November 2021 

In this issue we feature:

  • MPFS and OPPS Final Rules
  • 2021 Fly-in Recap
  • Reconciliation Update
  • COVID-19 Public Health Emergency Extension
  • The Prostate Cancer Prevention Act
  • Reminder: Provider Relief Fund Phase 3 Payment Reconsideration
  • CMS reopens reweighing request period for 2020 MIPS performance year

MPFS and OPPS Final Rules 

CMS published final rules addressing changes to the Medicare Physician Fee Schedule and the Hospital Outpatient Prospective Payment System for 2021. As you may recall, LUGPA submitted commentary on these rules as they were proposed in September. While LUGPA’s Health Policy and Political Affairs teams are in the process of analyzing the final rules, we wanted to bring your attention to some key takeaways:

MPFS

Clinical Labor Pricing Update

  • Despite opposition from LUGPA and other stakeholders, CMS is moving forward with the implementation of clinical labor pricing updates.
  • CMS is planning implementation of the clinical labor pricing update over 4 years to transition from current prices to final updated prices in 2025.

Telehealth

  • Certain services added to the Medicare list of covered telehealth services will remain on the list through the end of 2023. This will allow CMS to determine whether they should remain on the list permanently.
  • With some exceptions, patients receiving telehealth services are required to have one in-person visit every 12 months.
  • CMS is amending the definition of interactive telecommunications systems for telehealth to include audio-only communications for the evaluation, management, and treatment of mental health disorders for established patients in their homes, under certain parameters.

OPPS

Price Transparency

  • Starting January first, CMS will increase penalties for noncompliance with hospital price transparency requirements.
  • CMS sets the minimum civil monetary penalty of $300 per day for smaller hospitals with a bed count of thirty or fewer, and a penalty of $10 per bed per day for hospitals with a bed count greater than thirty. The penalty cannot exceed a maximum daily dollar amount of $5,500.
  • The minimum total penalty amount would be $109,500 per hospital, and the maximum total penalty amount would be $2,007,500 per hospital for a full calendar year of noncompliance.

OPPS and ASC Payment Rates

  • CMS finalized a proposal to apply the hospital market basket update to ASC payment system rates for an interim period of five years (2019-2023)
  • CMS is updating the ASC payment rates for CY 2022 by 2.0 percent for ASCs that meet applicable quality reporting requirements.

340B Drug Reimbursement

  • CMS will continue its payment policy for Part B drugs acquired under the 340B program.
  • Reimbursement will remain at average sales price minus 22.5 percent for program participants

Be sure to attend the LUGPA Health Policy Forum at the LUGPA Annual Meeting on Friday, November 12 at 8:30 AM. LUGPA’s Health Policy team will discuss the MPFS and OPPS final rules and other issues impacting your practice in much greater detail.

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2021 Fly-in Recap 

This year, the LUGPA Political Affairs Committee resumed in-person fly-ins in Washington, DC for the first time since the start of the pandemic. LUGPA representatives promoted the 2021 Legislative and Regulatory Agenda, in particular making permanent the telehealth changes provided through waivers set to expire at the conclusion of the Public Health Emergency and reforms to Part-B drugs to bring greater efficiency to the program and lower out of pocket costs to the patients. We also advised Members to act before the end of the year to prevent Medicare physician payment cuts.

LUGPA representatives met with the following Members of Congress in 2021:

  • Representative Jodey Arrington (R-TX) | House Ways and Means Committee
  • Senator John Barrasso (R-WY) | Senate Finance Committee and Doctors Caucus
  • Senator Bill Cassidy (R-LA) | Senate Finance Health Care Subcommittee and Doctors Caucus
  • Senator Mike Crapo (R-ID) | Senate Finance Committee Ranking Member
  • Representative Dan Crenshaw (R-TX) | House Energy and Commerce Committee
  • Representative Brett Guthrie (R-KY) | House Energy and Commerce Health Subcommittee
  • Senator Maggie Hassan (D-NH) | Senate Finance Health Care Subcommittee
  • Representative Kevin Hern (R-OK) | House Ways and Means Committee
  • Representative John Joyce (R-PA) | House Energy and Commerce Committee and Doctors Caucus
  • Representative Robin Kelly (D-IL) | House Energy and Commerce Committee
  • Representative Ann McLane Kuster (D-NH) | House Energy and Commerce Health Subcommittee
  • Senator Catherine Cortez Masto (D-NV) | Senate Finance Health Care Subcommittee
  • Representative Greg Murphy (R-NC) | Doctors Caucus
  • Representative Lisa Blunt Rochester (D-DE) | House Energy and Commerce Committee
  • Representative Cathy McMorris Rodgers (R-WA) | House Energy and Commerce Committee Ranking Member
  • Representative Linda T. Sánchez (D-CA) | House Ways and Means Committee
  • Representative Kim Schrier (D-WA) | House Energy and Commerce Health Subcommittee
  • Representative Terri A. Sewell (D-AL) | House Ways and Means Health Subcommittee
  • Representative Lori Trahan (D-MA) | House Energy and Commerce Committee
  • Senator Mark Warner (D-VA) | Senate Finance Health Care Subcommittee
  • Representative Brad Wenstrup (R-OH) | House Ways and Means Committee and Doctors Caucus
  • Senator Ron Wyden (D-OR) | Senate Finance Committee Chair


The LUGPA Political Affairs committee would like to thank the physicians and administrators of the following groups whose efforts made the 2021 fly-ins possible:

  • Advanced Urology Institute – Oxford, FL
  • Amarillo Urology Associates, LLP – Amarillo, TX
  • Anne Arundel Urology – Annapolis, MD
  • Arkansas Urology - Little Rock, AR
  • Associated Medical Professionals of NY - Syracuse, NY
  • Associated Urological Specialists – Palos Heights, IL
  • Associated Urologists, PA – Manhattan, KS
  • Central Ohio Urology Group – Columbus, OH
  • Comprehensive Urology – Royal Oak, MI
  • First Urology – Jeffersonville, IN
  • Garden State Urology, LLC – Morristown, NJ
  • Genesis Healthcare Partners – San Diego, CA
  • Golden Gate Urology – San Francisco, CA
  • Greater Boston Urology – Framingham, MA
  • Houston Metro Urology – Houston, TX
  • Idaho Urologic Institute – Meridian, ID
  • Integrated Medical Professionals – Melville, NY
  • Kansas City Urology Care, P.A. – Lenexa, KS
  • Michigan Institute of Urology – Saint Clair Shores, MI
  • MidLantic Urology, LLC – Bryn Mawr, PA
  • Minnesota Urology – Woodbury, MN
  • New Jersey Urology – Bloomfield, NJ
  • Oregon Urology Institute – Springfield, OR
  • Golden Gate Urology – San Francisco, CA
  • Greater Boston Urology – Framingham, MA
  • Houston Metro Urology – Houston, TX
  • Idaho Urologic Institute – Meridian, ID
  • Integrated Medical Professionals – Melville, NY
  • Kansas City Urology Care, P.A. – Lenexa, KS
  • Michigan Institute of Urology – Saint Clair Shores, MI
  • MidLantic Urology, LLC – Bryn Mawr, PA
  • Minnesota Urology – Woodbury, MN
  • New Jersey Urology – Bloomfield, NJ
  • Oregon Urology Institute – Springfield, OR
  • Pioneer Valley Urology – Springfield, MA
  • Premier Medical Group of the Hudson Valley – Poughkeepsie, NY
  • Rio Grande Urology – El Paso, TX
  • Summit Urology Group – Salt Lake City, UT
  • The Conrad Pearson Clinic – Germantown, TN
  • The Urology Center of Colorado – Denver, CO
  • The Urology Group – Cincinnati, OH
  • Urologic Specialists of Northwest Indiana / UroSurgery Associates – Merrillville, IN
  • Urological Associates of Western Colorado – Grand Junction, CO
  • Urological Associates, PC – Davenport, IA
  • Urological Surgeons of Northern California, Inc. – San Jose, CA
  • Pioneer Valley Urology – Springfield, MA
  • Premier Medical Group of the Hudson Valley – Poughkeepsie, NY
  • Rio Grande Urology – El Paso, TX
  • Summit Urology Group – Salt Lake City, UT
  • The Conrad Pearson Clinic – Germantown, TN
  • The Urology Center of Colorado – Denver, CO
  • The Urology Group – Cincinnati, OH
  • Urologic Specialists of Northwest Indiana / UroSurgery Associates – Merrillville, IN
  • Urological Associates of Western Colorado – Grand Junction, CO
  • Urological Associates, PC – Davenport, IA
  • Urological Surgeons of Northern California, Inc. – San Jose, CA
  • Urology Associates of Central California Medical Group – Fresno, CA
  • Urology Associates of Delaware – Dover, DE

  • Urology Centers of Alabama, P.C. – Homewood, AL

  • Urology of Indiana – Greenwood, IN

  • Urology of St. Louis, Inc. – St. Louis, MO

  • Urology of Virginia – Virginia Beach, VA

  • Urology of San Antonio – San Antonio, TX 

  • Urology Specialists of The Carolinas - Charlotte, NC

  • UroPartners – Melrose Park, IL

  • Wichita Urology Group – Wichita, KS

It is essential that lawmakers hear from you. Are you willing to attend a LUGPA fly-in in 2022? For more information on how to participate, contact Morgan Cox in the LUGPA office at [email protected].

 

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Reconciliation Update

The White House announced an updated Build Back Better Act framework. The framework includes $1.8 trillion in spending, a significant reduction from the  $3.5 trillion proposed earlier. As part of an agreement reached by Congressional Democrats last week, Medicare Parts B and D would be able to negotiate the prices of certain drugs directly with manufacturers. The deal would also cap out of pocket spending for seniors at $2,000 per year and includes a monetary penalty for drug manufacturers that increase their prices at a rate greater than the national inflation.

LUGPA remains engaged with lawmakers from both parties to ensure that any changes proposed to lower the cost of prescription drugs will not adversely impact our practice’s capability to administer and receive reimbursement for Part B drugs in their offices and ASCs.


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COVID-19 Public Health Emergency Extension 

Effective October 18, the HHS Secretary has renewed the COVID-19 PHE for another 90 days. This most recent extension will continue the PHE through January 16, 2022. This extension will allow for telehealth and other flexibilities granted under the PHE to continue.


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The Prostate Cancer Prevention Act

Representatives Neal Dunn (R-FL) and Bobby Rush (D-IL) have introduced The Prostate Cancer Prevention Act of 2021. The bill, which received input from LUGPA’s political affairs and health policy teams, would reauthorize preventive health programs with respect to prostate cancer. LUGPA welcomes the effort to expand screening programs to detect prostate cancer earlier and will provide further updates as we continue to monitor the progress of this legislation.


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Reminder: Provider Relief Fund Phase 3 Payment Reconsideration 

HHS has released information about the methodology used to determine the payment amounts issued to providers within Phase 3 payments. Providers who believe their Phase 3 payment was incorrectly  calculated will have the opportunity to request reconsideration. The deadline to request reconsideration is at 11:59 EST on November 12, 2021. Additional information on how to submit a reconsideration request is available on the HHS website.


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CMS reopens reweighing request period for 2020 MIPS performance year 

Due to the ongoing impact of the COVID-19 pandemic, CMS has reopened the reweighing request period for 2020 MIPS performance year. Under the extreme and uncontrollable circumstances policy, MIPS eligible clinicians can request performance category reweighting for performance 2020 through November 29, 2021 at 8 p.m. ET. Additional information can be found in the 2020 Extreme and Uncontrollable Circumstances Reweighting Requests Extension Guid

·       Urology Associates of Central California Medical Group – Fresno, CA

·       Urology Associates of Delaware – Dover, DE

·       Urology Centers of Alabama, P.C. – Homewood, AL

·       Urology of Indiana – Greenwood, IN

·       Urology of St. Louis, Inc. – St. Louis, MO

·       Urology of Virginia – Virginia Beach, VA

·       Urology of San Antonio – San Antonio, TX

·       Urology Specialists of The Carolinas - Charlotte, NC

·       UroPartners – Melrose Park, IL

·       Wichita Urology Group – Wichita, KS