Blogs

State Advocacy Update Alaska Introduces Bill Allowing Insurance Director to Waive Prior Authorization; Telehealth Payment Parity and no In-Person Requirement – the AUA continues to support the full expansion of telehealth services post the current public health emergency, including adoption of audio-only visits. Join the Discussion at Urology Place ; and Texas Law Grants “Gold Card” Exemption for Prior Authorization – the AUA partnered with the AMA in supporting prior authorization reform; For information about bills the AUA is tracking in your state, please contact AUA State Advocacy Manager Catherine Hendricks at CHendricks@AUAnet.org . Check out ...
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During the week of September 13, the AUA met with staff in the office of Senators Tim Kaine (D-VA) and Jacky Rosen (D-NV) to garner support and sponsorship for a Senate companion of H.R. 944. Additionally, the AUA met with staff in the office of Representatives Lisa Blunt Rochester (D-DE-At Large), Buddy Carter (R-GA-01), and Dan Crenshaw R-TX-02) to discuss cosponsorship of H.R. 944. As a reminder, Representatives David McKinley (R-WV-01) and Peter Welch (D-VT-AL) introduced this legislation in February 2021. It establishes a loan repayment program to encourage specialty medicine physicians to serve in rural communities experiencing a shortage of specialty ...
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On September 15, AUAPAC participated in a fundraiser for Senator Bill Cassidy, MD (R-LA), a member of the Senate Finance and Health, Education, Labor, and Pensions (HELP) Committees. He also is a member of the Senate Veterans’ Affairs Committee. Sen. Cassidy, a gastroenterologist before coming to Congress, has an extensive record of accomplishment in healthcare. He has led many of the Senate’s efforts to protect health care providers during this pandemic, including supporting telehealth expansion through the CONNECT Act. For more information on AUAPAC and its activities, please go to www.MyAUAPAC.org .
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On September 14, 15, and 17, the AUA hosted the 2021 Patient Advocacy Connections Program (PACP) as part of AUA2021. This year’s virtual event successfully connected more than 70 participants from 28 urology-focused patient advocacy organizations, AUA members, and industry partners throughout the three-day Lunch & Learn series. The Lunch & Learn program included two engaging roundtable discussions. The first roundtable addressed the needs in improving clinical trial diversity, where attendees discussed key challenges, partnerships, and legislative efforts to make participation in clinical trials more accessible. The second roundtable discussion focused ...
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On September 15, the Veterans’ Prostate Cancer Treatment and Research Act was introduced in the Senate (S. 2720) by Senators Jerry Moran (R-KS) and Jon Tester (D-MT) – Ranking Member and Chairman of the Senate Veterans’ Affairs Committee, respectively. For the first time, this bill is now in both chambers of Congress, which is a critical step in the legislative process. As mentioned in previous updates, the House version of the VA bill was introduced in the U.S. House of Representatives (H.R. 4880) earlier this year. This legislation directs the Secretary of Veterans Affairs to establish a national clinical pathway for prostate cancer within the National Surgery ...
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Insurance Updates:  September 22, 2021 Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding erectile dysfunction and prostate specific antigen testing. BCBS Illinois BCBS Illinois published its Erectile Dysfunction Policy, effective December 1. Read the update. BCBS Illinois released its Prostate Specific Antigen (PSA) Testing Policy from draft policy to pending status. Read the update. BCBS Illinois released its Urinary Tumor Markers for Bladder Cancer Policy from draft policy to pending status. Read the update. BCBS Oklahoma ...
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On August 31, the AUA held its second meeting of the month with staff in the office of Senator Bill Cassidy, MD (R-LA) regarding telehealth. The AUA has been actively pursuing permanent telehealth expansion after the current COVID-19 public health emergency expires, including audio-only telehealth services and removing geographic and originating site restrictions, and endorsing federal legislation such as the CONNECT for Health Act of 2021. Sen. Cassidy has been a staunch supporter of telehealth and is a member of both committees with jurisdiction on health care policy – the Senate Health, Education, Labor and Pensions Committee and the Senate Finance Commit ...
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Since August 30, the AUA has met with staff in the offices of Senators Tim Scott (R-SC) and Tina Smith (D-MN) to garner support and sponsorship for a Senate companion to H.R. 944, the AUA-led rural workforce bill. Additionally, the AUA has met with staff in the offices of Representatives Michael Burgess, MD (R-TX- 26), Yvette Clarke (D-NY-09), Jim Costa (D-CA-16), and Brian Fitzpatrick (R-PA-01) to discuss co-sponsorship of H.R. 944.  On August 31, Representatives Vicky Hartzler (R-MO-4) and Paul Tonko (D-NY-20) signed on as cosponsors of this important measure. The AUA held direct meetings with staff in both offices the previous week, which ultimately led ...
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The AUA Gallagher Scholar application is open until October 12. This yearlong scholar program provides AUA members with opportunities to attend key health policy meetings, the Brandeis Health Leadership Program in Health Policy and Management, and more. Highly seasoned AUA health policy volunteers mentor the Gallagher Scholar throughout their tenure. Interested members can find more about the program and the application portal here . Please share this opportunity and the application link with your colleagues. In addition, the AUA is soliciting applications for the Policy & Advocacy Resident Work Group. The Policy & Advocacy Resident Work Group, currently ...
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On September 10, the AUA submitted comments in response to the Calendar Year (CY) 2022 Medicare Physician Fee Schedule. Our comments to the Centers for Medicare & Medicaid Services (CMS) focus on the following: CMS’ Proposed Update to Direct Practice Expense Clinical Labor Rates Implementation of Telehealth and Other Services Involving Communications Technology 010-day and 090-day Global Period Codes Policies CY 2022 Identification and Review of Potentially Misvalued Services Proposed Valuation of Specific Codes for CY 2022 (Periurethral Adjustable Balloon Continence Devices) Split (or Shared) Evaluation and Management (E/M) Visits Quality ...
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Insurance Updates:  September 15 Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Urinary Biomarkers for Bladder Cancer. BCBS Michigan BCBS Michigan reviewed its Urinary Biomarkers for Bladder Cancer Policy adding study selection criteria for the evaluation of the clinical validity of urinary biomarkers: Reported on the accuracy of the marketed version of the technology Included a suitable reference standard (endoscopy or clinical follow-up) Patient/sample clinical characteristics were described Patient/sample selection criteria ...
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Insurance Updates:  September 8, 2021 Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding as gene expression profile analysis for risk stratification for prostate cancer management. BCBS Michigan BCBS Michigan reviewed its Gene Expression Profile Analysis for Risk Stratification for Prostate Cancer Management Policy changing the following CPT codes from investigational to medically necessary with criteria: 81541 – Oncology (prostate), mRNA gene expression profiling by real-time RT-PCR of 46 genes (31 content and 15 housekeeping), utilizing ...
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Insurance Updates:  September 1, 2021 Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding erectile dysfunction and extracorporeal shock wave therapy for peyronie’s disease. Aetna Aetna reviewed its Erectile Dysfunction (Commercial) Policy adding investigational statements for: Genetic polymorphism testing for the evaluation of response to phosphodiesterase 5 (PDE5) inhibitors in members with erectile dysfunction; Xiaflex for all other indications except for Dupuytren’s contracture (refer to related policy CPB 0800 on Dupuytren’s contracture ...
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Insurance Updates:  August 25, 2021 Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding prostate biopsies and erectile dysfunction. BCBS New Mexico BCBS New Mexico revised its Prostate Biopsies (Commercial) Policy adding the following statements: Medical necessity: Comprehensive 3D (three-dimensional) mapping with biopsy involving 12 core extended sampling in the initial diagnosis of prostate cancer as a follow up to abnormal PSA results, presence of a palpable nodule on digital rectal examination, or suspicious radiologic findings ...
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On August 10, the Biden Administration announced its plan via a proposed rule to rescind the Most Favored Nation (MFN) rule instituted during the waning days of the Trump Administration. The MFN set drug prices for Medicare Parts B and D to “the lowest price, after adjusting for volume and differences in national gross domestic product, for a pharmaceutical product that the drug manufacturer sells in a member country of the Organisation for Economic Co-operation and Development that has a comparable per-capita gross domestic product.” A major concern regarding the MFN model rule was its mandatory implementation across all Medicare participants and the resulting ...
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On August 18-19, the AUA met with staff in the office of Senators Bob Casey (D-PA), Patty Murray (D-WA), and Bill Cassidy, MD (R-LA) to garner support and sponsorship for a Senate companion of the aforementioned H.R. 944. As a reminder, Representatives David McKinley (R-WV-01) and Peter Welch (D-VT-AL) introduced this legislation in February 2021. The bill would establish a loan repayment program to encourage specialty medicine physicians to serve in rural communities experiencing a shortage of specialty medicine physicians. Overall, the offices were receptive to the idea of incentivizing specialists to practice in rural areas while helping patients gain much-needed ...
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On August 19-20, the AUA met with staff in the offices of first-term Representatives Sara Jacobs (D-CA-53) and Michelle Steel (R-CA-48) to establish connections within these offices and educate staff about the AUA’s legislative priorities, including H.R. 944, the specialty physician loan repayment bill, and H.R. 4880, the Veterans’ Prostate Cancer Treatment and Research Act. The AUA will continue conversations with these and other freshman offices as this 117th Congress continues.
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On August 17, AUAPAC participated in a fundraiser for Representative Dwight Evans (D-PA-03). Ruchika Talwar, MD, a resident physician at the University of Pennsylvania, constituent, and Policy & Advocacy Resident Work Group member attended. Rep. Evans is a member of the House Ways and Means Subcommittee on Health, which is one of two main committees that oversee health policy in the House. He has a longstanding interest in protecting healthcare and reducing health disparities, and supports expanded access to telemedicine whenever possible. AUAPAC raises the house of urology's profile and fosters relationships with members of Congress in Washington, DC, as ...
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On August 17, the AUA met with the National Institutes on Aging (NIA) leadership, including NIA Director Richard Hodes, MD. Meeting attendees discussed the need to diversify the urologic research workforce through AUA/NIA collaborative efforts in scholarship programs, supplemental grants, and increased mentorship opportunities for underrepresented minorities. Dr. Hodes noted the importance of collaboration within the urologic community and the NIA for programs with similar and overlapping goals such as co-morbidity research, focus on neurogenetics and incontinence, and the links to Alzheimer’s and urologic conditions in older adults. A special thank you to ...
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Insurance Updates:  August 18 Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding systems pathology for predicting risk of recurrence in prostate cancer and treatment of benign prostatic hyperplasia. BCBS Alabama BCBS Alabama reviewed its Systems Pathology for Predicting Risk of Recurrence in Prostate Cancer (Commercial) Policy revising its position statement for systems pathology from “not medically necessary and investigational” to “investigational”. Read the update. BCBS Alabama reviewed its Treatment of Benign Prostatic Hyperplasia ...
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