In comments to the Centers for Medicare & Medicaid Services (CMS) on the 2023 Hospital Outpatient Prospective Payment System (OPPS) proposed rule, the Association for Clinical Oncology (ASCO) continues to call for a final rule that supports patient access to high-quality, equitable cancer care and support for oncology providers. Highlights from ASCO’s comments are includeded here.
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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In a step towards addressing one of multiple pending Medicare physician payment cuts, Representatives Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) introduced the Supporting Medicare Providers Act (H.R. 8800), which would increase the conversion factor to 4.42%, effectively putting the Medicare physician fee schedule cut on hold for a year. The new legislation also includes language that says lawmakers and the Department of Health and Human Services should work to promote and reward value-based care, as well as safeguard timely access to high-quality care by advancing health equity and reducing disparities. The Association for Clinical Oncology supports this effort to provide short-term stability and urges Congress to pass the bill before the end of the year.
The American Society of Clinical Oncology (ASCO) issued a new position statement on Medicare billing for split or shared (split/shared) evaluation and management (E/M) services. The statement summarizes ASCO’s concerns about changes to split/shared E/M services and makes recommendations to better align Medicare coding for E/M services with the care that beneficiaries with cancer need.
Medicare providers are facing significant reimbursement cuts starting January 1. The 2023 Medicare Physician Fee Schedule proposal jeopardizes the financial stability of many oncology practices by proposing a cut to the Medicare conversion factor of approximately 4.5%. Urge Congress to pass important changes that will provide practices with short-term fiscal stability, while simultaneously laying the foundation for long-term payment reforms.
The Centers for Medicare & Medicaid Services (CMS) released a Request for Information seeking public comment on various aspects of the Medicare Advantage (MA) program as CMS works toward establishing more equitable, high-quality care in MA. The Association for Clinical Oncology (ASCO) submitted a response to the agency on a variety of issues including health equity, expanding access to coverage and care, promoting person-centered care, and supporting sustainability and affordability. Some of the issues addressed in ASCO’s comments are summarized here.
The Inflation Reduction Act extends Affordable Care Act (ACA) tax credit subsidies, allows Medicare to negotiate prescription drug prices, places inflationary caps on price increases for Medicare Part B and Part D drugs, and limits Medicare beneficiaries’ out-of-pocket spending on Part D prescription drugs.
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 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.
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.
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.
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.