Federal Update: Reconciliation to parts of Build Back Better
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Senate Democrats recently revived their efforts to enact parts of Build Back Better, using a procedural mechanism known as “reconciliation,” which enables passage by simple majority in that Chamber. Although the climate and tax components remain in negotiation, the drug pricing provisions were made public and are rumored to have the support of all fifty Senate Democrats.
Of interest, the legislation would establish a so-called “maximum fair price” (MFP) for Medicare on certain selected single-source medications, as well as require inflationary rebates from drug manufacturers, establish out-of-pocket cost protections for Part D beneficiaries, and more. Unfortunately, the legislation prohibits implementation of the so-called “rebate rule,” which would eliminate safe harbor protection from the payments made by drug companies to pharmacy benefit managers in exchange for formulary placement.
With regard to the MFP provisions, throughout this process, CSRO has always expressed a logistical concern, which is that providers who acquire and administer Part B medications must be kept whole in the event that they cannot acquire a medication at the new MFP. This is a critical issue since, for medications subject to the new MFP structure, providers would be reimbursed at MFP plus 6%. CSRO will continue to express this concern in the hopes that it will be addressed in the next iteration of the legislation.
For now, the drug pricing provisions must be reviewed by the Senate parliamentarian, who will determine whether they meet the requirements of the reconciliation procedure. Majority Leader Schumer (D-NY) has expressed his goal of Floor action on this bill before the Congress adjourns for August, but that will depend in large part on how fast the parliamentarian can complete her required review and how many provisions, if any, must be amended or deleted as a result of that review. Stay tuned for updates from CSRO!
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Legislative News: Release of CY 2023 Medicare Physician Fee Schedule Proposed Rule
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On July 7, the Centers for Medicare and Medicaid Services (CMS) released its calendar year (CY) 2023 Medicare Physician Fee Schedule (MPFS) proposed rule, updating payment rates and proposing other policy changes that will impact rheumatologists and their patients.
The most pressing matter is the steep reduction in the CY 2023 MPFS conversion factor, which will drop by 4.42% down to $33.0775. The cut is the result of budget neutrality adjustments generated by the CY 2023 proposed policies, along with the expiring 3% boost to the conversion factor provided by Congress for CY 2022. For rheumatologists, CMS estimates an overall 2% reduction, which does not factor in the loss of the 3% boost at the end of this year. Rheumatology practices will face varying impacts at the practice level.
Other proposals of interest relate to reductions in ultrasound services, policies requiring physician to report data on Part B drug waste, and provisions that revise and update the Quality Payment Program (QPP), among other things. CSRO, along with its coalition partners, will weigh-in on the rule and its impact on the rheumatology community through formal comments to CMS, as well as to Congressional offices and the Administration. Formal comments on these policies are due September 6, 2022. A general fact sheet on the rule, as well as fact sheets on provisions related to Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) and the Quality Payment Program (QPP) is available on CMS’ website.
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Status Update: CMS "Pause" on Downcoding
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CSRO continues to work with the Centers for Medicare and Medicaid Services (CMS) to address inappropriate “down coding” associated with the administration of certain medications used in rheumatology.
Our most recent engagement with the Office of the Administrator (OA) is expected to clarify and, hopefully, resolve the disconnect between the agency and its Medicare Administrative Contractors (MACs) with respect to the technical guidance that was issued on June 10. More information will be shared as soon as it becomes available.
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Register Now: State Society Advocacy Conference
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CSRO is dedicated to empowering the rheumatology community with resources to proactively increase patient access to care. Our program will center on advocacy that addresses current issues impacting patients and practices, including a keynote presentation from Damon Tweedy, MD, author of the New York Times bestseller Black Man in a White Coat: A Doctor's Reflection on Race and Medicine.
To learn more about our agenda and other event details, visit our website, then complete your complimentary registration to be a part of this thought-provoking conference! |
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September 9-10
The Westin O'Hare
Rosemont, IL
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Member Exclusive: ACR Breakfast Save the Date
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CSRO will be exhibiting at ACR Convergence 2022 this November 10-14!
Mark your calendar to join us on Sunday, November 13 for an exclusive state society member breakfast - more information will be shared in the coming months.
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Legislation Around the Country
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What's Happening in the States
CSRO tracks legislative activity relevant to the rheumatology community and their patients. Check out the list below to see the status of CSRO priority bills from the past two weeks. For a full status report on all the bills CSRO tracks, click here.
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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DELAWARE
Accumulator Programs
- SB 267: Transmitted to the Governor
NEW YORK
Accumulator Programs
- S5299: Transmitted to the Governor
- A1741: Transmitted to the Governor
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Register Now:
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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CSRO is a 501c3 nonprofit organization dedicated to ensuring access to the highest quality care for the management of rheumatologic diseases - donate today.
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