May 2022  

In this issue we feature:

  • Fly-in Recap
  • Public Health Emergency extended  
  • Telehealth flexibilities extended for most of 2022  
  • Radiation Oncology payment model delayed
  • No Surprises Act Updates 
  • LUGPA suggestion adopted by GOP Healthy Future Task Force
  • CMS Reweights 2021 MIPS Cost Performance Category

Fly-in Recap   

In April, the Political Affairs committee met with Members of Congress and their staff to promote the 2022 Legislative and Regulatory Agenda for the first DC fly-in of 2022. In particular, participants focused on urging Congress to make permanent the telehealth changes provided through waivers set to expire at the conclusion of the Public Health Emergency, promote competition between independent practices and hospital systems, and to protect the average sales price for Part B drugs.

LUGPA members met with the following Members of Congress:

  • Senator Michael Bennet (D-CO) | Senate Finance Committee Member
  • Representative Vern Buchanan (R-FL) | House Ways and Means Health Subcommittee Ranking Member
  • Representative Larry Bucshon (R-IN) | House Energy and Commerce Health Subcommittee Member, Doctors Caucus
  • Representative Neal Dunn (R-FL) | House Energy and Commerce Health Subcommittee Member, Doctors Caucus
  • Representative Ron Estes (R-KS) | House Ways and Means Member
  • Representative Diana Harshbarger (R-TN) | Doctors Caucus
  • Senator James Lankford (R-OK) | Senate Finance Committee Member
  • Representative Brad Schneider (D-IL) | House Ways and Means Health Subcommittee  Member

In addition to the lawmakers listed above, fly-in participants met with health aides and staff members of the House Ways and Means and Energy and Commerce Committees. We focused on the importance of protecting independent practices from provider consolidation and promoted site-of-service neutrality for reimbursement and patients out-of-pocket liability. We just learned that several of our recommendations to the GOP Healthy Futures Task Force were adopted, including equalizing reimbursement for physician-administered drugs and providing the same copayment cap in the physician office that is currently provided in hospitals. We also promoted continuing telehealth flexibilities beyond expiration of the Public Health Emergency and protecting physician reimbursement in any pricing reform of Part B drugs. 

The next fly-in is scheduled for June 14-15. LUGPA members are encouraged to attend fly-ins to let Members of Congress and their staff no what is going on in your practices. LUGPA physicians and senior administrators who have attended in the past say that they find the experience to be worthwhile and essential to their understanding of the political process.

If you are interested in attending a fly-in with LUGPA in Washington, DC, or would like more information, contact Morgan Cox in the LUGPA office at [email protected]. First time attendee Dr. Fei Lian of AA Urology had this to say about his first fly-in experience: 

“As a LUGPA member, it is important that we all fight for ourselves, our practices, and for urology in general. As a first-time attendee, the April fly-in demonstrated the importance of long-term connections and strategic political advocacy. Looking to the future, it is clear that we have to band together and impart meaningful change—which affects us all--at the local, state, and national levels.”

With the utmost gratitude, the LUGPA Political Affairs committee wishes to thank the physicians and administrators of the following groups whose efforts made the April fly-in possible:

  • Associated Urological Specialists, LLC
  • Florida Urology Partners, LLP
  • Greater Boston Urology
  • Kansas City Urology Care
  • Pioneer Valley Urology
  • The Urology Center of Colorado
  • Urologic Specialists of Oklahoma
  • Urology of St. Louis

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Public Health Emergency extended

Effective April 16, HHS Secretary Xavier Becerra renewed the public health emergency related to COVID-19 for an additional 90 days with a mid-July expiration date. At a minimum, we anticipate another 90-day extension to be issued in mid-July.     

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Telehealth flexibilities extended for most of 2022  

With the passage of the Consolidated Appropriations Act of 2022, telehealth will continue for at least 151 days after the official end of the federal public health emergency. LUGPA is advocating for legislation that builds on coverage gains made during the COVID-19 Public Health Emergency to make telehealth expansion permanent. 

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Radiation Oncology payment model delayed 

As you may recall from a previous LUGPA communication, the implementation of the Radiation Oncology Model has been indefinitely delayed, with CMS stating, “We are proposing to delay the current start date of the RO Model to a date to be determined through future rulemaking, and to modify the definition of the model performance period to provide that the start and end dates of the model performance period for the RO Model will be established in future rulemaking.” 

You can access the full text of the Radiation Oncology (RO) Model Proposed Rule here.

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No Surprises Act Updates 

Last month CMS released two sets of FAQs- one for providers on the No Surprises Act requirements and one for good faith estimates. The provider FAQ addresses a broad range of questions related to No Surprises Act requirements and implementation, provider requirements and prohibitions, and explains the Independent Dispute Resolution (IDR) process. The good faith estimate FAQ answers provider questions related to the content of good faith estimates and when they must be provided. The CMS IDR portal is now live. The IDR process can be initiated to resolve payment disputes between providers and issuers.

Dr. Mara Holton, LUGPA Board member and Health Policy Vice Chair, will join Rob Finch, Certified Genetic Counselor for a webinar, Incorporating “no surprise billing” into informed consent on May 24 at 5:00 PM Eastern Time. The webinar will include:

  • Review of LUGPA’s health policy on the no surprises act
  • Discussion regarding good faith estimates and balance billing
  • Demonstration of how this topic can be incorporated into informed consent for genetic/genomic testing
  • An opportunity for questions

The LUGPA Regional Meeting June 3-4 in Las Vegas, NV will include a comprehensive health policy update, as well as Dawn Plested, FACHE, MBA, JD, ESQ presenting a session titled “Tools and Solutions to Address Surprise Billing.” For more information or to register for the Las Vegas Regional Meeting, please visit the LUGPA website.

LUGPA has assembled a page of helpful links and resources to assist urology practices in the implementation of the No Surprises Act. Click here to access the No Surprises Act Information and Resource Hub


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LUGPA suggestion adopted by GOP Healthy Future Task Force

LUGPA’s suggestion to cap patient out-of-pocket liability for Part B drugs administered in the physician office or free standing infusion center at the hospital outpatient cap was adopted by the House Republican Healthy Future Task Force. The purpose of the Healthy Future Task Force is to build on Republican health policy objectives and create patient-focused agendas. You can view the Task Force’s plan on the LUGPA website.


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CMS Reweights 2021 MIPS Cost Performance Category

CMS announced the reweighting of the Merit-Based Incentive Payment System (MIPS) cost performance category for 2021 performance year from 20% to 0% due to the COVID-19 pandemic’s impact on clinicians and cost measures. CMS based this decision on analysis of the 2021 performance year data, with the agency unable to confidently calculate scores for some of the cost measures that would adequately capture and reflect the performance of MIPS eligible clinicians.