Legislative News: Fee Schedule Cuts
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Faced with the possibility of several large Medicare Physician Fee Schedule cuts in 2022, Congress enacted S.610, the Protecting Medicare and American Farmers from Sequester Cuts Act. The legislation addresses three separate reimbursement reductions that were looming over Medicare providers:
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In December 2020, Congress provided a temporary “bump-up” of 3.75% across the 2021 Fee Schedule, in response to scheduled payment reductions resulting from budget neutrality requirements. However, that add-on payment only lasted one year; thus, it was set to expire at the end of this month. S. 610 provides a one-year 3% increase to the 2022 conversion factor, averting most of the scheduled cut.
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In March 2020, Congress created a moratorium on collection of the 2% Medicare sequester, as a temporary pandemic relief provision. Although the moratorium had been extended several times, it was set to expire on December 31. S. 610 extends the moratorium for three months, through March 31, 2022. For the second quarter of 2022, the sequester returns at 1%. For the second half of 2022, the sequester will be reinstated at the full 2%.
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Finally, as a result of the American Rescue Plan triggering statutory PAYGO requirements, Medicare providers were also facing a 4% PAYGO sequestration. S. 610 prevents the 4% sequester from taking effect in 2022. Since this is only one year of relief, Congress will have to address this issue again before 2023.
While we are pleased that Congress averted the majority of reductions for 2022, we will continue to engage in efforts for broader Fee Schedule reform, with the goal of creating long-term stable, consistent, and reliable Medicare reimbursement.
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Advocacy: CSRO's Priority Issues in 2022
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Reflect on the rheumatology community's successes from the past year and get a sneak peek of our priority issues for 2022 in the latest edition of Rheum for Action, CSRO's advocacy column produced in partnership with Rheumatology News. |
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Learn more about white bagging, step therapy, and the rest of our issues on the CSRO website, which was recently refreshed to bring you more information on the what, why, and how you can work with the CSRO to take action on state and federal legislation. Check it out to better understand the impact our priorities have on patients.
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Federal Update: Build Back Better
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In November, the U.S. House passed the Build Back Better (BBB) legislation, which is now in the Senate, where negotiations are still ongoing.
Regarding healthcare policy, the bill passed by the House includes extensive coverage and access expansions, like providing increased premium assistance for the Affordable Care Act exchanges, adding hearing benefits to fee-for-service Medicare, and putting in place a monthly $35 cost-sharing cap in Medicare and private markets for insulin.
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Step Therapy Reform: Share Your Stories and Provide Input
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Today, we are asking you, our rheumatology community, to complete a brief survey to provide your input on step therapy reform, which will be used:
- to ensure the state laws are working for patients and providers
- to provide updates to the state legislature and hard-working legislative leaders and sponsors who worked tirelessly on the bill and
- use the feedback/stories on how well the state law is working to gain support for the federal bill.
Any feedback you can provide will be a great help with advocacy efforts throughout the country in 2022 - thank you for your consideration.
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Make a Difference: Donate Today
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Advocacy can have a tremendous impact on quality of life. One father expressed his gratitude for CSRO’s support in successfully advocating for his son’s continued access to effective treatment for juvenile arthritis by making a donation to CSRO.
His gift helps ensure others will benefit from our commitment to achieving the highest quality of care for patients with rheumatologic and musculoskeletal disease.
Want to join him in supporting advocacy for critical rheumatological care? Give now!
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Spotlight: CSRO In the News
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In the litany of examples of how the U.S. health care system has become so broken, none is as instructive as the 340B Drug Discount Program.
Once an obscure program that ensured that a few dozen safety-net hospitals and clinics could help low-income patients without suffering financially, it has become twisted into a “cash cow” for major healthcare systems that, ironically, incentivizes participants to put patients with commercial insurance first…and uninsured and Medicaid patients last.
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Legislation Around the Country
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The following states also have active legislation that need your support - visit our Action Center to make your voice heard today:
- Michigan
- Massachusetts
- New Jersey
- Ohio
- Pennsylvania
- Wisconsin
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Be sure to check out our interactive legislative map tool for additional information about current policy in your state. Plus, don't forget to add your state to your email profile here to receive state-specific updates and action alerts via email.
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Registration Now Open!
Save the Date!
Find all of CSRO's event dates by visiting our Upcoming Events page, and check out past events and webinars in our Library.
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Check out our summary of OptumRx’s contract for the new MSPN here! The recording of last night’s overview webinar coming soon.
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CSRO is a 501c3 nonprofit organization dedicated to ensuring access to the highest quality care for the management of rheumatologic diseases. |
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