• Vol. 81, November 2021 DC E-Newsletter

    • Nov 19, 2021

    COVID-19

    Administration Renews COVID-19 Public Health Emergency Declaration

    On Oct. 15, U.S. Department of Health and Human Services Secretary Xavier Becerra renewed the COVID-19 public health emergency (PHE) declaration. Effective Oct. 16, the PHE was extended for an additional 90 days. This means that all telehealth and other waivers and flexibilities implemented during the PHE will remain in effect. The department has also stated that it will provide 60 days’ notice when a decision is made to terminate the declaration or let it expire.

    CMS Requires Health Care Providers to be Vaccinated

    On Nov. 4, the Centers for Medicare & Medicaid Services (CMS) issued rules requiring COVID-19 vaccinations for workers at facilities participating in Medicare — including hospitals and ambulatory surgery centers. The rules do not apply to physician offices (unless part of a larger system) because they are not subject to CMS health and safety regulations. The vaccination requirements apply to all eligible staff, both current and new, working at a facility regardless of clinical responsibility or patient contact, including: 

    • Facility employees
    • Licensed practitioners
    • Students
    • Trainees
    • Volunteers
    • Contracted staff

    Under the rules, covered facilities must have a process or plan for: 

    • Vaccinating all eligible staff;
    • Providing exemptions and accommodations for those who are exempt; and
    • Tracking and documenting staff vaccinations.

    All eligible staff must receive their first dose or a one-dose vaccine by Dec. 5 and be fully vaccinated by Jan. 4, 2022.

    Legislative Affairs

    Prior Authorization Reform Legislation Gaining Steam in Congress

    On Oct. 20, the Improving Seniors’ Timely Access to Care Act (S. 3018) was introduced in the U.S. Senate. Sponsored by Sens. Roger Marshall, MD, (R-Kan.), Kyrsten Sinema (D-Ariz.) and John Thune (R-S.D.), this bipartisan legislation would help protect patients from unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program. The CNS and the AANS issued a press release endorsing the Senate bill. Additionally, the neurosurgical groups signed an Alliance of Specialty Medicine letter supporting this legislation.

    Meanwhile, identical legislation introduced in the House of Representatives earlier this year has reached a significant milestone by garnering enough co-sponsors to pass Congress’ lower chamber. If the bill is brought forward for a vote, the 245 bipartisan co-sponsors are more than enough to pass the House. The CNS and the AANS celebrated this turn of events by issuing a press release expressing enthusiasm for the progress of H.R. 3173.

    House Members Urge Action on Medicare Payment Cuts

    On Oct. 14, a bipartisan group of 247 members of Congress wrote to House Speaker Nancy Pelosi (D-Calif.) and Republican Leader Kevin McCarthy (R-Calif.) urging action to prevent steep Medicare payment cuts scheduled to take effect on Jan. 1, 2022. The letter expressed concerns these cuts could have serious financial consequences for physicians who are already under financial distress due to the sustained COVID-19 pandemic.

    The CNS and the AANS issued a press release thanking Reps. Ami Bera, MD, (D-Calif.) and Larry Bucshon, MD, (R-Ind.) for leading this effort. The neurosurgery organizations continue to lead the Surgical Care Coalition (SCC) and its campaign to prevent these cuts. Incorporating messages from surgeons across the country into its campaign, the SCC recently featured a message from CNS vice president Alexander A. Khalessi, MD, FAANS.

    Click here to read neurosurgery’s press release and here for the latest on the SCC campaign.

    CNS and AANS Endorse the Good Samaritan Health Professionals Act

    On Oct. 6, Sens. Angus King (I-Maine) and Bill Cassidy, MD, (R-La) introduced the Good Samaritan Health Professionals Act (S. 2941). This legislation offers health professionals providing voluntary care in response to a federally declared disaster with medical liability protections. While federal and state laws are intended to protect volunteer health professionals from unwarranted lawsuits, there are many inconsistencies, which may leave physicians vulnerable. Earlier this year, Reps. Raul Ruiz, MD, (D-Calif.) and Larry Bucshon, MD, (R-Ind.) introduced the Good Samaritan Health Professionals Act (H.R. 5239) in the House.

    Click here to read neurosurgery’s letter of support.

    Neurosurgery Supports the BRAIN Act

    Introduced on Sept. 30 by Rep. Earl Blumenauer (D-Ore.), the Bringing Regulatory Advances Into Neuroscience (BRAIN) Act (H.R. 5435) would authorize $25 million and direct the Food and Drug Administration (FDA) to establish a Neuroscience Center of Excellence. This new center would coordinate activities within the FDA to create a more collaborative and innovative process to develop crucial treatments and cures that target the brain and central nervous system. This would specifically include those conditions with few or no approved treatments, as they take longer to develop and are less likely to be approved than treatments for other disease areas.

    Click here to read the CNS/AANS letter of support.

    Coding and Reimbursement

    CMS Encouraged to Reform Prior Authorization

    On Oct. 28, Sens. Sherrod Brown (D-Ohio) and John Thune (R-S.D.) spearheaded a letter to CMS Administrator Chiquita Brooks-LaSure calling for improvements to the prior authorization process. Signed by 29 U.S. Senators, the bipartisan letter encourages the agency to streamline prior authorization protocols across government health programs, including Medicare Advantage, to make them more efficient. The CNS and the AANS issued a press release expressing support for the Senate letter.

    Simultaneously with the Senate letter, the CNS and the AANS joined the Regulatory Relief Coalition (RRC) in a letter to CMS encouraging CMS to assess all utilization review programs — including prior authorization, step therapy and AUC for imaging — and to take appropriate action to improve and streamline these programs. The letter pointed out that the previous administration issued a proposed rule to, among other things, reduce provider and patient burden by adopting an electronic prior authorization program in Medicaid, the Children’s Health Insurance Program (CHIP) and the individual health insurance markets. The RRC urged the agency to finalize this rule and expand it to include the Medicare Advantage program. The coalition hopes to meet with CMS officials later this fall.

    Click here to read the Regulatory Relief Coalition letter.

    Biden Administration Publishes Additional Surprise Billing Regulations

    On Sept. 30, the Biden Administration issued an interim final rule (IFR) — the third in a series to implement the No Surprises Act and curb the practice of surprise medical billing. Among other things, the IFR provides a process to settle out-of-network (OON) rates between providers and payers. The regulation establishes the federal independent dispute resolution (IDR) process that providers and plans may use to determine payment rates for OON care after unsuccessful negotiations. The IFR establishes a de facto payment rate in contravention of the law, making the median in-network rate the default factor considered in the IDR process — which will drive down reimbursement for both OON and in-network care and will likely exacerbate the problem of narrow provider networks.

    Key members of Congress involved in negotiating the surprise billing law are demanding changes to the IFR before it takes effect on Jan. 1, 2022. One such letter to the Biden Administration — spearheaded by Reps. Tom Suozzi (D-N.Y.), Brad Wenstrup, DPM (R-Ohio), Raul Ruiz, MD, (D-Calif.) and Larry Bucshon, MD, (R-Ind.) and signed by 152 bipartisan members of Congress — points out that after extensive negotiations, Congress specifically rejected a benchmark rate.

    In a press release supporting this Congressional letter, CNS/AANS Washington Committee chair, John K. Ratliff, MD, FAANS, pointed out that “Congress enacted a thoughtful and balanced approach to protect patients from unanticipated medical bills for out-of-network care that also included a fair process for resolving billing disputes. Unfortunately, this rule directly conflicts with both the letter and intent of the law by prioritizing median in-network payment rates. It is therefore incumbent upon the Biden Administration to revise the new rules before they take effect on January 1.”

    Click here to read the Congressional letter and here for the CNS/AANS press release.

    Cigna to Cover LITT Following Neurosurgery Position Statements

    On Oct. 15, Cigna announced it would cover Laser Interstitial Thermal Therapy (LITT) for certain brain tumor, radiation necrosis and epilepsy indications. Following a meeting with Cigna medical directors in September, the CNS/AANS Joint Section on Tumors and the American Society for Stereotactic and Functional Neurosurgery released position statements regarding LITT for brain tumors, radiation necrosis and epilepsy. The documents included an analysis of current clinical literature for LITT and were cited by Cigna in their policy document.

    Click here for the brain tumor statement, here for the epilepsy statement and here for Cigna’s LITT policy.

    Neurosurgery Urges CMS to Increase Global Surgical Code Values

    On Oct. 28, the CNS and the AANS joined the American College of Surgeons and other surgical groups in a letter to CMS urging the agency to increase global surgery code post-operative evaluation and management (E/M) values. The letter follows up on issues raised during a Sept. 7 meeting the societies had with CMS. CNS/AANS Washington Committee and Coding and Reimbursement Committee leaders, John K. Ratliff, MD, FAANS, and G. Edward Vates, MD, FAANS, represented neurosurgery at this meeting. In 2021, the values for new stand-alone E/M office visit codes were increased, but CMS refused to increase the E/M portion of the 10- and 90-day global codes. The letter emphasized that this omission disrupts the relativity of the Medicare Physician Fee Schedule and inappropriately undervalues these codes.  

    Click here to read the letter.

    Drugs and Devices

    Neurosurgery Urges U.S. Attorney General to Address Pain Control Enforcement

    On Oct. 21, the CNS and the AANS joined the American Medical Association and others in a letter to U.S. Attorney General Merrick B. Garland asking for his assistance to resolve a harmful interpretation of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (P.L. 115-271). The Department of Justice currently interprets the SUPPORT Act as prohibiting pharmacies from delivering prescriptions for controlled substances to physicians for implantation or injection in their patients except for medications to treat opioid use disorder. The letter points out that if the Drug Enforcement Administration (DEA) enforces this interpretation, “up to 100,000 patients who rely on intrathecal pain pumps to control the symptoms of extremely painful conditions, such as advanced cancer, would lose access to safe and effective pain control.”

    Earlier this year, neurosurgeons Albert E. Lee, MD, FAANS, Joshua M. Rosenow, MD, FAANS, and Jason M. Schwalb, MD, FAANS, provided information to the DEA about their experience with patients in need of this pain control treatment.

    Click here to read the letter.

    Neurosurgeon Testifies at FDA Hearing on Medical Device User Fees

    On Sept. 30, Peter E. Konrad, MD, PhD, FAANS, represented the CNS/AANS Drugs and Devices Committee at a Medical Device User Fee Amendments (MDUFA) stakeholders meeting. The meeting focused on discussions on diversity and equity for neurosurgical devices, including access to neurostimulators and pediatric devices. Negotiations to reauthorize MDUFA for fiscal years 2023 through 2027 are underway in Congress, as the current legislative authority for the program expires on September 30, 2022. Representatives from the CNS and the AANS will engage in this process as the negotiations continue.

    Click here for meeting details.

    Of Note

    Neurosurgeons Elected to ACS Leadership Positions

    New members of the American College of Surgeons (ACS) Board of Regents and Board of Governors were recently elected. Former AANS president, Shelly D. Timmons, MD, PhD, FAANS, FACS, was selected as the Board of Regents neurosurgery member. She replaces John L. Atkinson, MD, FAANS, FACS, who served with distinction in this role for the past nine years. The Board of Regents formulates policy and directs the affairs of the ACS.

    Mark E. Shaffrey, MD, FAANS, FACS, was selected as a Specialty Society Governor representing the AANS on the Board of Governors. As a Specialty Society Governor, Dr. Shaffrey will serve as a direct communications link between the Fellows of the College and the members of the Board of Governors.

    Click here for the announcement.

    Neurosurgeon Featured in AMA’s “Shadow Me” Specialty Series

    The American Medical Association (AMA) offers advice and information for medical students about different specialties by interviewing physicians in their “Shadow Me” Specialty Series. On Oct. 28, Krystal L. Tomei, MD, MPH, FAANS, FACS, FAAP, was featured in the series, detailing a typical day as a pediatric neurosurgeon, discussing the most challenging and rewarding aspects of pediatric neurosurgery and providing insights for individuals interested in the specialty.

    Communications

    Neurosurgery Featured in Articles about Prior Authorization

    On Oct. 8, John K. Ratliff, MD, FAANS, chair of the CNS/AANS Washington Committee, was featured in a Ritz Herald article titled “Prior Authorization Relief Bill Reaches Significant Milestone.” In pointing out that H.R. 3173, the Improving Seniors’ Timely Access to Care Act, now has enough co-sponsors to pass the U.S. House of Representatives, Dr. Ratliff noted, “The need to modernize prior authorization is now. The burden of prior authorization has reached a critical stage as health plans continue to delay and deny medically necessary services to patients who have critical health care needs.”

    Meanwhile, on Oct. 20, Katie O. Orrico, Esq., CNS/AANS senior vice president for health policy and advocacy, was featured in a WIBW article titled, “Sen. Marshall Working to Prioritize Patients Over Paperwork.” The piece reported on the introduction of S. 3018, the Improving Seniors’ Timely Access to Care Act, which would improve timely access to quality care for seniors under Medicare Advantage. Ms. Orrico stated, “The bill is a carefully crafted, bipartisan work product that reflects significant input from all direct stakeholders. The congressional team behind this bill focused on transparency, oversight, and modernization of the Medicare Advantage program to benefit patients and the providers and health plans who serve them. We eagerly await congressional action. The bill is ready for the finish line.”

    CNS/AANS Washington Committee Chair Featured in Articles about Medicare Payment Cuts

    On Oct. 15, John K. Ratliff, MD, FAANS, chair of the CNS/AANS Washington Committee, was featured in a Becker’s ASC Review article titled, “As 9%+ Physician Pay Cut Looms, Congress Urged to Take Action.” The article discussed a letter led by Reps. Ami Bera, MD, (D-Calif.), and Larry Bucshon, MD, (R-Ind.) and signed by 247 bipartisan members of Congress calling for systemic changes to the Medicare payment system. “Such an overwhelming showing on this letter to House leaders clearly demonstrates significant bipartisan support for Congress to act this year to protect Medicare beneficiaries’ timely access to care,” according to Dr. Ratliff.

    In addition, on Nov. 2, Dr. Ratliff was featured in a Modern Healthcare article titled, “CMS to Boost Pay for Home Health, Hospital Outpatient Services.” The report noted that CMS is boosting payment for hospital outpatient services and home health and reducing reimbursement for physicians next year. Hospital-owned outpatient and ambulatory surgery center payment rates will increase by 2%, and Medicare home health reimbursement rates will increase by 2.6%. Meanwhile, regulators are reducing Medicare payments to physicians by nearly 9% next year. “Amid the ongoing pandemic, it’s critical now more than ever, to protect patients by stopping these cuts and working toward a long-term solution to stabilize the health care system,” said Dr. Ratliff.

    Finally, on Nov. 3, Dr. Ratliff was featured in a Radiology Business article titled, “Final Medicare Physician Fee Schedule Offers Positives, But Still ‘Disappointing’ Cuts to Radiologist Pay.” The article discussed the final 2022 Medicare Physician Fee Schedule and noted that physicians across specialties are asking Congress to intervene, as lawmakers did in late 2020. “Patients have already delayed important preventative care like cancer screenings due to COVID-19. These cuts will further delay care to our nation’s seniors,” said Dr. Ratliff.

    Neurosurgery Blog Publishes Article on CHIP Funding

    Neurosurgery Blog: More than Just Brain Surgery recently published a guest post by Catherine A. Mazzola, MD, FAANS, titled, “Permanently Funding CHIP is Essential for the Health of Our Children.” CHIP has provided access to care that low-income families would not have had otherwise. If Congress does not act, federal funding for CHIP will expire. The Comprehensive Access to Robust Insurance Now Guaranteed (CARING) for Kids Act (H.R. 66) would ensure that gaps in CHIP coverage would never again happen.

    Click here to read Dr. Mazzola’s blog post.

    Join the Conversation on Social Media

    Connect with the CNS/AANS Washington Committee and Washington Office on various social media platforms to keep up with the many health policy activities in the nation’s capital and beyond the Beltway.

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