ASCO in Action

ASCO in Action provides the latest news and analysis related to critical policy issues affecting the cancer community, updates on the Association for Clinical Oncology’s ongoing advocacy efforts, and opportunities for members and others in the cancer care community to take action.

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May 10, 2022

A new report found that 13% of prior authorization denials in the Medicare Advantage (MA) program were for service requests that met Medicare fee-for-service coverage rules, likely delaying or preventing patient care. The report, conducted by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), on the impact of prior authorization within MA found that imaging services, stays in post-acute facilities, and injections were three prominent service types among the denials that met Medicare coverage rules.

April 29, 2022

The Centers for Medicare & Medicaid Services released the Patient Protection and Affordable Care Act 2023 Notice of Benefit and Payment Parameters final rule. The rule finalizes regulatory changes in the individual and small group health insurance markets and establishes parameters and requirements issuers need to design plans and set rates for the 2023 plan year. The rule also aims to improve enrollment policies for qualified health plans offered on the federal Marketplace to ensure consumer access to quality and affordable coverage and to advance health equity.

April 26, 2022

The Centers for Medicare & Medicaid Services (CMS) recognizes the impact that the COVID-19 pandemic public health emergency (PHE) continued to have on clinicians and the services they provided during the Quality Payment Program’s 2021 performance period. As such, CMS is reweighting Merit-based Incentive Payment System (MIPS) cost performance category from 20% to 0% for the 2021 performance period for both groups and individuals.

April 21, 2022

The Association for Clinical Oncology (ASCO) responded to a Centers for Medicare & Medicaid Services-issued Request for Information on the barriers that people face when trying to enroll and maintain health care coverage in Medicaid and the Children’s Health Insurance Program. ASCO is committed to advocating for coverage and reimbursement, access and quality, and cancer research and prevention policies that promote high-quality, equitable cancer care throughout the health care system.

April 19, 2022

The Centers for Medicare & Medicaid Services issued the fiscal year 2023 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long‑Term Care Hospital (LTCH) Prospective Payment System (PPS) proposed rule. In addition to updating Medicare payment rates and policies for inpatient hospitals in FY 2023, the proposed rule aims to measure health care quality disparities, improve the quality of maternity care, and obtain stakeholder feedback to advance health equity.

April 11, 2022

The Centers for Medicare & Medicaid Services issued a proposed rule in the Federal Register that, if finalized, would delay the start date of the agency’s Radiation Oncology Model from January 1, 2023, to “a date to be determined through future rulemaking.”

March 31, 2022

On December 10, 2021, President Biden signed the “Protecting Medicare and American Farmers from Sequester Cuts Act,” which phased in the Medicare sequester cuts that had been paused during the COVID-19 Public Health Emergency (PHE), starting April 1, 2022. From April 1, through June 30, 2022, the cut will be 1%. The cut will return to 2% on July 1, 2022.

March 29, 2022

The Association for Clinical Oncology (ASCO) submitted comments to the Office of the National Coordinator for Health Information Technology (ONC) in response to the agency’s Request for Information (RFI) on electronic prior authorization (ePA).

March 10, 2022

Members of the Regulatory Relief Coalition—including the Association for Clinical Oncology (ASCO)—participated in a week of action to call on Congress to pass the Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018). The bipartisan legislation would help protect patients from unnecessary care delays by streamlining and standardizing the prior authorization process under the Medicare Advantage program. More than 450 organizations currently endorse the bill.