Blogs

Insurance Updates: May 25 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 transperineal implantation of a permanent adjustable balloon continence devices and bulking agents for the treatment of urinary incontinence. BCBS Montana BCBS Montana reviewed its Transperineal Implantation of a Permanent Adjustable Balloon Continence Device (Commercial) Policy stating transperineal implantation of a permanent adjustable balloon continence device is considered experimental, investigational, and/or unproven. Read the update. BCBS New Mexico ...
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State Advocacy Update Connecticut Enacts Interest Calculation on Offer of Compromise Bill; and Minnesota Introduced Another Gender Affirming Care Protection Bill. Legislative session ended for Missouri (May 13). 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 . Connecticut H.B. 5235 – Medical Business ENACTED Introduced by the Joint Committee on Judiciary, H.B. 5234 changes the time period for the calculation of interest on a plaintiff’s prejudgment offer of compromise ...
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On May 19, the AUA participated in a meet and greet hosted by the Alliance for Specialty Medicine with U.S. Senate candidate J.D. Vance. He is running for the open senate seat held by retiring Senator Rob Portman (R-OH). J.D. Vance is a businessman, Marine and graduate of Yale Law School. During the meet and greet, Mr. Vance engaged in conversations regarding reimbursement issues for specialty providers and prior authorization. While Mr. Vance does not have a healthcare background, he expressed an interest in continuing to learn more about the issues facing specialty providers moving forward.
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On May 17, the AUA met with staff in the office of Representative Dan Kildee (D-MI-5), who serves on the House Ways & Means Committee. During the meeting, AUA staff thanked Rep. Kildee’s office for his support of H.R. 2903, the CONNECT for Health Act, and his support for H.R. 2256, the Resident Physician Shortage Reduction Act. As a reminder, the CONNECT for Health Act permanently expands telehealth services and the Resident Physician Shortage Reduction Act adds an extra 14,000 GME slots over the next seven years – both of which remain top legislative priorities. The AUA also discussed other AUA priorities, such as reforming the Medicare Physician Fee Schedule, ...
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On May 16, the AUA met with staff in the office of Representative Elissa Slotkin (D-MI-08), a primary cosponsor of H.R. 4880, to discuss ongoing efforts related to the bill and its outlook for the remainder of the 117th Congress. Both majority staff and minority staff at the House Veterans’ Affairs Committee have expressed an interest in including this in a larger bipartisan package later this summer. H.R. 4880 would establish a viable clinical pathway for prostate cancer within the Department of Veterans Affairs for men who selflessly served this nation in uniform. The AUA will continue to promote and advance this critical measure in numerous ways moving ...
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On May 17, the AUA joined the Alliance of Specialty Medicine (ASM) in response to the Federal Trade Commission’s (FTC) Request for Information (RFI) regarding whether the FTC should undertake a study of the pharmacy benefit manager (PBM) industry and if the study should focus on pharmacy industry issues or explore manufacturer issues. In the letter, the Alliance states PBMs become primary gatekeepers to commercial pharmaceutical markets which benefits that price concession system. This ultimately causes out-of-pocket drug prices to increase for patients. The letter references a finalized rule by the Office of the Inspector General to remove the safe harbor from ...
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On May 20, the AUA joined the Step Therapy Coalition in asking the Centers for Medicare & Medicaid Services (CMS) to reinstate the step therapy prohibition in Medicare Advantage (MA) plans for Part B drugs as described in the September 17, 2012 HPMS memo Prohibition on Imposing Mandatory Step Therapy for Access to Part B Drugs and Services . The Step Therapy Coalition highlighted concerns that, if step therapy remains permissible, patients will continue to see reductions in access to care. The AUA remains committed to reducing regulatory burdens in an effort to promote practice sustainability during the COVID-19 public health emergency and beyond. A copy ...
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Insurance Updates: May 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 Besremi and whole gland cryoablation of prostate cancer. BCBS Arkansas BCBS Arkansas reviewed its Electrical and/or Magnetic Stimulation, Pelvic Floor Muscles Adult Urinary and Fecal Incontinence Policy with the following changes: Electrical or magnetic stimulation of the pelvic floor muscles (pelvic floor stimulation) as a treatment for urinary or fecal incontinence does not meet member benefit certificate primary coverage criteria that there be scientific evidence ...
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State Advocacy Update Arizona Enacts a Biomarker Coverage Bill; Delaware Seeks to Create Temporary License for Out-of-State Health Care Professionals; Maine Enacts Pharmacy Cost Sharing Bill; Maryland Extends the Interstate Medical Licensure Compact – This measure aligns with the AUA’s state advocacy priority to expand the IMLC in all 50 states; Minnesota Introduces Transgender Treatment Safe Haven Bill – The AUA continues to advocate for medical decision-making on behalf of children remain the responsibility of parents and therefore, should not be criminalized; New Jersey Seeks Amendments to State Surprise Billing Law; Tennessee Enacts Step-Therapy ...
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On May 11, the AUA joined the American Medical Association (AMA) in a letter to the Centers for Medicare and Medicaid (CMS) asserting the goal of simplifying and aligning efforts between providers and CMS to improve financial viability of physician practices and alleviate administrative burdens. These efforts include promoting value-based care, ensuring financial stability and predictability, and safeguarding access to quality care. The current physician payment system fails to recognize increases in practice costs, resulting in systemic underfunding. The AUA continues to support reforms to the Medicare physician payment system and will continue to seek ways ...
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Insurance Updates: May 11 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 urodynamics, prostate surgeries and interventions. BCBS Minnesota BCBS Minnesota reviewed its Water Vapor Energy Ablation and Waterjet Tissue Ablation for Benign Prostatic Hyperplasia Policy with the following changes: Added waterjet tissue ablation (AquaBeam) to medically necessary policy statement for benign prostatic hyperplasia, along with associated criteria Added waterjet tissue ablation (AquaBeam) as experimental/investigative for all other indications ...
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State Advocacy Update Colorado Introduces Cultural Training Bill; District of Columbia Enacts Non-Compete Ban; Louisiana Introduces Professional Liability Bill; New York Seeks to Become Safe Haven for Transgender Children and Their Parents; Rhode Island Introduces Interest Calculation on Civil Actions Bill; and Virginia Enacts Telemedicine Bill – 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 . Legislative session ended for Connecticut (May 4), Hawaii (May 5) and Tennessee (April 28). ...
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On May 2-3, the AUA met with staff in the offices of Representatives Ron Estes (R-KS-04) and Adrian Smith (R-NE-03). The purpose of these meetings were to reiterate the legislative asks from the 2022 Annual Urology Advocacy (AUA) Summit. During the meetings, the AUA expressed support for such initiatives as easing the specialty physician workforce shortage, making telehealth expansion permanent, diversifying clinical trials and reforming the Medicare Physician Fee Schedule. AUA staff will continue to broaden interest and support for our top priorities among key policymakers during the second session of this 117th Congress. If you have any interest in continuing ...
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Insurance Updates: May 4 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 Nerve Graft with Radical Prostatectomy. Aetna Aetna reviewed its Benign Prostatic Hyperplasia Policy with the following changes: Changing its coverage decision for aquablation from experimental/investigational to medically necessary for members with benign prostatic hypertrophy as an alternative to transurethral resection of the prostate. Added melatonin and XFLO expander system (Mercury expander system) to experimental/investigational ...
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State Advocacy Update California, Minnesota, New York Introduce Bills to Provide Protection to Those Seeking Gender-Affirming Care; California Negotiated a Professional Liability Ballot Initiative into an Assembly Bill; New Hampshire Introduced a Medical Licensure Bill; and New York Introduces Bill to Allow Certain Minors to Consent to Medical Treatment; Introduces Bill to Establish the Transgender and Gender Non-Binary Wellness and Equity Program. Legislative session ended for: Kentucky (April 14), Maine (April 25), Maryland (April 11), Nebraska (April 20) and Tennessee (April 29). For information about bills the AUA is tracking in your state, ...
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On April 25, the AUA joined the Alliance of Specialty Medicine (ASM) in a letter urging the Centers for Medicare and Medicaid Services (CMS) to address concerns with utilization management practices. In the letter, the Alliance provided feedback on statistics that should be included in a proposed prior authorization dashboard, encouraged adoption of the Safe Step Act’s provisions within CMS and urged CMS to adopt ASM’s previously released alternative payment model recommendations. The AUA continues to support reforms to the prior authorization process and will seek out further ways to engage CMS on this issue. The letter is attached. 04_29_2022_ASM_Blum ...
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On April 20, the AUA joined the Ad Hoc Group for Medical Research in a sign-on-letter to support and promote a program level of at least $49.048 billion for the fiscal year 2023 for the NIH base budget. The Ad Hoc Group is urging lawmakers to ensure that the budget increase is in addition to any funding for the Advanced Research Project Agency for Health (ARPA-H). In addition, the Ad Hoc Group supports a budget increase for pandemic readiness at NIH. The NIH’s decades long support for medical research has led to innovative treatment advancements. To continue to fully harness the novel research tools and partnerships to combat diseases, meaningful investments ...
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On April 28, the Department of Health and Human Services (DHHS) Office of Inspector General (OIG) issued a new report entitled “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns about Beneficiary Access to Medically Necessary Care,” which is attached. The OIG found that 13% of rejected prior authorization claims should have been covered under Medicare and 18% of payments were denied despite meeting Medicare coverage rules. The OIG conducted this review due to concerns that Medicare Advantage Organizations (MAOs) were incentivized to deny beneficiaries access to services and payments to providers in an effort to increase ...
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For the third year, Representative Julia Brownley (D-CA-26) led a Dear Colleague letter in support of bladder cancer research funding within the Congressionally Directed Medical Research Programs (CDMRP). Rep. Brownley was joined by 35 members of Congress in urging Chairs and Ranking Members of the House Committee on Appropriations and House Defense Appropriations Subcommittee to consider the prevalence of bladder cancer in the veteran population and directly allocate $8 million in research funding within CDMRP. The AUA has supported direct CDMRP funding for bladder cancer for several years and continues to advocate to members of Congress on behalf of bladder ...
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On April 27, AUAPAC participated in a fundraiser for Senator Tim Scott (R-SC) —a member of the Senate Health, Education, Labor & Pensions (HELP) and Senate Finance Committees. Senator Scott is a champion of increasing access to telehealth and expanding access to life-saving pharmaceuticals through the Safe-Step Act, both of which the AUA strongly supports. During the fundraiser, the senator expressed his concern about the future of healthcare. He feels Congress needs to take the necessary steps to resolve underlying issues to increase access to healthcare and reduce costs – particularly in light of the numerous public health challenges this country witnessed ...
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