State and National Legislative & Regulatory Issues
Late stage cancer rates could rise if ACA ruling stands, experts worry
A federal judge’s recent ruling on the Affordable Care Act means that patients would have to pay for some cancer screenings that are currently free—a ruling that, if it holds, could make the potentially life-saving tests unaffordable for many, experts say.
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President Biden Prioritizes Cancer Research, Access to Care in FY 2024 Budget Proposal
The proposal allocates $48.3 billion for the National Institutes of Health (NIH)—an $811 million increase compared to FY 2023; $7.8 billion for the National Cancer Institute (NCI)—a $500 million increase compared to FY 2023; and $2.5 billion for the Advanced Research Projects Agency for Health (ARPA-H)—a $1 billion increase compared to FY 2023. The request also specifically allocates $1 billion for the Cancer Moonshot initiative.
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CMS & Noridian Updates
Hospital In-Patient, Long-Term Care Proposed Rule Aims to Advance Equity, Support Underserved Communities
On April 10, 2023, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2024 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) proposed rule.
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On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 Medicare Advantage and Part D Final Rule, which will revise regulations governing Medicare Advantage (MA), the Medicare Prescription Drug Benefit (Part D), Medicare cost plans, and Programs of All-Inclusive Care for the Elderly (PACE). The rule makes changes related to prior authorization, health equity, marketing and communications, and other areas.
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CMS Proposes Policies to Improve Patient Safety and Promote Health Equity
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Reduced Beneficiary Coinsurance for 20 Part B Drugs in Effect April 1; Includes Cancer Drugs
On January 1, a provision of the Inflation Reduction Act (IRA) went into effect requiring drug companies to pay rebates to Medicare when prescription drug prices increase faster than the rate of inflation for certain drugs given to people enrolled in the program. The provision also provides for lower Medicare Part B beneficiary cost sharing on such drugs beginning April 1, 2023.
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FDA Approvals
31 Patient and Provider Groups Warn that Mifepristone Ruling Threatens All FDA-approved Drugs
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Coding and Reimbursement Updates
The California Medical Association (CMA) has submitted a letter in strong opposition to Cigna’s decision to re-release its costly, burdensome modifier 25 policy. The policy – Modifier 25-Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service – will require the submission of medical records with all Evaluation and Management (E/M) claims with CPT 99212-99215 and modifier 25 when a minor procedure is billed. It is scheduled to become effective nationwide on May 25, 2023.
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