicians and practitioners working for Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs)  • allow audio-only telehealth services  • expand access to telehealth services for the recertification of hospice care eligibility during an emergency period 

    The Association for Clinical Oncology (ASCO) was pleased to see that several provisions in the bill align with provisions in the Permanency for Audio-Only Telehealth Act and the CONNECT for Health Act and Telehealth Modernization Act—two bills that ASCO endorsed and advocated for on Capitol Hill. Those provisions include removing geographic and originating site restrictions, expanding reimbursement for telehealth services provided by physicians working for FQHCs and RHCs, and expanding access to audio-only telehealth services.

    The bill has moved to the Senate, where its path forward is unclear. While there is broad support for extending telehealth flexibilities beyond the COVID-19 Public Health Table of Contents Encourage your members to join the State Society Network Emergency, a full agenda and limited legislative days are creating obstacles.

    Take action now via the ASCO ACT Network. 

  • 01 Aug 2022 1:59 PM | Katy Monaco (Administrator)

    The formal legislative session ended this morning around 10 AM. The House and Senate could not reach a consensus on the differing approaches to the issue of the timeline for insurers to act on step therapy exemptions. The House had 3 business days/ 1 business day for emergencies. The Senate had 72 hrs/24 hrs, similar to what was in the original bill. The legislative leaders were busy dealing with major issues in the closing days of the session and didn’t get to step therapy.  However, we are told they will deal with it during an informal session which is in place for the remainder of the year. The latest compromise floated is 3 business days or 24 hrs. if an emergency.  More to come later. I am optimistic we will get a step therapy bill passed this year.

    Provided by Edward J. Brennan, Esq. 

  • 26 Jul 2022 11:00 PM | Katy Monaco (Administrator)

    The Senate passed the step therapy bill today. The Senate reinstated the provision requiring insurers to grant or deny a step therapy exception request or an appeal back to 72 hrs. or 24 hrs. if additional delay would result in significant risk to the insured’s health or well-being. The House passed bill sets the time as 3 business days and the next business day. The House and Senate need to reconcile their differences. We have heard that the House will accept the Senate change. It looks like we will see the bill on the governor’s desk by the end of the week.

    Provided by Edward J. Brennan, Esq. 

  • 22 Jul 2022 7:10 AM | Katy Monaco (Administrator)

    Gov. Baker signed the bill delaying until January 1, 2025 - the implementation of the state’s notice and disclosure law. The statute is Chapter 107 of the acts of 2022.

    This is good news and will give the state and health care providers time and the opportunity to assess implementation of the federal No Surprises Act provisions relating to patient notices and pricing disclosures. From the perspective of the provider community, it would be best if the state deferred to the feds, or at least make them consistent. We will continue to monitor this issue.

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