| CMS to Modernize Medicare Advantage, Part D plans
On February 5, the Centers for Medicare & Medicaid Services (CMS) released the CY 2021 Medicare Advantage (MA) Proposed Rule and Advance Notice Part II Call Letter for Methodological Changes to the MA Capitation Rates and Parts C and D payment policies. The proposals contain several provisions of interest to AAOS including: requiring Part D Drug Management Programs to be implemented in line with the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act; increasing provider and patient real-time access to prescription drug costs through beneficiary portals; and expanding incentives for telehealth in rural areas. CMS is also seeking feedback from stakeholders on tethering quality measures to the use of electronic prior authorization. AAOS is reviewing the rule and will continue to update members on the result of these proposals. Read the CMS fact sheet…
Surprise Billing Debate Continues with Markups of New Proposals
Late last week, the House Ways and Means Committee released its proposal to address surprise medical bills. The legislation includes a framework for Independent Dispute Resolution, without a threshold for mediation, and would ban balance billing for emergency care. While the AAOS recognizes and thanks the committee for its progress with this legislation, we are asking it to further clarify that the median in-network rate is meant to be a floor for negotiation, not the primary or deciding factor. Meanwhile the House Education and Labor Committee marked up its proposal on February 11. The bill is similar to the version that the House Energy and Commerce Committee released late last year, as it contains a median in-network rate benchmark. AAOS maintains the concern that use of the median in-network rate as a benchmark is tantamount to government rate-setting and will continue advocating for a fair, accessible process for resolving disputes. Take action via the AAOS Advocacy Action Center…
AAOS Responds to Price Transparency Proposal
AAOS recently submitted comments to the Centers for Medicare & Medicaid Services (CMS) on its Transparency in Coverage proposed rule. The proposal would require commercial health plans and issuers to provide beneficiaries access to a free website with cost-sharing information available for items and services. The website would also provide consumers with cost-of-care information for specific in-network providers and out-of-network allowed amounts for services furnished by those providers who are out-of-network. In its comments, AAOS stressed that while providing patients with easily understandable cost and quality information is important, mandating the publication of commercially-negotiated rates could result in independent physician’s professional fees being devalued to the lowest common denominator. AAOS advised the agency to move towards a solution that would be both helpful to patients and limited in the burden it places on providers. Read AAOS’ full comments…
President Weber Advocates for AAOS Priorities on Capitol Hill
AAOS President Kristy L. Weber, MD, FAAOS, recently spent a busy day in Washington, D.C., meeting with members of Congress and advocating for key health priorities. Fellow orthopaedic surgeon Sen. John Barrasso, MD (R-WY), even took time out from the impeachment proceedings to meet with her and discuss preventing cuts to hip and knee codes. Dr. Weber also met with Rep. Rosa DeLauro (D-CT), who is chairman of the Labor, Health and Human Services, Education and Related Agencies Appropriations Health Subcommittee, about adding appropriations language urging more medical research into sexual dimorphism, racial/ethnic differences and socio-economic disparities in musculoskeletal health. She further discussed both the diversity research issue and potentially misvaled codes with Rep. Andy Harris, MD (R-MD), an anesthesiologist. In addition to these legislators, Dr. Weber met with Reps. Mike Simpson (R-ID), Anna Eshoo (D-CA), and the offices of Sen. James Lankford (R-OK), and Reps. Cheri Bustos (D-IL), Tom Cole (R-OK) and Debbie Mucarsol-Powell (D-FL). See photos from her visit… |
