March 2026

At-a-Glance

LUGPA remains committed to advancing policies that strengthen independent urology, protect patient access to high-quality specialty care, and ensure fair, sustainable reimbursement for urologic services.

February was a particularly active and consequential month at the federal, payer, and state levels. Significant regulatory proposals, new administrative initiatives, and major state legislation underscore the rapidly evolving policy landscape affecting independent practices. LUGPA has been actively engaged across all fronts to ensure the voice of independent urology is represented.

Federal Advocacy

• Joint national insurer downcoding survey launched with the Community Oncology Alliance
• Detailed MACRA reform recommendations submitted to the bipartisan House Doctors Caucus
• Analysis underway of CY 2027 Medicare Advantage Advance Notice from the Centers for Medicare & Medicaid Services
• Strong support for the United States Department of Labor PBM transparency proposal
• Monitoring rollout of TrumpRx.gov drug pricing transparency platform
• Continued engagement on 340B reform following withdrawal of rebate model pilot
• Review of CMS final rule tightening Medicaid provider tax oversight

Payer Advocacy

• Formal letter to UnitedHealthcare opposing new Medicare Advantage referral requirements that impede specialty access

State Advocacy

• Active opposition to New York Assembly Bill A.2140-A imposing commercial payment caps
• Coalition opposition to Virginia Senate Bill 278, expanding 340B without accountability
• Support for Pennsylvania legislation eliminating cost-sharing for PSA screening

Share Your Story —
Amplify the Voice of Urology 

Have reimbursement issues, administrative burden, patient access, workforce challenges, or sustainability affected your practice? 

LUGPA is renewing its call for member stories to strengthen our advocacy at the federal and state levels. Policymakers respond to real-world impact, and your experiences with the Medicare Physician Fee Schedule, MACRA, prior authorization, step therapy, telehealth, workforce shortages, genetic testing, and other coverage and reimbursement challenges bring urgency and credibility to our message.

Personal stories from physicians and patients help humanize the data, influence legislative conversations, and build support among local lawmakers. Whether you submit a brief written account or record a short video, your perspective can directly shape policy discussions affecting independent urology.

Members may also record stories at upcoming LUGPA meetings as part of our expanded advocacy outreach.

To participate, submit your story to Matthew Glans. Please ensure all shared patient information complies with HIPAA requirements and includes appropriate consent.

Your voice matters, and together, we can ensure independent urology is heard loud and clear.

Key Advocacy Highlights   

Insurer Downcoding: National Survey in Progress 

LUGPA, in partnership with COA, distributed a joint national survey to assess the scope and impact of insurer downcoding of evaluation and management (E/M) services in specialty care.

The survey evaluates:

• Frequency and patterns of unilateral downcoding
• Whether downcoding occurs without medical record review
• Revenue losses associated with coding changes
• Administrative time and costs required to appeal

Downcoding of properly documented, medically necessary services undermines fair reimbursement for complex urologic care. It diverts physician and staff resources away from patient care and contributes to financial instability for independent practices.

Once analyzed, survey data will support targeted federal and state advocacy promoting transparency, accountability, and clinically grounded coding policies.

If your practice has experienced downcoding, please take a few minutes to share your experience. Your input will strengthen our ability to document patterns, quantify financial impact, and advocate for fair reimbursement.

MACRA Reform: Protecting Independent Practice   

LUGPA submitted detailed comments to the House Doctors Caucus outlining needed reforms to the Medicare Access and CHIP Reauthorization Act of 2015.

Independent urology practices continue to face structural challenges under MIPS, including:

• Inadequate or stagnant payment updates that fail to reflect inflation
• Escalating administrative complexity
• Limited access to specialty-appropriate Advanced APM pathways
• Financial instability tied to budget neutrality constraints

LUGPA urged Congress to adopt:

• Permanent, inflation-adjusted physician payment updates
• Streamlined and clinically relevant reporting requirements
• Viable specialty-focused APM options
• Structural reforms that preserve independent community-based care

Stabilizing Medicare physician payment remains one of LUGPA’s top federal priorities.

CMS CY 2027 Medicare Advantage Advance Notice 

CMS released the CY 2027 Medicare Advantage and Part D Advance Notice, outlining proposed updates to payment and risk-adjustment methodologies.

Proposals include:

• Continued transition away from the 2017 CMS-HCC model
• Adjustments to diagnostic data sources
• Modest projected payment growth

LUGPA is analyzing how these changes may affect reimbursement for:

• Advanced prostate cancer management
• Chronic urologic disease
• High-acuity specialty patients

Accurate risk adjustment is essential to ensuring Medicare Advantage plans adequately reimburse complex specialty care.

PBM Transparency: Department of Labor Proposed Rule

The United States Department of Labor issued a proposed rule requiring pharmacy benefit managers to disclose detailed compensation arrangements—including rebates and fees—to self-insured group health plans.

This proposal represents a significant step toward:

• Strengthening fiduciary oversight
• Reducing conflicts of interest
• Increasing accountability in prescription drug pricing

LUGPA strongly supports PBM transparency reforms, particularly given the high cost of oncology and specialty medications used in urologic care.

TrumpRx.gov: Direct-to-Consumer Transparency Initiative 

The administration launched TrumpRx.gov, a federal platform directing patients to manufacturer-sponsored discount programs for certain brand-name drugs.

While not a purchasing platform, the initiative aims to:

• Increase price transparency
• Reduce reliance on intermediaries
• Lower out-of-pocket costs

LUGPA is closely monitoring implications for high-cost urologic therapies and evaluating how this initiative may interact with existing payer policies.

340B Rebate Model Withdrawal   

The United States Department of Health and Human Services formally withdrew the proposed 340B rebate model pilot following legal and stakeholder challenges.

LUGPA continues to advocate for meaningful 340B reforms that ensure:

• Transparency
• Accountability for contract pharmacy arrangements
• Demonstrable patient benefit
• Preservation of program integrity

The withdrawal presents an opportunity for a more balanced, evidence-driven reform process. However, the administration reissued an RFI on a similar model, indicating they are likely to attempt to relaunch the model with new accommodations for the legal challenges they faced.

Medicaid Provider Tax Oversight       

CMS finalized new requirements that tighten oversight of Medicaid provider tax arrangements, prohibit higher tax rates on Medicaid business, and impose stricter uniformity standards.

The phased implementation (2027–2028) is intended to safeguard federal Medicaid funding. LUGPA is assessing how these changes may affect the stability of reimbursement for urology services, particularly in expansion states where Medicaid volumes are significant.

UnitedHealthcare Medicare Advantage Referral Requirements     

UnitedHealthcare implemented new referral requirements for most Medicare Advantage HMO and POS plans effective January 1, 2026.

LUGPA submitted a formal letter expressing serious concerns that the policy:

• Creates unnecessary administrative barriers
• Delays time-sensitive care, including prostate cancer diagnosis and treatment
• Increases burdens on referring providers and specialists

We urged UnitedHealthcare to prioritize patient access and clinical judgment over administrative gatekeeping.

Updated LCD/NCD Coverage Guide 

LUGPA updated its Medicare Local and National Coverage Determinations (LCD/NCD) Guide to provide members with streamlined access to the most relevant coverage policies affecting urologic care.

The guide consolidates key Local Coverage Determinations and National Coverage Determinations impacting diagnostics, procedures, and molecular testing, and links directly to the Medicare Coverage Database for real-time updates.

Given the significant role LCDs play in determining whether services are considered “reasonable and necessary,” this resource helps independent practices monitor coverage changes, strengthen documentation, and reduce claim denials.

Pennsylvania: PSA Cost-Sharing Elimination Legislation

LUGPA is actively supporting Pennsylvania legislation that would eliminate patient cost-sharing for prostate-specific antigen (PSA) screening for high-risk populations.

The bill would:

• Prohibit deductibles, copayments, or coinsurance for PSA testing consistent with clinical guidelines
• Expand access to early detection for men at elevated risk, including African American men and those with a family history of prostate cancer
• Align commercial coverage more closely with preventive care standards

Early detection of prostate cancer significantly improves treatment options and survival outcomes. However, cost-sharing requirements can discourage high-risk patients from obtaining recommended screening.

LUGPA has engaged state lawmakers to emphasize:

• The clinical importance of risk-based PSA screening
• The modest actuarial impact of eliminating cost-sharing
• The downstream cost savings associated with early detection versus late-stage treatment

This legislation represents a proactive, patient-centered reform consistent with LUGPA’s commitment to improving cancer outcomes and advancing health equity.

New York: Assembly Bill A.2140-A
(“Fair Pricing Act”) 

LUGPA actively engaged in opposition to Assembly Bill A.2140-A, which would impose a statutory cap on commercial reimbursement for designated outpatient services at 150% of Medicare’s non-hospital rates.

The bill would:

• Override negotiated provider-insurer contracts
• Expand site-neutral concepts into private markets
• Impose significant civil penalties for noncompliance
• Require premium adjustments tied to reduced provider payments

In communications to the New York State Assembly Health Committee, LUGPA emphasized that:

• Medicare Physician Fee Schedule and ASC rates frequently fall below the cost of care
• Commercial reimbursement offsets chronic Medicare underpayments
• Mandatory caps would destabilize independent specialty practices
• Ambulatory surgical centers delivering cost-efficient urologic procedures would face disproportionate harm
• The policy risks accelerating consolidation into hospital systems, ultimately increasing overall system costs

LUGPA continues to monitor the bill’s progress and engage policymakers to protect independent specialty care in New York.

Virginia: Senate Bill 278 (340B Expansion)

LUGPA joined a coalition opposing Virginia Senate Bill 278, which would expand 340B eligibility and contract pharmacy arrangements without sufficient accountability mechanisms.

We urged lawmakers to ensure that any expansion of 340B safeguards measurable patient benefits and program transparency.

Looking Ahead

February’s developments reflect intensifying policy activity affecting independent urology at every level. From Medicare payment reform and PBM transparency to commercial price controls and access to preventive screening, LUGPA remains fully engaged in defending fair reimbursement, protecting patient access, and preserving independent specialty infrastructure.

The coming months will be critical as Congress considers additional healthcare extenders, state legislatures advance payment and drug pricing proposals, and payers continue to implement utilization management changes. LUGPA will continue to advocate forcefully for policies that sustain independent urology and ensure patients retain access to high-quality, community-based specialty care.