Updates from Capitol Hill: News for the Rheumatology Community

Omnibus Bill Enacted by Congress: Legislation Only Partially Addresses Physician Payment Cuts

As we alerted members to before the holidays, Congress enacted an “Omnibus” end-of-year spending package just in time to avoid a government shutdown. The 4,155-page legislation addressed a wide range of issues, including Medicare payment.


Read more in the full article below.

Advocating for You: CSRO's Work Critical to Reversal of Flawed Medicare Policy on Neuromuscular Ultrasound

On December 19, CSRO leadership met with staff at the Centers for Medicare and Medicaid Services (CMS) Center for Medicare (CM) to discuss concerns about neuromuscular ultrasound coding and billing following the agency’s consolidation of CPT 76881 in key Medicare documents.


Read more in the full article below.

Plus: New Guidance Improves Access to Specialty Care in Medicaid, CHIP full details in the article below.

Cheers to 2023!  A Milestone Year for CSRO.

Happy 20th anniversary to CSRO! Officially founded in 2003, this year marks two decades of CSRO serving as a voice for the rheumatology community, working to ensure patients have access to the highest quality of care. 


Throughout the year, we invite you to join us in celebrating the impact we’ve had on rheumatology and improving access to care:

  • Kick-off 2023 at our National Town Hall: Join us as we gather virtually on January 25 to hear updates on federal policy and regulation, as well as to share about issues impacting your patients and practices. Click here to register.
  • Visit us at your state society meeting: Throughout the year, CSRO attends various state rheumatology society meetings to network, share information, and present on advocacy – check out a list of upcoming meetings on our website.
  • Don't see your society on our list? Email us with your meeting date and location.
  • Share your stories with us: If you have memories of CSRO's founding, we'd love to hear from you – email info@csro.info to share your stories or photos.
  • Support CSRO's ongoing advocacy work: CSRO is a 501c3 nonprofit organization dedicated to ensuring access to the highest quality care for the management of rheumatologic diseases. Help make a difference by making a tax-deductible donation in honor of our 20 years of advocacy today.
  • Plan to attend our in-person celebration: Be there with us this August 25-27 in Austin, Texas for CSRO's Advocacy Conference and special anniversary event.

Stay tuned for more details about how you can join us throughout the year in celebrating our two decades of serving as the voice for rheumatology.

New Year, New Look!

CSRO's website has been updated!


You'll find all of the same great CSRO resources, in the same easy-to-access place, just with a new, modernized look.


Visit us at www.csro.info to check it out.

Visit our Website

Feedback Due January 15: Issues Impacting Rheumatology

CSRO is requesting input from the rheumatology community to gather information about the issues most impacting patients and practices.


Results from this survey, which will be shared at CSRO's National Town Hall, will help us understand the landscape of our community and better advocate for change. All feedback is needed by this Sunday, January 15 – thank you for your consideration.

Take Survey

Updates from Capitol Hill

Omnibus Bill Enacted by Congress: Legislation Only Partially Addresses Physician Payment Cuts

As we alerted members to before the holidays, Congress enacted an “Omnibus” end-of-year spending package just in time to avoid a government shutdown. The 4,155-page legislation addressed a wide range of issues, including Medicare payment. The Omnibus fully averted the 4% PAYGO sequestration for 2023 and 2024, but did not technically eliminate this sequestration. Rather, the legislation pushed forward the “balance due” to 2025. While this ensures full relief of the 4% sequester for providers in 2023 and 2024, it also ensures that this sequestration will need to be addressed again by Congress before 2025. With regard to the Physician Fee Schedule conversion factor, the Omnibus covered only 2.5% of the 4.5% needed for 2023 and only 1.25% for 2024. That leaves Medicare providers with an approximately 2% cut in 2023. The impact for 2024 is less quantifiable since the conversion factor for that year is not yet known. Since the legislation was signed into law, CMS released an updated 2023 conversion factor reflecting this congressional intervention, so there should be no disruption to claims processing.

 

Among other Medicare provisions, the Omnibus extended by two years the telehealth flexibilities originally created pursuant to the COVID public health emergency and extended the safe harbor allowing coverage of telehealth services in high deductible health plans. The legislation also provided an extension at 3.5% of the expiring 5% bonus for providers in alternative payment models and – in a provision welcomed by the medical community – the bill provided funding for 200 new residency slots, with half of those directed to psychiatry or psychiatry subspecialties.

 

In a very disappointing provision, the Omnibus extended the existing 2% Medicare sequester (which is already in effect) by six months in 2032. In other words, Congress levied additional cuts on providers in 2032 to partially avert cuts to providers in 2023 and 2024, and to help pay for other spending priorities in the 1.6-trillion-dollar bill. Not surprisingly, the provider community expressed frustration and disappointment at the legislation.



In the past year, lawmakers on both sides of the aisle in both chambers introduced legislation to offset the full cuts and exerted significant pressure on congressional leadership to ensure that the 4.5% conversion factor reduction was averted in full. Some lawmakers also expressed opposition to the budget gimmickry of offsetting near-term cuts with long-term cuts. However, the pressure of a looming government shutdown ensured that a sufficient number of Members voted for the bill to ensure passage, even if they disliked provisions in it.

 

The continued annual reimbursement reductions combined with inflation have created a near-impossible business environment for physician practices, which in turn affects beneficiary access. In the year ahead, the physician community will aggressively push Congress towards long-term Medicare Physician Fee Schedule stabilization.

Advocating for You: CSRO's Work Critical to Reversal of Flawed Medicare Policy on Neuromuscular Ultrasound

On December 19, CSRO leadership met with staff at the Centers for Medicare and Medicaid Services (CMS) Center for Medicare (CM) to discuss concerns about neuromuscular ultrasound coding and billing following the agency’s consolidation of CPT 76881 in key Medicare documents. Specifically, CMS removed the technical (TC) and professional (PC) components, forcing practices to bill the “global” service.


During the meeting, CSRO noted that eliminating the TC and PC would mean that many rheumatology practices would no longer be able to provide this medically necessary service to Medicare beneficiaries because many practices outsource the interpretation and report in order to reduce appointment wait times and expand access to rheumatologic care. Long wait times have been a challenge in rheumatology given workforce and other challenges created by declining reimbursements.


While CMS did not commit to “fix” the issue during the meeting, the agency has responded favorably to CSRO’s and other stakeholders’ request by posting updated files that again reflect the TC and PC break-out. CMS staff also communicated to CSRO that it was “persuaded to address the issue given the implications.”

New Guidance Improves Access to Specialty Care in Medicaid, CHIP

Last week, CMS issued guidance that allows Medicaid and CHIP programs to pay specialists’ directly when a beneficiary’s primary health care provider asks for advice by way of an interprofessional consultation, aligning with current Medicare payment policies around these services. A press notice explains that access to specialty care has been a significant challenge in the Medicaid and CHIP population, highlighting how interprofessional consultations can be “an effective component of expanding access to specialty care for physical health conditions, particularly in rural and remote areas that may be lacking specialists.” The guidance points to examples like Project ECHO, which has been adopted by several universities and medical centers to address key health conditions, including rheumatologic, and importantly, states that these services are “not intended to be a replacement for direct specialty care when such care is clinically indicated.” 

Mark Your Calendar: CSRO's 2023 Events

CSRO's Fellows Conference: March 10-11, 2023

Help rheumatology fellows as they prepare for their future roles as physicians by encouraging them to attend CSRO's 2023 Fellows Conference – an annual event curated by rheumatologists specifically for rheumatology fellows. Registration closes February 8.


CSRO's National Town Hall: January 25, 2023

2023 marks 20 years of advocacy for CSRO! Join us virtually for a National Town Hall to learn updates on our advocacy work and share about issues impacting you or your practice.


CSRO's Advocacy Conference: August 25-27, 2023

Mark your calendars to join us in Austin for CSRO's Advocacy Conference and celebration of our 20th Anniversary! 

Legislation Around the Country

What's Happening in the States

CSRO tracks legislative activity relevant to the rheumatology community and their patients – click here to view a full status report.


Be sure to check out our interactive legislative map tool for additional information about current policy in your state.

FLORIDA

Accumulators:

  • SB 46: Introduced and referred to Banking and Insurance, Health Policy, and Fiscal Policy committees

Step Therapy:

  • SB 112: Introduced and referred to Health Policy, Appropriations committee on Health and Human Services, and Fiscal Policy committees 


KENTUCKY

Gold Card:

  • HB 134: Introduced and referred to Committee on Committees


MISSISSIPPI

Non-medical Switching:

  • HB 211: Introduced and referred to Insurance Committee


MISSOURI

Accumulators:

  • HB 442: Introduced
  • SB 269: Introduced

Step Therapy:

  • SB 268: Introduced

White Bagging:

  • HB 198: Introduced 
  • SB 26: Introduced 


SOUTH CAROLINA

Accumulators:

  • HB3537: Introduced and referred to Committee on Labor, Commerce and Industry


TEXAS

Accumulators:

  • HB 999: Introduced

Non-medical Switching:

  • HB 826: Introduced


WASHINGTON

Biomarker Testing:

  • SB5074: Pre-filed for introduction


CSRO Resources for You

  • Payer Issues Reporting Form
  • Request assistance with any payer relation issues that may be impacting your patients or office.
  • Legislative Map Tool
  • Find your state on our interactive map tool to learn about current or proposed policy and ways you can take action to make an impact.
  • Action Center
  • Use CSRO's Voter-Voice engagement platform to easily communicate and engage directly with your elected officials.
  • Policy Correspondence Archive
  • Easily access all of CSRO’s policy letters submitted to payers, state, and federal governments as an informational resource.
  • Career Center
  • Locate the perfect fit whether you're looking for new career opportunities or trying to find the right candidate.


Questions?
Please visit the CSRO website for other news and updates, and do not hesitate to contact us with any questions at info@csro.info.
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