This Week in Washington DC – December 12, 2020

Great News! On Wednesday, the U.S. House of Representatives passed an amended version of H.R. 1570, the Removing Barriers to Colorectal Cancer Screening Act. Passing this bill has been among the top ACG policy priorities for years. This is a big win for our patients across the country. The bill now moves to the Senate, where S. 668 currently has 61 cosponsors. ACG also recently joined a coalition of organizations urging congressional leadership to pass the bill before the end of the year. Urge your Senators to pass this important bill before Congress adjourns! 

CMS Still Moving Forward with Medicare Cuts: We still need your advocacy help! Medicare physician payments are scheduled to be cut across most specialties in CY 2021 when increases to evaluation and management (E/M) services are implemented. GI procedures are scheduled to be cut roughly 10%.

But Progress on Capitol Hill! This week Sen. John Boozman (R-AR) introduced the Senate counterpart of the “Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020” (S. 5007/H.R. 8702). This bill delays these Medicare cuts for 2 years, maintains the scheduled reimbursement increases to E/M services, and allows more time for a permanent resolution. Reps. Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) introduced the House version. We need your advocacy voice!

FDA Advisory Panel OK’s COVID-19 Vaccine: On Thursday, an independent U.S. Food and Drug Administration (FDA) advisory committee said that the benefits of Pfizer's coronavirus vaccine outweigh the risks, setting the stage for the FDA to approve emergency use of the shot for people 16 and older. The panel — comprised of academic scientists, doctors and officials from other federal health agencies — voted 17 to 4 in favor of the vaccine, with one member abstaining. While the FDA is not obligated to follow the advisory panel’s recommendation, the agency is expected to approve the vaccine within days (at the time of this writing). The results of the trial were also recently published in the New England Journal of Medicine.

ACG Webinar: On December 22, 2020 a panel moderated by ACG President David A. Greenwald, MD, FACG will discuss the accelerated timeline for COVID-19 vaccines, review the role of CDC's Advisory Committee on Immunization Practices (ACIP), and discuss mRNA vaccines in the context of gastroenterology. Click here to register!

CMS Releases Proposed Rule on Prior Authorization: This week, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule designed to increase the transparency and efficiency of the prior authorization process. The rule impacts Medicaid, CHIP and qualified health plan (QHP) payers, who would be required to build software, or application program interfaces (APIs), to help streamline the process. The rule does not impact Medicare fee for service or Medicare Advantage plans (CMS is considering whether to do so in future rulemaking). This rule includes five sets of proposals, starting January 2023. Among the proposed changes, payers would have to provide an answer to a prior authorization request within 72 hours of any urgent request, or 7 calendar days for any standard request. CMS is also proposing to require payers to publicly report data, such as the percent of prior authorization requests approved, denied, and ultimately approved after appeal, as well as the average time between submission and determination. CMS proposes the initial set of these metrics to be reported by March 31, 2023.

Click here to read CMS Administrator Seema Verma’s blog post.

Click here to view the proposed rule.

Click here to view the fact sheet.

Prior authorization and step therapy requirements continue to hinder GI patient care. ACG is reviewing the proposed rule and will continue to advocate for necessary changes to streamline these processes and reduce provider burdens.

2020 MIPS Hardship Exemption Still Available: CMS also recently announced that the MIPS "Extreme and Uncontrollable Circumstances" Application was recently extended until February 1, 2021. It was previously open until December 31, 2020. The “Extreme and Uncontrollable Circumstances” policy allows MIPS eligible clinicians, groups, and virtual groups to submit an application requesting a reweighting of one or more MIPS performance categories to 0%. Submit an application now and be sure to cite COVID-19 as the reason for your application. If approved, you can still receive scores for the Quality, Improvement Activities, and Promoting Interoperability MIPS performance categories. Please note that if the Cost performance category is included in your approved application, you will not be scored on cost measures even if other data are submitted. Learn more in the 2020 Exceptions Applications Fact Sheet.