Blogs

Each week, the AUA publishes updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Brachytherapy, Prostate, High Dose Rate Temporary, Urinary Incontinence, and Focal Treatments for Prostate Cancer, and Laboratory Analysis for Prostate Cancer. BCBS Arkansas BCBS Arkansas reviewed Brachytherapy, Prostate, High Dose Rate Temporary medical policy with changes to criteria. Read the update. Humana Humana reviewed Laboratory Analysis for Prostate Cancer with changes to coding. Read the update. LifeWise Health Plans LifeWise Health Plans reviewed Focal ...
0 comments
Each week, the AUA publishes updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Prostate Cancer Vaccine, Urinary Incontinence, and reviewed Saturation Biopsy for Diagnosis, Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer, and Urinary Tumor Markers for Bladder Cancer. Aetna Aetna reviewed Urinary Incontinence medical policy with changes to with changes to criteria and supplementary information. Read the update. Aetna reviewed Prostate Cancer Vaccine medical policy with changes to criteria, coding, and supplementary information. ...
0 comments
Insurance Updates: January 16, 2023 Each week, the AUA publishes updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Brachytherapy, Prostate, High Dose Rate Temporary, Pelvic Organ Prolapse, Urinary Bladder Dysfunction, and Focal Treatments for Prostate Cancer, and Nerve Graft to Restore Erectile Function during Radical Prostatectomy. Blue Advantage Administrators of Arkansas Blue Advantage Administrators of Arkansas reviewed High Dose Rate Temporary Prostate Brachytherapy medical policy with changes to criteria and administrative information. Read the update. Humana ...
0 comments
State advocacy update: Arkansas seeks to amend prostate cancer screening to include clinical recommendations by the national comprehensive cancer network Florida looks to allow audio-only telehealth Mississippi introduces bills to remove end-stage renal facilities from con law, require MCOS to set care guidelines for medical necessity in Medicaid and prescription benefit protections Missouri seeks to expand telehealth controlled substance prescribing Montana looks to remove supervisory agreement for physician assistants, and require criminal background checks for physician licensure New York enacts co-pay accumulator law Texas and Utah seek ...
0 comments
This week, Republican Leadership in the House selected Committee chairmen. Most notably Congressman Jason Smith (R-MO-08) was chosen to lead the Committee on Ways and Means, which has jurisdiction over Medicare payment policy in the House of Representatives. Congresswoman Cathy McMorris Rodgers (R-WA-05) will now chair the House Committee on Energy and Commerce, where she served as Ranking Member during the 117th Congress. Additional notable Republican committee selections include: Appropriations: Rep. Michael Cloud (R-TX-27), Rep. Michael Guest (R-MS-03), Rep. Stephan Bice (R-OK-05), Rep. Jerry Carl (R-AL-01), Rep. Jake Ellzey (R-TX-06), Rep. ...
0 comments
On December 22, Congress passed the Consolidated Appropriations Act of 2023 (the “Fiscal Year 2023 Omnibus Bill), whichwas signed into by President Biden on December 29. Along with government funding, this massive $1.7 trillion legislative package includes significant wins for the urology community, including provisions to create 200 new Medicare graduate medical education slots, extended Medicare telehealth flexibilities through the end of 2024, and reduced the Medicare physician payment cut to 2% from the 4.5% outlined in the 2023 Medicare Physician Fee Schedule. The final conversion factor for 2023 is $33.89. Telehealth Provisions Congress has extended ...
0 comments
On January 11, U.S. Health and Human Services Secretary Xavier Becerra extended the COVID-19 public health emergency (PHE) and its affiliated waivers for telehealth and other flexibilities for another 90 days. With most nursing home waivers phased out and Medicaid’s continuous enrollment freeze now decoupled from the declaration, the likelihood of the administration extending the PHE again is unlikely. The COVID-19 public health emergency was initiated January 27, 2020. The Trump and Biden administrations have renewed the coronavirus PHE declaration more than 10 times, making it the second longest ongoing PHE declaration. At more than five years old, the ...
0 comments
It is not too late to register for the 6 th Annual Urology Advocacy Summit in Washington, DC on February 27 – March 1. Spend Monday afternoon diving into the details of our legislative “asks” on Capitol Hill. This year’s agenda sessions include physician payment reform, expanding telehealth access, no-cost sharing PSA screenings for high-risk men and bolstering the physician workforce by incentivizing practice in rural areas. On Tuesday, you will head to Capitol Hill with your state’s delegation to meet with your lawmakers and their staff to discuss these issues. Finally, continue to learn about advocacy priorities and top-of-mind urologic policy issues on ...
0 comments
Insurance Updates: January 3, 2022 Each week, the AUA publishes updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Prostate Cancer Vaccine, Urinary Incontinence, and reviewed Saturation Biopsy for Diagnosis, Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer, and Urinary Tumor Markers for Bladder Cancer. Aetna Aetna reviewed Urinary Incontinence medical policy with changes to with changes to criteria and supplementary information. Read the update. Aetna reviewed Prostate Cancer Vaccine medical policy with changes to criteria, ...
0 comments
State Advocacy Update: New Jersey Introduces APN Scope of Practice and Pre-Authorization Bills Missouri Seeks to Join the Interstate Medical Licensure Compact and a Bill Relating to the Examination of an Unconscious or anesthetized patient Montana Introduces Bills to Amend the Board of Medicine, Define the Physician/Physician Assistant Supervisory Agreement, Require Health Insurers to Provide Gender Affirming Care Coverage, Changes to the Certificate of Need Laws and Medical Malpractice Oklahoma and Montana Introduce Out-of-Network Billing Bills South Carolina Seeks to Criminalize Gender Affirming Care, Eliminate Certificate of Need and Prevent ...
0 comments
On December 20, the Senate and House Appropriations Committees released language for the Consolidated Appropriations Act of 2023, a comprehensive omnibus bill, to fund the government beyond Friday, December 23 and the bill includes significant impactsfor urologic advocacy, including: Medicare physician payment cut of 2% rather than the 4.5% outlined in Calendar Year 2023 Medicare Physician Fee Schedule with an updated conversion factor coming shortly Medicare telehealth flexibilities—waiver of originating site and geographic restrictions, coverage of audio-only, and some others —are extended through the end of 2024 200 new Medicare GME (graduate medical ...
0 comments
Insurance Updates: December 19, 2022 Each week, the AUA publishes updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Pelvic Floor Stimulation, Nerve Graft with Radical Prostatectomy, Transurethral Waterjet Ablation of the prostate, and Radiation Therapy for Kidney Cancer. Aetna Aetna reviewed Ablative Procedures for Prostate Cancer with changes to supporting and administrative information. Read the update. BCBS New Mexico BCBS New Mexico reviewed Saturation Biopsy for Diagnosis, Staging and Management of Prostate Cancer, Including Comprehensive 3D mapping ...
0 comments
State Advocacy Update Massachusetts Enacts Commission on Step-Therapy Protocols Missouri Introduces Bills Addressing: Repeal Certificate of Need Laws, Eliminate the Collaborative Agreement Requirement for Nurse Practitioners, Unconscious Patient Exams and Step-Therapy Exceptions South Carolina Seeks to Prohibit Gender Reassignment Services to Persons Under 25 Texas Introduces Bill to Create a Statute of Limitations on Claims Involving Gender Modifying Services 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 the interactive legislative ...
0 comments
On December 6, the AUA joined the Alliance for Specialty Medicine (ASM) on a letter to the Medicare Payment Advisory Commission (MedPAC). The letter expressed concern with a number of recent policy recommendations from MedPAC that sought to increase payment to primary care providers, potentially at the expense of specialty care providers. MedPAC’s rationale was that lower pay to primary care providers drives future workforce toward specialties. One such suggestion to combat this alleged issue involves two separate fee schedules for evaluation and management (E/M) services, with separate conversion factors and different requirements under budget neutrality. ...
0 comments
The AUA joined the Friends of VA Medical Care and Health Research (FoVA) on a letter in support of the VA Infrastructure Powers Exceptional Research Act of 2021, or VIPER Act (H.R. 5721). The VIPER Act would improve the functionality and efficiency of the VA Medical and Prosthetic Research program, while also ensuring continuity of existing research affiliations. This distinction is in light of updated guidance from the VA that would impact outside salary support for VA researchers. The VA Office of the General Counsel issued a January 31 memo, addressed to VA medical center research leadership and associate chiefs of staff, detailing the office’s updated ...
0 comments
On December 6, the AUA joined the Alliance for Specialty Medicine on a response letter to the Centers for Medicare and Medicaid Services (CMS) regarding the concept of a National Directory of Health Care Providers and Services that could help facilitate care coordination, health information exchange and data reporting efforts. The letter from the Alliance highlights numerous concerns around the prior authorization process and supports streamlining systems as a means of burden reduction. The request for information (RFI) from CMS discusses the numerous directories and reporting portals currently managed by CMS, the burden imposed on providers who must comply with ...
0 comments
On December 6, AUAPAC participated in a meet and greet event with Congressional members from the Future Forum PAC hosted by MaDPAC, a coalition of Medical and Dental Political Action Committees. Future Forum members in attendance included Reps. Brendan Boyle (D-PA-02), Jimmy Gomez (D-CA-34), Raja Krishmamoorthi (D-IL-08), Darren Soto (D-FL-09), Haley Stevens (D-MI-07) and Eric Swalwell (D-CA-15). During the meeting, AUA staff discussed the impending Medicare payment cuts and the need for a permanent solution. AUA staff touched on the need for new House sponsors for the Specialty Physicians Advancing Rural Care Act and the initiative's importance for physicians ...
0 comments
On December 8, the AUA participated in a virtual fly-in hosted by the Alliance of Specialty Medicine. The AUA’s American Medical Association House of Delegates Lead Delegate and Public Policy Council member Hans Arora, MD, PhD, as well as Legislative Affairs Committee member Eric Biewenga, MD joined more than 100 other physicians from several specialties to hear from a dozen Democratic and Republican legislators from the U.S. House of Representatives and the Senate. During the meetings, lawmakers and physician participants discussed several timely issues, including stopping the aforementioned impending Medicare payment cuts and prior authorization reform. ...
0 comments
Insurance Updates: December 12, 2022 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 Whole Gland Cryoablation of Prostate Cancer, treatments for prostate cancer, prostate biopsies and treatment for urinary incontinence in adults. BCBS Arizona BCBS Arizona reviewed urinary disorder treatment with changes to criteria and references. Read the update. BCBS North Carolina BCBS North Carolina reviewed prostate biopsies (commercial) with changes to criteria and supporting information. Read the update. UPMC Health ...
0 comments
State Advocacy Update Illinois and Pennsylvania Introduce Bills Protecting Patients Receiving Gender Affirming Care Nevada Pre-files Student Loan Bill Tennessee, Texas, and Virginia Introduce Several Bills Prohibiting Physicians from Providing Gender Affirming Care Texas Introduces No Cost-Sharing Prostate Cancer, Prescription, and Telemedicine Bills For information about legislation 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 . Ohio The AUA sent testimony supporting two insurance ...
0 comments