The American Medical Association (AMA) recently released new guidelines for reporting Evaluation and Management (E/M) services, which are to go into effect on January 1, 2023.
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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UPDATE: On August 7, 2022, the Senate passed the Inflation Reduction Act (IRA), a broad climate, tax, and healthcare reconciliation bill, 51 to 50. Healthcare provisions in IRA will extend Affordable Care Act (ACA) premium tax credits, allow Medicare to negotiate prescription drug prices, place inflationary caps on Medicare Part B and Part D drugs, and cap out-of-pocket spending on prescription drugs for Medicare beneficiaries. The House of Representatives will reconvene on August 12 to consider and vote on the legislation--which is expected to pass--after which President Biden will sign the bill into law.
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:
On August 1, 2022, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2023 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long‑Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule. In addition to updating Medicare payment rates and policies for inpatient hospital services in FY 2023, the final rule aims to improve beneficiary access, improve the quality of maternity care, and advance health equity.
UPDATE: On July 27, 2022, the House Ways and Means committee passed the Improving Seniors’ Timely Access to Care Act out of committee. The bill will be voted on by the entire House of Representatives in the days ahead. Upon passage in the House, it will move to the Senate. This is a critical moment when your lawmakers need to hear your support for this legislation. Please ask them to pass this bill—it only takes seconds using the ACT Network.
On July 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for the 2023 Medicare Hospital Outpatient Prospective Payment System (OPPS). The Association for Clinical Oncology (ASCO) is assessing the full proposal, but ASCO’s initial analysis is included here.
The Centers for Medicare & Medicaid Services (CMS) has published 2022 Alternative Payment Model (APM) Incentive Payment details on the Quality Payment Program (QPP) website. Clinicians can access the information by logging in to the QPP website using their HARP credentials. In an effort to ensure correct payments and information are available during the 2022 payment year, CMS verifies eligible clinicians’ APM participation and the APM Incentive Payment calculation.
On July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for the 2023 Medicare Physician Fee Schedule (PFS) and updates to the Quality Payment Program (QPP). The Association for Clinical Oncology (ASCO) continues to analyze the full proposal, but based on a preliminary analysis, key provisions for the cancer care community are included here.
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 is 1%. The cut will return to 2% on July 1, 2022.
On June 27, 2022, the Centers for Medicare & Medicaid Services (CMS), through its Center for Medicare & Medicaid Innovation (CMMI), announced a new, voluntary oncology payment model, the Enhancing Oncology Model (EOM).
The Association for Clinical Oncology (ASCO) submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to the fiscal year (FY) 2023 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long‑Term Care Hospital (LTCH) Prospective Payment System (PPS) proposed rule. ASCO’s Comments address CAR-T reimbursement and respond to several Requests for Information (RFI) on social determinants of health data collection, measuring healthcare disparities across CMS’s quality programs, climate change, and advancing digital quality.
The Supreme Court released a unanimous decision in American Hospital Association et al. v. Becerra, Secretary of Health and Human Services, et al. in favor of the American Hospital Association (AHA) and its objection to reduced reimbursement rates for Medicare Part B drugs purchased through the 340B drug pricing program.
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.
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.
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.