Blogs

Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. Due to the volume of insurance policy updates, we are focusing our updates on the Medicare Administrative Contractors (MACs) and the major commercial insurance companies. This week’s update includes the release of a new Prostate Cancer Screening policy from BCBS Kansas City Missouri, as well as updates to its Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence and Sacral Nerve Neuromodulation/Stimulation policies. BCBS Alabama has updated its Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management while BCBS Michigan ...
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On March 24, the Centers for Medicare & Medicaid Services (CMS) held a conference call on Telehealth, Patient Triage and Workforce Challenges while dealing with COVID-19. The call was part of a series that CMS will hold to provide physicians across the country with “front-line learning” on COVID-19, and allowed participants to share their own experiences. CMS Administrator Dr. Seema Verma shared on the call that CMS will issue rulemaking later this week to address some of the policies that cannot be implemented outside of the rulemaking process. Several physicians from around the country shared their concerns and experience on topics such as the status ...
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On March 20, the AUA, along with the American College of Surgeons and 20 other surgical specialties, sent an urgent letter to House and Senate Leadership outlining numerous provisions that are greatly needed as Congress continues to push legislation to help stave off the extreme challenges created by the COVID-19 crisis. The Surgical Coalition’s communication covered a wide-range of issues, including protecting front-line physicians by ensuring they have the equipment they need and that Good Samaritans are protected when crossing state lines. Additionally, the letter calls for lawmakers to promote efficient access to necessary care by relieving prior authorization ...
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On March 5, Congressmen Neal Dunn (R-FL-02) and Joe Cunningham (D-SC-1) introduced H.R. 6092 , Veteran’s Prostate Cancer Treatment and Research Act , a long-awaited bill that would establish a national clinical pathway for prostate cancer, a comprehensive standardized system of treatment for veterans and establishes a real-time registry to track patients' progress. The bipartisan bill also creates a national prostate cancer care program with recommendations on the use of transformative innovations, research and uniform clinical data designed in collaboration with disciplines across the public and private sector to guide evidence-based care for veterans. Read ...
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On March 5, MedPAC met and discussed recommendations related to quality improvement, risk adjustment and payment innovation. Presentation topics include: Addressing Medicare Shared Savings Program vulnerabilities The role of specialists in alternative payment models and accountable care organizations Redesigning the Medicare Advantage quality bonus program The impact of changes in the 21 st Century Cures Act to risk adjustment for Medicare Advantage enrollees The 21st Century Cures Act directed the Centers for Medicare and Medicaid Services (CMS) to implement changes to the Hierarchical Condition Category (HCC) model that it uses to risk adjustment ...
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The top takeaways from the Centers for Medicare & Medicaid Services (CMS) March Clinician Outreach Meeting focused on the Request for Information (RFI) regarding Maternal Health Care and the National Provider Call entitled “Your Role in Healthcare Transparency” being held later this month. Request for Information (RFI) Regarding Rural Maternal Health Care Last month, CMS announced that an RFI would be released that would be designed to build on a forum held last summer. The purpose of the forum, hosted by the Health Resources and Services Administration (HRSA), was to better understand challenges and opportunities for maternal and obstetric care in ...
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The Merit-based Incentive Payment Program (MIPS) is comprised of four reporting categories: Quality, Cost, Promoting Interoperability, and Improvement Activities. In 2020, the Quality category accounts for 45 percent of the total MIPS score. Because it is such a large part of one’s overall score, it is important to know the details of the category. Quality reporting requires completing designated actions for at least six Quality measures and submitting this information to the Centers for Medicare & Medicaid Services (CMS). At least one of the six measures must be an outcome measure. There are several hundred individual measures to consider in 2020. Participants ...
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The Food and Drug Administration (FDA) announced that Med Man Distribution has voluntarily recalled Bow and Arrow, a supplement promoted for sexual enhancement.  This product has been found to contain sildenafil.  The presence of this undeclared active ingredient renders the product an unapproved drug for which safety and efficacy have not been established and, therefore, subject to recall.  Sildenafil is an FDA approved drug for the treatment of male erectile dysfunction. While there are no reports of illness associated with the supplement, it could pose a threat to consumers because an undeclared product can interact with nitrates found in some prescription ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week, the following plans have released new or amended prior authorization requirements: CarePlus, Minnesota Medicaid, Providence Health Plan, Total Healthcare, Uniform Medical Plan, and UnitedHealthcare (UHC). Additionally, these plans have updated their medical policies as follows: BlueAdvantage Administrators of Arkansas (Nerve Graft with Radical Prostatectomy), BCBS Kansas City Missouri (Biofeedback as a Treatment of Urinary Incontinence in Adults, Yonsa, Percutaneous Tibial Nerve Stimulation [PTNS], Transurethral Water Vapor Thermal Therapy for Benign ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes revisions to Aetna’s tumor markers and urinary incontinence medical policies, as well as changes to the Sacral Nerve Stimulation (SNS) and Percutaneous Tibial Nerve Stimulation (PTNS) for Urinary and Fecal Incontinence; Urinary Retention medical policy that affects Amerigroup, Anthem, BCBS Georgia, BlueChoice HealthPlan of South Carolina, Community Connect Health Plan, Empire BCBS, Healthlink, and Unicare. AmeriHealth has updated its medical policies for Experimental/Investigational Services CPT/HCPCS Codes, Surgical and Minimally Invasive ...
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On February 27, the AUA, in conjunction with the Regulatory Relief Coalition (RRC), met with staff in the offices of Reps. Jamie Herrera Beutler (R-WA-03), John Katko (R-NY-24) and Rick Allen (R-GA-12) to educate them on the Improving Seniors' Timely Access to Care Act (H.R. 3107). The bill – sponsored by Reps. Suzan DelBene (D-WA-01), Mike Kelly (R-PA-16), Roger Marshall, MD (R-KS-01), and Ami Bera, MD (D-CA-07) –  would protect patients from unreasonable Medicare Advantage plan requirements that needlessly delay or deny access to medically necessary care (more information can be found  here ). Cosponsorship of this legislation will be one of the four congressional ...
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On February 20, the AUA signed onto a coalition letter in support of  SB 952 , a step therapy reform bill introduced by Maryland State Senator Joanne Benson. SB 952 ensures appropriate, common sense guardrails are applied to step therapy to help patients receive the most effective treatments as quickly as possible. This legislation accomplishes this by: Establishing an exceptions process for patients if trying or staying on a medication would create a significant barrier to compliance, worsen a comorbid condition, be contraindicated, or decrease the patient’s ability to achieve or maintain reasonable function; Ensuring step therapy protocols are based ...
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In February, Illinois Representative Deanna Mazzochi (R) introduced HB 4847 , a bill that requires insurance coverage for prostate-specific antigen tests and for colorectal cancer examination and screening. This bill also removes provisions requiring a physician to recommend or prescribe the testing. On February 18, HB 4847 was referred to the Rules Committee and awaits a hearing. We will keep you updated as this bill moves forward. Missouri Representative Chris Carter (D) introduced HB 1930 , a bill that establishes two “Prostate Cancer Pilot Programs” to provide prostate cancer screening, referral services, treatment services, and education to men. Specifically, ...
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The AUA Summit is just a few weeks away, and provides a unique opportunity to engage lawmakers and regulators in meaningful discussion about the top issues facing urology. This dialogue is even more important during an election year! With the 2020 election cycle well underway, AUAPAC is offering its donors the opportunity to hear from political analyst Charlie Cook during an exclusive donors-only breakfast on March 17.  This event will be open to all 2020 AUAPAC donors who have given at the silver membership level or higher*. Charlie Cook is widely considered one of the nation’s most respected and impartial analysts of American politics, elections and ...
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The registration deadline is quickly approaching for the AUA’s 2020 Merit-based Incentive Payment System (MIPS) Reporting Webinar.  Respond now while spots still remain. What:  Free webinar featuring experts from the Centers for Medicare & Medicaid Services (CMS), who will explain changes to the program and answer questions When: Tuesday, March 10, 2020, at 1:00 p.m. Eastern Who is Eligible: AUA and PMN members Cost: Free How to Register:    Email your name and email address to Quality@AUAnet.org The webinar topics include: Four ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes prior authorization (PA) updates from Aetna, an updated drug policy from AllWays Health Partners, and updated Benign Prostatic Hyperplasia (BPH) treatments policies from Amerigroup and Humana. There is a new drug policy from BCBS Florida, and a draft policy for Prostatic Urethral Lift from BCBS Illinois. Also, there are updates to prostate cancer genetic test policies from BlueAdvantage, a new Biofeedback policy from BCBS Idaho, and an updated drug policy from HealthNet. Furthermore, Highmark has combined and revised its Erleada, Nubeqa, ...
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Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes new policies from AlohaCare and UPMC, revisions to current policies from Aetna, AmeriHealth, BCBS North Carolina, BlueAdvantage, Horizon, and HealthNet, and updates in Prior Authorization (PA) criteria from ArchCare, BCBS Minnesota, Highmark, Premera, and Tufts Health Plan. Also, there are two Local Coverage Articles (LCAs) from WPS Government Health Administrators. Please see below for additional details on each policy update. Aetna Aetna has reviewed and updated its ablative procedures for prostate cancer medical policy with the ...
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On February 18, 2020, Congressmen David McKinley (R-WV-1) and Peter Welch (D-VT-AL) introduced a bill that would help to address the workforce shortage of specialty physicians in rural America (H.R. 5924). This bipartisan bill would create a student loan repayment program for specialty physicians that practice in rural communities for a minimum of six years. While student loan forgiveness programs exist through agencies like the National Health Service Corps, none of them are open to specialty care physicians such as urologists. The AUA worked closely with Rep. McKinley and his staff to develop this legislation, and stands in support of H.R. 5924. This bill ...
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On February 3, Maryland House Delegate Erek Barron (D-24) introduced HB 852 to specifically require the state of Maryland to cover a digital rectal exam and a PSA test for men between 40 and 75 years old and men who are at high risk of developing the disease. Following the introduction, on February 13, the legislation was heard by the Health and Governance Operations Committee where AUA Mid-Atlantic Section President Dr. Benjamin Lowentritt testified in support of the bill. To listen to the hearing, click here (hearing begins at the 1:45:45 mark; Dr. Lowentritt’s testimony begins at the 1:54:44 mark ) “This is about incorporating prostate cancer ...
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On February 7, the AUA and Bladder Cancer Advocacy Network (BCAN) met with appropriations staff from Congressman Dutch Ruppersberger’s (MD-02) office to discuss Fiscal Year (FY) 2021 appropriations funding for bladder cancer under the Department of Defense’s Congressionally Directed Medical Research Program (CDMRP). The collaborative meeting discussed the need for bladder cancer to have its own $10 million line within the CDMRP. Since 2016, bladder cancer has resided within the Peer Reviewed Cancer Research Program (PRCRP) that entails sharing a pot of funding with multiple disease areas. In FY 2019, bladder cancer received $8.7 million of the total $90 million ...
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