This Week – April 23, 2016

This Week in Washington, DC

  • A Breakthrough at the State Level? Oklahoma State Legislature Passes Law Making MOC Optional
  • Federal Government Provides Further Guidance on Patient Cost-Sharing for Colonoscopy
  • Check out the Photos of ACG on Capitol Hill: Your Voice for Clinical GI

Kastens From ACG Governor for Oklahoma, Donald J. Kastens, MD, FACG

Oklahoma Passes Legislation Banning MOC Mandates

On April 8th, the state of Oklahoma passed legislation preventing MOC from being a conditional requirement for state license, hospital privileges, reimbursement, or employment.  This law was passed unanimously in both the Oklahoma State House and Senate legislative bodies.  This is obviously welcomed news for ACG members in Oklahoma and could be the beginning of a ripple effect nationwide.  The relevant section of the new OK law states:

“Nothing in the Oklahoma Allopathic Medical and Surgical Licensure and Supervision Act shall be construed to require a physician to secure a Maintenance of Certification (MOC) as a condition of licensure, reimbursement, employment, or admitting privileges at a hospital in this state.  For the purposes of this subsection “MOC” shall mean a continuing education program measuring core competencies in the practice of medicine and surgery and approved by a nationally-recognized accrediting organization.”

Fortunately, the unique function and structure of the ACG Board of Governors is a natural fit for these issues, allowing the College to be actively engaged at the state level.  ACG will continue to update membership on this important issue.

Knapple From ACG National Affairs Committee Chair, Whitfield L. Knapple

Private Insurers Participating in Health Exchanges Must Waive Bowel Preparation Costs

On April 20th, the Federal Government provided important guidance for private group plans participating in health exchanges set up via the ACA (Patient Protection and Affordable Care Act).  The Departments of Labor as well as Health and Human Services provide ongoing coverage and patient cost-sharing guidance for these plans.  The latest installment impacts our GI patient cost-sharing for bowel preparation:

Q1: If a colonoscopy is scheduled and performed as a screening procedure pursuant to the USPSTF recommendation, can a plan or issuer impose cost sharing for the bowel preparation medications prescribed for the procedure?

No. Consistent with a previous FAQ, the required preparation for a preventive screening colonoscopy is an integral part of the procedure. Bowel preparation medications, when medically appropriate and prescribed by a health care provider, are an integral part of the preventive screening colonoscopy, and therefore, are required to be covered in accordance with the requirements of PHS Act section 2713 and its implementing regulations (that is, without cost sharing, subject to reasonable medical management).

Please note that this guidance does not include Medicaid or Medicare

ACG will continue to update members on insurance exchange coverage issues impacting members and our patients.  ACG remains disappointed that the Federal Government requires private plans to waive cost-sharing during the continuum of colorectal cancer screening on one hand, but believes it does not have the regulatory authority to do so in Medicare.  This inconsistency in policy was specifically discussed last week during the ACG Governors’ Washington D.C. Congressional Fly-in, when educating Congress on the importance of the SCREEN Act (H.R.2035/S.1079), as well as the Removing Barriers to Colorectal Cancer Screening legislation (H.R.1220/S.624).

Manny From ACG Board of Governors Chair, Immanuel K. H. Ho, MD, FACG

ACG Governors Take on Washington D.C.

On Thursday, April 14th, over 45 ACG Governors met with over 250 members of Congress as part of the 2016 ACG Board of Governors Washington D.C. Fly-in.  The two themes ACG Governors focused on were the illogical and inconsistent policies of trying to increase colorectal cancer screening utilization rates at the same time as cutting reimbursement for these services, and the inability to practice medicine in this environment of lower reimbursement and more red tape and regulatory burdens, such as Meaningful Use.  ACG Governors conveyed real world, clinical examples of how these policies impact patient care and GI practices.

Check out ACG’s Facebook page to see the pictures of ACG members and Members of Congress.

ACG urges you to contact Congress and keep this momentum going.