Blogs

Insurance Updates: August 17 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 botulinum toxin and prostate procedures. BCBS North Carolina BCBS North Carolina reviewed its Bundling Guidelines Reimbursement & Billing Document adding standby services to applicable services with associated reimbursement guidelines. Read the update. BCBS North Dakota BCBS North Dakota reviewed its Chemodenervation with Botulinum Toxin Policy with the following changes: Removed CPT code 53899 Revised applicable CPT codes associated with each ...
0 comments
State Advocacy Update 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 our interactive map on the AUA State Advocacy Webpage . A special thank you to Jonathan Heinlen, MD, (Oklahoma) and Kevin Koo, MD, (Minnesota) for their participation in the Prostate Cancer Awareness Month proclamation contest. To date, proclamation requests have been submitted for the District of Columbia, Georgia, Illinois, Maryland, Minnesota, New York, Oklahoma, Oregon, Pennsylvania, Texas and West Virginia. Thank you to all who have participated! Washington ...
0 comments
August 19 is National Patient Advocacy Day. We have plenty to celebrate! The AUA collaborates with more than 75 patient organizations. Looking ahead, here are a few ways our patient advocacy serves to educate, address urologic health disparities, and identify new policy related issues. The Urology Care Foundation’s Prostate Cancer Impact Alliance (PCIA) and Kidney Cancer Impact Alliance (KCIA) will meet in person in Washington, D.C. in September 2022 and November 2022, respectively, to advocate on Capitol Hill and to discuss and identify prostate and kidney cancer initiatives. Additionally, the PCIA Health Equity and Patient Physician work groups will host ...
0 comments
On August 4, the AUA met with staff in the office of Senator Michael Bennet (D-CO) to discuss cosponsorship of the Specialty Physicians Advancing Rural Care (SPARC) Act (S. 4330). During the meeting, Sen. Bennet’s staff was generally supportive of the legislation because it would help physicians’ financial burden of student debt and increase access to care in the rural areas of Colorado. However, the Senator’s staff emphasized the need for constituents to convey the importance of the legislation. Additionally, the AUA met with staff in the office of Senator Jon Ossoff (D-GA) regarding the SPARC Act on August 12. Sen. Ossoff’s staff was understanding ...
0 comments
Insurance Updates: August 10 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 benign prostatic hyperplasia and infertility. Aetna Aetna reviewed its Benign Prostatic Hyperplasia Policy adding CPT code 0714T to the non-covered list. Read the update. Anthem Anthem reviewed its Infertility and HCG Agents policy adding gender dysphoria as an approved indication for agents for fertility preservation, along with associated criteria. Read the update. BCBS Federal Employee Plan BCBS Federal Employee Plan ...
0 comments
On August 1-3, the AUA was an active participant at the 2022 National Conference of State Legislatures (NCSL) Legislative Summit in Denver, Colorado. State Advocacy Manager, Catherine Hendricks, went to several NCSL Health and Human Services committee meetings and spoke with several legislators interested in introducing/supporting no cost-sharing prostate cancer screening legislation in their state, including: Arkansas: Representative Deb Ferguson Georgia: Representative Billy Mitchell Missouri: Senator Wayne Wallingford North Carolina: Senate Democrat Leader Daniel T. Blue Jr. Pennsylvania: Representative Jeanne McNeill More ...
0 comments
The Centers for Medicare & Medicaid Services (CMS) issued the FY2023 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule . Most notably, the rule finalizes: Increase of 4.3% in operating payment rates for general acute care hospitals paid under the IPPS. This reflects a hospital market basket update of 4.1% reduced by a 0.3 percentage point productivity adjustment and increased by a 0.5 percentage point adjustment required by statute. This update is 1.1% higher than the proposed update; Changes to Graduate Medical Education (GME) policies, including a policy ...
0 comments
The U.S. Department of Health and Human Services (HHS) and Department of Justice (DOJ) issued guidance on the protections in federal nondiscrimination laws requiring that telehealth be accessible to people with disabilities and limited English proficient persons on July 29, 2022. The guidance will help healthcare providers better understand their nondiscrimination obligations and patients better understand their rights under federal law in this regard. The guidance provides examples of actions that may be discriminatory and describes steps that providers may need to take to ensure that health care offered via telehealth is accessible. The guidance also provides ...
0 comments
The AUA joined the Alliance of Specialty Medicine (ASM) in responding to a Request for Information (RFI) from the U.S. Department of Health and Human Services (HHS) regarding an initiative to strengthen primary health care. The AUA and the Alliance of Specialty Medicine included information on the role of specialists in primary care, making COVID-19 telehealth flexibilities permanent, supporting the physician workforce and improving the Medicare payment system. A copy of the letter is attached. The letter urges HHS to support the partnership between primary and specialty care, particularly as it relates to ensuring continuity of care. The AUA and ASM urge HHS ...
0 comments
On, August 7, the U.S. Senate passed the Inflation Reduction Act , a keystone piece of legislation meant to fulfill promises by Democrats to address inequities in the healthcare system, climate and taxes. Negotiation by Medicare for the cost of prescription drugs is a centerpiece of the bill. This provision, if signed into law, will allow Medicare to negotiate drug prices starting in 2026 for the top ten high-cost, most-used drugs, and expand to 20 drugs by 2029. Starting in 2025, Medicare beneficiaries will also have their out of pocket costs capped at $2,000 annually. The bill will penalize drug manufacturers if the cost of their treatments for Medicare beneficiaries ...
0 comments
The AUA’s Gallagher Health Policy Scholar Program application opened on August 8. The Gallagher Scholar Program is open to AUA physician members who demonstrate a commitment to or have deep interest in the field of health policy. Scholars receive mentoring from seasoned physician volunteers and participate in key meetings, conferences and public policy activities. The AUA provides a stipend and previous Gallagher Scholars have gone on to become chairs of the Public Policy Council, Science and Quality Council, AUAPAC and reporting committees. Learn more about the program and reach out to Juliana Nicolini at jnicolini@AUAnet.org with any questions or for ...
0 comments
Insurance Updates: August 3 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 infertility and HCG agents. BCBS Federal Employee Plan BCBS Federal Employee Plan issued its new Tumor Informed Circulating Tumor DNA Testing for Cancer Management Policy stating tumor-informed circulating tumor DNA testing (Signatera) is considered not medically necessary for all indications. Read the update. BCBS Minnesota BCBS Minnesota reviewed its Infertility and HCG Agents policy adding gender dysphoria as an approved indication for agents for fertility ...
0 comments
On July 28, the AUA joined the Alliance of Specialty Medicine in a letter to the sponsors of H.R. 7995, the Gold Card Act of 2022, formally endorsing the Gold Card Act. The bill expedites the prior authorization process in the case of physicians for whom at least 90% of their requests submitted to a plan in the preceding year were approved. The AUA and its coalition partners remain committed to finding and supporting legislation solutions that reduce the regulatory burden on urologists and help accelerate care that may be delayed because of prior authorization. The letter is attached for you to read in its entirety. 7_29_2022_ASM_Letter_of_Support_for_GO ...
0 comments
On July 27, AUAPAC participated in a fundraiser for Representative Markwayne Mullin (R-OK-02). Rep. Mullin serves on the House Energy & Commerce Subcommittee on Health, which has jurisdiction on critical healthcare workforce issues, including loan repayment for specialty physicians and GME funding. The congressman is currently seeking the Republican nomination for the open U.S. Senate seat in Oklahoma. During the fundraiser, Rep. Mullin stressed the need to strengthen the specialty physician workforce in rural America, including incentivizing specialist with loan repayment to practice where there is the greatest need.
0 comments
On July 27, the House Ways & Means Committee voted unanimously to pass H.R. 8487, the Improving Seniors’ Timely Access to Care Act of 2022. This measure would establish several requirements and standards relating to prior authorization processes under Medicare Advantage (MA) plans, such as real-time decisions for services routinely approved and annual reports detailing prior authorization information including the average response time. H.R. 8487 now moves to the full House for further deliberation. The AUA will monitor and continue to advocate in support of this important legislation. The AUA remains committed to mitigating prior authorization and other ...
0 comments
On July 27, the U.S. House of Representatives voted 416-12 to pass H.R. 4040, the Advancing Telehealth Beyond COVID–19 Act of 2022. The bill would ensure telehealth flexibilities available during the COVID-19 Public Health Emergency continue until at least December 31, 2024. It will continue Medicare flexibility around geographic requirements and originating sites, will allow additional practitioners to provide telehealth services, extend payment for Federally Qualified Health Centers and Rural Health Clinics, allow audio-only telehealth services to continue, and allow recertification of eligibility for hospice care. H.R. 4040 now moves to the Senate for further ...
0 comments
On July 27-28, the AUA met with staff in the offices of Senators John Boozman (R-AR) and Joe Manchin (D-WV) to discuss co-sponsorship of the Specialty Physicians Advancing Rural Care (SPARC) Act (S. 4330). During the meeting, Sen. Boozman’s staff acknowledged that the SPARC Act is within the jurisdiction of other issues the senator supported and the legislation would increase access to care and support the physician workforce. Additionally, Sen. Manchin’s staff was empathetic about the need for a program that helps alleviate specialty physicians' student loan debt and decisions about where they will practice. The senator’s staff also understood that such ...
0 comments
On July 27, the AUA joined 32 other medical and dental organizations, including the Alliance of Specialty Medicine, to send a letter to Senate Finance, House Ways & Means, and House Energy & Commerce Committee leadership urging them to take action to mitigate the scheduled cuts proposed in the 2023 Medicare Physician Fee Schedule. The letter highlights alleviating the 4.5% Medicare conversion factor reduction as the starting point to help reduce the financial instability physicians are still facing. The letter states, “These year-over-year cuts clearly demonstrate that the Medicare physician payment system is broken. Systemic issues such as the ...
0 comments
Insurance Updates: July 27 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 gene expression profiling for bladder cancer and once in a lifetime procedures. BCBS Arkansas BCBS Arkansas issued its new Pluvicto Policy stating Pluvicto may be considered medically necessary when criteria are met. Read the update. BCBS Georgia BCBS Georgia reviewed its Gene Expression Profiling for Bladder Cancer Policy revising the code descriptor for CPT code 0016M. Read the update. BCBS Georgia reviewed its Gene Mutation Testing for Solid Tumor ...
0 comments
State Advocacy Update Massachusetts Seeks to Legally Protect Gender Affirming Care; and Changes to Wisconsin Chaperone Rule – the AUA is opposed to unwarranted regulatory requirements related to the genitourinary physical examination. 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 our interactive map on the AUA State Advocacy Webpage . Massachusetts S. 3003 – Diversity, Equity and Inclusion Introduced by Senator Cindy Friedman (D), S. 3003 seeks to make gender affirming care a “legally-protected health care activity”. “Gender-affirming ...
0 comments