LUGPA has submitted a comment letter on the 2023 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs Proposed Rule. LUGPA’s comments focused on CMS reaction to the recent Supreme Court decision which held that the agency illegally reduced payments to 340B hospitals from ASP+6% to ASP -22.5% because it failed to conduct a statutorily required survey of hospital costs to justify that payment change from 2018-22. Points raised by LUGPA in the comment letter:

• Requesting that CMS confirm that as the agency prospectively reverses the alternative 340B payment methodology to comply with the recent Supreme Court decision, Ambulatory Surgical Centers reimbursement, which is based on HOPPS, will not be adversely impacted.
• Urging CMS to ensure that the methodology determined to remedy underpayments between 2018-2022 does not inadvertently impact non-340B eligible providers who receive no benefit from the HOPPS payment increase of 3.2 percent which was triggered by the reduction in reimbursement for Part B drugs provided by 340B hospitals to ASP -22.5%, including Ambulatory Surgical Centers.
• Urging CMS to commission a hospital acquisition cost survey for 340B drugs, as is required under the statute, so that it may continue to pay for 340B drugs at a rate that more closely approximates the costs incurred by 340B providers, ensuring that the 340B program functions as it was intended, to subsidize care, rather than to create large margins for hospitals between the purchase and administration price for certain drugs across the board
• Supporting CMS’s application of the hospital market basket index to update the ASC payment system as a commonsense payment policy that promotes safe, convenient, and cost- effective care.
• Supporting the CMS proposal to add proposed C-APC 5372 (Level 2 Urology and Related Services).
• Supporting the CMS proposal to reassign certain procedure codes from APC 5375 to APC 5376.

The full text of LUGPA’s comment letter to CMS is available on the LUGPA website.

LUGPA and coalition express support for bipartisan legislation to mitigate Medicare reimbursement cuts

LUGPA’s efforts to block pending physician payment cuts have received bipartisan support in Congress. A new bill introduced by Representatives Ami Bera (D-CA) and Larry Bucshon (R-IN) provides a 4.42% increase to funding in the 2023 Physician Fee Schedule. Adoption of the Supporting Medicare Providers Act of 2022 would provide relief from Medicare cuts by adding additional funding to the fee schedule conversion factor through next year. The coalition letter supporting HR 8800 is available on the LUGPA website.  Blocking physician payment cuts will be a focus of LUGPA for year-end congressional negotiations.

LUGPA continues to advocate for telehealth flexibilities

The ongoing Public Health Emergency allows for telehealth waivers to remain in place.  These flexibilities include: waiving geographic/originating site requirements; payment parity with in-person reimbursement levels; waiving cost-sharing requirements; and allowing for audio-only visits.

The Public Health Emergency (PHE) will be extended for an additional 90 days in mid-October.  It’s unclear whether the Biden Administration will extend the PHE again beyond mid-January.  In March of 2022, Congress passed legislation to extend telehealth waivers for an additional 151 days following the termination of the PHE.

In July of 2022, the House passed additional legislation by nearly a unanimous vote, to extend telehealth waivers through December 31, 2024.  LUGPA is working closely with House and Senate leaders to ensure this additional extension gets included in a year-end healthcare package.

House passes prior authorization legislation

Improving Seniors' Timely Access to Care Act, a bipartisan measure, was unanimously approved by the US House of Representatives on September 14, 2022. By streamlining and standardizing prior authorization, the measure mandates greater openness and faster coverage determinations from Medicare Advantage plans, preventing needless delays in care. The bill, HR 3173, was introduced by Representatives Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera (D-CA), and Larry Bucshon (R-IN).

Unfortunately, the Congressional Budget Office scored the bill as costing $16 billion over 10 years which has halted progress on the bill.  Such a steep price tag is prohibitive in a Congress where all these types of initiatives must be offset.  We expect that the Congressional champions will work with CMS in the coming months to have the Administration try and accomplish these same goals through regulatory action. LUGPA will continue to monitor this activity moving forward.

LUGPA has long been at the forefront in opposing prior authorization policy, having previously expressed concerns that patients are at risk under “fail-first” step therapy requirements. LUGPA opposes any policies that restrict appropriate access to drugs, including step therapy and prior authorization, and supports legislation removing barriers to physician prescribing decisions for their patients.

Final Rules issued on No Surprises Act

The Departments of Health and Human Services, Labor, and the Treasury released Final Rules addressing numerous aspects of the No Surprises Act's payment mechanism for out-of-network care and account for the two district court rulings on the NSA.

The Final Rules and FAQs consider comments from stakeholders to the interim final rules released last year and provide some clarification on a number of NSA requirements, including how the law's protections apply to closed-network and no-network plans, disclosure-related requirements, and the calculation of the qualifying payment amount.

Thank you to LUGPA groups for supporting our 2022 Legislative and Regulatory Agenda

The LUGPA Political Affairs Committee wishes to thank the following groups for their incredible support of LUGPA political action this year. 

The fly in schedule for next year will be announced in early 2023. If you are interested in attending or would like more information, please contact the LUGPA office at [email protected].