Integrated Practices | Comprehensive Care

December 1, 2023  

In this issue we feature:  

New Resources from LUGPA on the 2024 Medicare Physician Fee Schedule Changes

Following the release of the 2024 Medicare Physician Fee Schedule final rule, LUGPA has assembled two indispensable resources for its members. The first is a comprehensive Policy Brief addressing the notable 3.34 percent reduction in the fee schedule's conversion factor and the associated challenges. Additionally, the brief explores CMS strategies, including extending telehealth provisions, and delves into payment adjustments for 340B-acquired drugs. Access the complete Policy Brief here for an in-depth understanding.

The second resource is a detailed Fact Sheet shedding light on CMS's impending implementation of HCPCS code G2211 on January 1, 2024. The Fact Sheet examines the G2211 code and its role as a cognitive code designed to recognize resource costs for specific Evaluation and Management (E/M) visits. The Fact Sheet outlines usage criteria, underscoring its applicability for ongoing care related to serious or complex conditions. It also recommends consultation with billing departments for proper implementation.

LUGPA remains steadfast in its commitment to monitoring the ongoing development of the Medicare Physician Fee Schedule, ensuring that our members receive timely updates as new information emerges.


CMS Proposes Rule to Strengthen Healthcare Programs and Beneficiaries

On November 6, 2023, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule aimed at enhancing various healthcare initiatives, including the Medicare Advantage Program (MA), Medicare Prescription Drug Benefit Program (Part D), Medicare Cost Plan Program, Programs of All-Inclusive Care for the Elderly (PACE), and Health Information Technology Standards and Implementation Specifications. The primary focus of these proposed changes is to fortify beneficiary protections, foster healthy competition, and ensure that Medicare Advantage plans effectively meet the needs of beneficiaries.

Specifically, the proposed policies seek to improve access to behavioral health care providers, promote coverage equity, and enhance supplemental benefits. These measures align with the administration's commitment to affordability, accessibility, and transparency in healthcare. Addressing concerns related to compensation for agents and brokers, promoting transparency, and safeguarding Medicare recipients from predatory marketing practices are integral components of the proposed rule, demonstrating CMS's dedication to refining and strengthening the Medicare Advantage and Part D programs.

The proposed rule targets anti-competitive steering, broadens access to behavioral health care, and strives to enhance the appropriateness and utilization of supplemental benefits. Additional proposals promote health equity by introducing new facility types for behavioral health care, simplifying enrollment options for individuals with Medicare and Medicaid, and establishing safeguards against prior authorization policies that may disproportionately impact underserved populations. In the prescription drug marketplace, CMS proposes flexibility for Part D plans to substitute biosimilar biological products, thereby increasing access to cost-effective alternatives.

For further details, visit CMS’s Fact Sheet here.


LUGPA Policy Brief: Enhancing Provider Safety 

This Policy Brief addresses the escalating issue of violence against healthcare workers, citing alarming statistics of assaults on nurses and examining two pieces of legislation that would help address the problem.

The first is the "Safety from Violence for Healthcare Employees" (SAVE) Act, introduced by U.S. Representatives Larry Bucshon, M.D. (R-IN) and Madeleine Dean (D-PA), as a crucial response to the lack of federal protections for healthcare employees.

The SAVE Act aims to criminalize assault or intimidation of healthcare workers, providing safeguards for mentally incapacitated individuals. Despite previous challenges, Senators Joe Manchin (D-WV) and Marco Rubio (R-FL) have introduced an updated version in the Senate, proposing stricter penalties for assaults on healthcare workers.

The second bill is Senator Tammy Baldwin's (D-WI) "Workplace Violence Prevention for Health Care and Social Service Workers Act," which seeks OSHA's involvement in creating violence prevention measures but has faced setbacks. The Policy Brief highlights the urgent need for federal regulations to ensure the safety and well-being of healthcare employees, promote better patient care, and mitigate stress and burnout in the healthcare workforce.


New Initiatives from the White House Target Medicare Advantage and Predatory Marketing

On November 6, the Biden-Harris Administration announced substantial initiatives to strengthen Medicare Advantage and the Medicare Prescription Drug Benefit Program (Part D). Aligned with President Biden's overarching healthcare objectives, which include fostering competition, reducing costs, and ensuring access to high-quality healthcare for all Americans, the Centers for Medicare & Medicaid Services (CMS) has introduced a rule designed to thwart anti-competitive practices within Medicare Advantage plans, with a primary focus on safeguarding the interests of beneficiaries.

This proposed rule addresses concerns related to compensation for agents and brokers, emphasizing transparency and implementing safeguards against predatory marketing tactics. CMS is also dedicated to enhancing access to behavioral health care by expanding network adequacy requirements to include various behavioral health provider types. Moreover, the rule aims to improve the utilization and appropriateness of supplemental benefits, prioritizing transparency regarding the impact of prior authorization on underserved communities.

In its effort to cultivate a competitive Medicare Advantage marketplace with meaningful benefits, CMS proposes initiatives such as personalized mid-year notifications for unused supplemental benefits and additional requirements for benefits intended for the chronically ill. The rule additionally tackles health equity concerns by integrating an expert in health equity on utilization management committees and simplifying enrollment options for individuals with Medicare and Medicaid. CMS also advocates for flexibility in Part D plans to substitute biosimilar biological products, facilitating prompt access to more cost-effective drugs. The proposed rule is open for a 60-day comment period until January 5, 2024. Additional details and the full proposed rule can be accessed on the Federal Register here.  


Work with LUGPA to Set Up a Legislative Visit at Your Practice!  

The LUGPA Legislative Visit Guide is an invaluable resource for members seeking to engage with elected officials to advocate for their practices. Recognizing lawmakers' pivotal role in shaping healthcare policies, the guide emphasizes the importance of building relationships through grassroots advocacy. It underscores that legislators prioritize addressing the needs of their constituents, making legislative visits an effective means to educate them directly from practitioners, staff, and residents on the significance of urological care.

LUGPA is dedicated to supporting its members throughout the process of planning and executing successful legislative visits. The guide outlines step-by-step procedures, from obtaining permission and reaching out to legislators to planning agendas and engaging with media. It encourages flexibility in scheduling visits when legislators are in their districts and stresses the need for transparency and clear communication in invitations. The guide also provides tips for preparing staff, organizing media coverage, and conducting the visit. With a comprehensive approach, LUGPA empowers its members to advocate effectively for their practices, contributing to positive legislative outcomes and fostering enduring relationships with policymakers. 

divider Senators Discuss Permanency of Medicare Telehealth Rules   

During a Senate Finance Healthcare Subcommittee hearing on November 14, senators unanimously voiced their support for making the current flexible telehealth rules permanent within the Medicare program. The discussions included the endorsement of payment for audio-only telehealth visits for Medicare beneficiaries. Subcommittee chairman Sen. Ben Cardin stressed the importance of predictability in healthcare services, particularly for those investing in health facilities.

The senators also delved into various factors influencing the future of telehealth, including discussions on coverage alignment among payers, payment parity, and the implementation of guardrails without clinical evidence. Witnesses at the hearing highlighted the importance of these considerations in shaping the telehealth landscape.

divider HHS Unveils Language Access Plan

On November 15, 2023, the U.S. Department of Health and Human Services (HHS) introduced its Language Access Plan, reinforcing efforts to ensure enhanced access to services for individuals with Limited English Proficiency (LEP) and disabilities. In line with President Biden's Executive Order 13166, the plan acknowledges the imperative to improve services for people with LEP throughout the Administration.

The plan concentrates on language access and integrates requirements from Sections 504 and 508 of the Rehabilitation Act of 1973, fostering inclusivity for individuals with disabilities. The plan encompasses various HHS entities, promoting a comprehensive language access and inclusivity approach.

Key Components of the Language Access Plan include:

  • Practical guidance, best practices, and action steps for HHS Operating and Staff Divisions.
  • Recognition of effective communication and accessibility requirements under Sections 504 and 508.
  • Data collection to enhance language access services and broaden access for persons with limited English proficiency.

The updated Language Access Plan may be found here.


LUGPA Policy Brief: The Modernizing and Ensuring PBM Accountability (MEPA) Act   

This Policy Brief discusses the Modernizing and Ensuring PBM Accountability (MEPA) Act, which aims to regulate Pharmacy Benefit Managers (PBMs). PBMs serve as intermediaries between insurers and pharmacies, reducing administrative costs. Despite their effectiveness, concerns have arisen about their impact on drug costs, leading to increased scrutiny and new regulations.

The MEPA Act, introduced as S.2973, focuses on three key provisions:

  1. Delinking PBM Compensation: Aiming to disconnect PBM compensation in Medicare from drug prices to eliminate incentives for higher costs.
  2. Enhanced Transparency: Introducing independent audit and enforcement measures to monitor PBM practices and foster transparency in the pharmaceutical supply chain.
  3. Support for Independent Community Pharmacies: Recognizing challenges faced by these pharmacies due to PBM practices, MEPA offers relief to maintain a diverse healthcare ecosystem.

The Act has bipartisan support, receiving overwhelming approval (26-1) during a Senate Finance Committee hearing in July. It emphasizes reducing prescription drug costs, improving pharmacy access, and enhancing accountability. The MEPA Act is estimated to save $1.726 billion, contributing to broader efforts to make healthcare more affordable.

While legislative efforts progress, the Federal Trade Commission (FTC) is investigating PBMs and their impact on prescription drug access. LUGPA expresses commitment to monitoring MEPA's development and advocating for reforms that address PBM challenges in the healthcare industry.


White House and HHS Release Resources on Social Determinants of Health 

On November 16, the White House, in collaboration with the U.S. Department of Health and Human Services (HHS) through the Centers for Medicare & Medicaid Services (CMS), announced initiatives to enhance coordination among federal agencies, states, and local governments in delivering healthcare, public health, and social services. These efforts focus on addressing the social determinants of health, recognizing the pivotal role of social and economic conditions in individuals' well-being.

Key components include:

  1. U.S. Playbook to Address Social Determinants of Health: Highlighting actions by federal agencies, including HHS, USDA, HUD, VA, and EPA, to improve social circumstances and health outcomes.
  2. Medicaid and CHIP Health-Related Social Needs Framework: Guidance for states to structure programs addressing housing and nutritional insecurity for enrollees.
  3. Call to Action to Address Health-Related Social Needs: Encouraging cross-sector partnerships to create a more integrated health and social care system, acknowledging the impact of social and economic conditions on health.

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