This week’s update includes information on state bills addressing surprise billing, as well as our Congressional meetings supporting reauthorization of the Patient-Centered Outcomes Research Institutes (PCORI), increased funding for the National Institutes of Health, and addressing prior authorization.
State Advocacy Update: Ohio and Washington, DC Introduce Surprise Medical Billing Legislation
On September 16, Senators Stephen Huffman (R) and Nickie Antonio (D) introduced SB 198 to address surprise medical billing issues in Ohio. SB 198 requires that the individual provider file a claim for reimbursement with a covered person's health plan issuer for unanticipated out-of-network care provided at an in-network facility. Within 30 days, the health plan must pay the individual provider or attempt to negotiate reimbursement.
SB 198 awaits a committee of referral in the Ohio State Senate. Read the 9/16/2019 version.
In addition, on September 17, DC Councilmember Mary Cheh (D) introduced B 429, which bans balance billing for emergency services and for non-emergency services if the facility is in-network. This measure sets up an arbitration process to resolve disputes involving balance bills and requires the Department of Insurance, Securities, and Banking to report on the use of arbitration. B 429 also requires the Department of Insurance, Securities, and Banking to issue a consumer rights notice about balance billing and to enforce this measure.
B 429 has been referred to the Committee on Business and Economic Development, and is available here.
The AUA continues to follow both federal and state surprise medical billing issues closely. We will keep you updated as these bills move forward.
Reducing Prior Authorization Burdens: AUA, AMA and Medical Society Recommendations
The AUA has joined the American Medical Association (AMA) and more than 75 medical societies in responding to concerns that the Centers for Medicare & Medicaid Services (CMS) may be focusing on automation as the only vehicle for implementing prior authorization (PA) reforms. The letter specifically states that, while CMS has invested heavily in the Da Vinci Project, there are issues with relying on technology to address the burdens of PA. Da Vinci is a self-funded project that is used to develop implementation guides, and sample code to support the development of and enhancement of provider-payers health exchanges. Additionally, the letter urges CMS to implement a strategy to reduce the burdens of AP by adopting principles that include:
- Selective application of PA to only “outliers”;
- Review/adjustment of PA lists to remove services/drugs that represent low-value PA;
- Transparency of PA requirements and their clinical basis to patients and physicians;
- Protections of patient continuity of care; and
- Automation to improve PA and process efficiency. .
Patient & Research Advocacy: Patient-Centered Outcomes Research Institutes (PCORI) Annual Meeting and Reauthorization Update
On September 18-20, the AUA attended the Patient Centered Outcomes Research Institute’s (PCORI) Annual Meeting. The meeting convened more than 1,000 members of the healthcare community, including patients, physicians, and researchers. Plenary and breakout sessions incorporated the meeting’s key theme, “Making a Difference: Using Patient-Centered Research Results in the Real World,” through engaging participants in meaningful discussions centralized around successful models of patient engagement. Key messages included the critical need for enabling patients to be empowered stakeholders to ensure research outcomes are useful and applicable in healthcare settings and ensuring the findings from PCORI research is translated into the healthcare system to improve patient outcomes. Learn more about PCORI and the research funded by their programs .
Prior to PCORI’s annual meeting, the AUA joined 40 PCORI advocates on Capitol Hill to meet with more than 40 Congressional offices to discuss the urgency for PCORI’s reauthorization. Specifically, the AUA met with the offices of Senators Chris Van Hollen (D-MD) and Ben Cardin (D-MD) and Representatives Elijah Cummings (D-MD-7) and Jamie Raskin (D-MD-8). Advocates encouraged a 10-year reauthorization to take place to ensure the more than 600 patient-centered Comparative Effectiveness Research (CER) studies and related projects that support CER receive the support needed to deliver impactful results. As background, PCORI is the only organization dedicated to funding studies, driven by patient and stakeholder input, comparing which approaches work best, for whom, and under what circumstances. Additionally, PCORI has partnered with patients and clinical networks to build an infrastructure to support the nation's capacity to conduct CER called the National Patient-Centered Clinical Research Network (PCORnet), a large national network for conducting CER faster, more efficiently, and at lower cost.
On September 18, the House released H.R. 4378, the continuing resolution (CR) to keep the government funded through November 21. The measure includes a short-term extension of a number of expiring health programs, including PCORI. The CR is currently being debated on the House floor. The AUA will continue keeping you apprised of updates relevant to the reauthorization of PCORI.
Patient & Research Advocacy: 2019 Rally for Medical Research
Last week, the AUA attended the 2019 Rally for Medical Research in Washington, DC. The Rally for Medical Research hosts a large group of stakeholders who convene annually to raise awareness and advocate for increased funding for the National Institutes of Health (NIH). Advocates met with Members of Congress to thank them for the $2 billion increase for NIH in Fiscal Year (FY) 2019, and urged them to continue momentum increasing funding to at least $41.6 billion for FY 2020 (a $2.5 billion increase). As background, the House Appropriations Committee released its first FY 2020 minibus appropriations bill H.R. 2740 in June which included funding for Labor Health and Human Services funding and an increase of $2 billion in NIH funding (total of $41.4 billion). Last week, the Senate Committee on Appropriations released their FY2020 subcommittee chairman’s recommendation for the Labor, Health and Human Services which included an increase of $3 billion to NIH. Rally for Medical Research advocates urged Members of Congress to work together in a timely and bipartisan way to complete the FY2020 appropriations process to ensure a robust, sustained and predictable funding stream for NIH. The AUA met with the offices of Representative Dutch Ruppersberger (D-MD-02) and Senators Ben Cardin (D-MD) and Chris Van Hollen (D-MD). The AUA will continue keeping you appraised of FY2020 appropriations bills as they continue to develop.
U.S. Preventive Services Task Force (USPSTF): AUA Building Bipartisan Support for Reform Bill
The AUA continued its efforts to garner additional cosponsors for the USPSTF Transparency and Accountability Act (H.R. 3534). On September 16 and 18, the AUA met with staff in the offices of Reps. Rick Larsen (D-WA-02) and Susie Lee (D-NV-03). Both lawmakers sit on the New Democrats Coalition, which looks to pass pro-economic growth, pro-innovation, and fiscally responsible policies.
As a reminder, the AUA has an active grassroots campaign supporting H.R. 3534. If you have not done so, please contact your representative (our Phone2Action system allows you to send both letters and customized tweets) and urge them to support the bill. We also ask that your colleagues do the same.
Insurance Updates: Week of September 23, 2019
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes a reminder from Anthem concerning timely filing of claims, Electronic Attachments transactions from Anthem California, and MolDX Prolaris Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease. Also, there are updates regarding Lupron and Eligard from Dean Health Plan and Oxford United Healthcare has updated their Office Based Procedures/ Site of Service medical policy. For more information, please read here.
2020 Gallagher Scholar: AUA Accepting Applications
The AUA is now accepting applications for the 2020 Gallagher Health Policy Scholar program. Applicants must be AUA member urologists who have demonstrated a commitment to or have a keen interest in the field of health policy and who are dedicated to advancing urology's health policy agenda. Previous Gallagher Scholars are now among some of the AUA’s top health policy leaders, and attribute participation in this program as a key step in making the transition into leadership roles. Learn more about the program and how to apply.