The Improving Seniors’ Timely Access to Care Act, federal legislation that would reform prior authorization in Medicare Advantage plans, was unanimously passed the U.S. House of Representative earlier this month and is now under further consideration by the Senate.
Providing much-needed oversight and transparency while protecting beneficiaries from unnecessary care delays and denials, the bill would require Medicare Advantage plans to:
· Establish an electronic prior authorization program.
· Standardize and streamline the prior authorization process for routinely approved services, including establishing a list of services eligible for real-time prior authorization decisions.
· Ensure prior authorization requests are reviewed by qualified medical personnel.
· Increase transparency around Medicare Advantage prior authorization requirements and their use.
Passage of this bipartisan bill was driven by more than 320 co-sponsors and over 500 endorsing organizations concerned over patient access to prompt care. In fact, a recently released report from the U.S. Department of Health and Human Services Office of Inspector General verified that some Medicare Advantage (MA) plans are inappropriately delaying and denying care.
The latest Marquette University Law Poll, which was conducted earlier this month and released on September14, shows incumbent Gov. Tony Evers (D) and Tim Michels (R) remain in a very tight race for governor, and incumbent U.S. Sen. Ron Johnson (R) and current Lt. Governor Mandela Barnes in a statistical dead heat for U.S. Senate. In the August Marquette Poll, Barnes was up 7-ponts over Johnson. Please find below highlights of the poll:
Wisconsin Governor’s Race:
· Wisconsin Voters’ Preference for Governor:
o Governor Tony Evers (Democrat): 47%
o Tim Michels (Republicans): 44%
o Joan Beglinger (Independent): 5%
NOTE: Joan Beglinger ended her gubernatorial campaign on September 6, 2022 and endorsed Republican candidate Tim Michels. However, her name will remain on the November general election ballot.
· Evers Favorability:
o Favorable: 45%
o Unfavorable: 45%
o Haven’t heard enough: 7%
o Don’t know: 3%
· Michels Favorability:
o Favorable: 34%
o Unfavorable: 39%
o Haven’t heard enough: 19%
o Don’t know: 8%
U.S. Senate Race:
· Wisconsin Voters’ Preference for U.S. Senate:
o U.S. Senator Ron Johnson (Republican): 49%
o Lt. Governor Mandela Barnes (Democrat): 48%
· Johnson Favorability:
o Favorable: 39%
o Unfavorable: 47%
o Haven’t heard enough: 11%
· Barnes Favorability:
o Favorable: 33%
o Unfavorable: 32%
o Haven’t heard enough: 25%
o Don’t know: 9%
WISCA works closely with our national association partner – the Ambulatory Surgery Center Association (ASCA) – on advocacy and other issues important to our members. In fact, the WISCA Government Affairs Team joins a national ASCA state chapter call twice a month for a federal regulatory and legislative briefing and closely follows their published Government Affairs Updates. Here is the latest government affairs news from ASCA:
On September 13, ASCA submitted a state ASC association sign-on letter in response to the Centers for Medicare & Medicaid Services’ (CMS) CY 2023 OPPS/ASC proposed payment rule. The letter was created to allow state ASC associations to easily show support for ASCA’s comments and had support from ASC associations across the country. Wisconsin and WISCA signed-on to the letter, joining 31 other states.
ASCA has heard from members who were unable to submit ASC-20: COVID-19 Vaccination Coverage Among Health Care Personnel data by the first quarterly deadline on August 15. In the event that your ASC was unable to submit any required information due to an extraordinary circumstance, your ASC may request an exception. To request an exception, you must submit a completed Extraordinary Circumstances Exceptions form with any required information and supporting documentation within 90 calendar days of the missed deadline. For all ASCs subject to this reporting requirement, please remember that the next quarterly deadline is November 15.
On September 13, the Supporting Medicare Providers Act of 2022 (H.R. 8800) was introduced by Representatives Ami Bera, MD (D-CA), and Larry Bucshon, MD (R-IN). The legislation would provide an additional 4.42 percent to the physician conversion factor (CF) for 2023. As a reminder, in the 2023 Medicare Physician Fee Schedule (MPFS) proposed rule, the Centers for Medicare & Medicaid Services (CMS) proposed a 4.4 percent cut to the 2023 CF, mostly due to the expiration of a temporary, one-year 3 percent increase to the CF passed as part of the Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610) in December 2021. ASCA is part of a coalition of provider organizations supporting such efforts and expects that a coalition letter will be sent on this specific legislation in the near future. Most recently, the coalition sent a letter asking Congress for relief from impending physician payment cuts. The letter asked Congress to approve at least a 4.5 percent increase in the 2023 physician CF and to waive a 4 percent statutory PAYGO cut.
Want to Be More Involved in WISCA Advocacy? Join the WISCA Legislative Committee
WISCA’s committee structure allows the association to be productive and is essential to meeting our principal goals. Of course, member service is voluntary and can lead to significant committee turnover at times. In fact, the WISCA Legislative Committee already has a handful of vacancies and is facing more member resignations due to retirement. In short, WISCA actively recruiting new members to serve on the Legislative Committee.
The WISCA Legislative committee is responsible for setting and communicating legislative priorities and policy positions that are representative of WISCA’s membership. The committee also works closely with WISCA’s professional lobbying/advocacy team to ensure that state and federal issues important to members are effectively communicated to policymakers.
If you are interested in serving on the WISCA Legislative Committee, please contact he WISCA office at WISCA@badgerbay.co.
Congressman Tom Tiffany, State Lawmakers Tour Northwood Surgery Center as Part of National ASC Month
Wisconsin Congressman Tom Tiffany (WI-07), a Republican from Hazelhurst, recently visited the Northwood Surgery Center in as part of the Association of Wisconsin Surgery Centers (WISCA) Capitol Connection program and to celebrate National Ambulatory Surgery Center (ACS) Month. He was joined by State Sen. Mary Felzkowski (R-Irma) and State Rep. Rob Swearingen (R-Rhinelander). WISCA’s Capitol Connection program aims to connect surgery center members with their local state and federal legislators to show them firsthand the benefits of the ASC model of care.
“We were thrilled to celebrate National Surgery Center Month by hosting Congressman Tiffany, Sen. Felzkowski, and Rep Swearingen for a tour of our surgery center,” said Jackie McLaughlin, RN, Administrator of the Northwoods Surgery Center. “Northwoods Surgery Center provides affordable, quality outpatient surgical care in a collaborative environment, and we were proud to showcase the ASC patient experience to the visiting lawmakers. We greatly appreciated their visit, their support for our center, and their acknowledgment of the hard work of our physicians, nurses, and employees to successfully carry out our vision.”
Northwoods Surgery Center is a partnership between Aspirus Wausau Hospital and local surgeons who created a joint ventured center of surgical excellence. The Center, which opened in 2008 and is certified by Medicare and the Accreditation Association for Ambulatory Health Care, is committed to providing quality service and extraordinary outpatient surgical care to their patients. The Center has two operating rooms where specially trained, highly skilled physicians and their professional health care teams perform ophthalmology, orthopedic, pain management, and podiatry procedures.
The photo includes the following individuals (L to R):State Sen. Mary Felzkowski (R-Irma), Jackie McLaughlin, RN, Dr. Michel Gelinas, Board Certified Ophthalmologist, Congressman Tom Tiffany (R-WI-07), Dr. Mark Balas, Board Certified Orthopaedic Surgeon, State Rep. Rob Swearingen (R-Rhinelander)
Prior Authorization Reform Bill Moving Advancing in Congress
The Improving Seniors’ Timely Access to Care Act recently cleared a key step in the legislative process, as the House Ways and Means Committee voted unanimously to advance the bill, which aims to reform prior authorization in Medicare Advantage plans.
The legislation, which would streamline and standardize prior authorization in the Medicare Advantage program, is now one step closer to consideration by the full U.S. House of Representatives. If passed by the full House, the bill will then move to the U.S. Senate for further consideration.
Post-Primary Marquette University Law Poll Shows Evers and Michels in Tight Race for Governor; Barnes with Lead in U.S. Senate Contest
The latest Marquette University Law Poll, which was conducted after the Aug. 9 Wisconsin primary election and released on August 17, shows incumbent Tony Evers (D) and Tim Michels (R) locked in a close race for governor, and has current Lt. Governor Mandela Barnes leading incumbent Ron Johnson (R) in the contest for U.S. Senate. Please find below highlights of the poll:
CLICK HERE to read the complete results from the latest Marquette University Poll.
Federal Government Affairs News and Notes:
ASCA will send the first draft of our ASC/OPPS Proposed Payment Rule comment letter to the Government Affairs Committee and the ASCA Board of Directors this week. They will have one week to provide feedback to Kara Newbury and then a second draft of the letter will be circulated for additional feedback. Comments are due to The Centers for Medicare and Medicaid Services (CMS) by September 13. ASCA will have a state associations sign-on letter ready for circulation by August 29. WISCA will likely sing-on to the letter, pending WISCA Legislative Committee approval.
The first quarterly data submission deadline for ASC-20: COVID-19 Vaccination Coverage Among HCP (Health Care Personnel) was August 15, 2022. While CMS provided no extension for the August 15 deadline, there is an “extraordinary circumstance exception” that can be requested.
When the Biden administration took office, they indicated they would give 60 days’ notice before ending the Public Health Emergency (PHE). Since the current extension of the PHE runs through mid-October and the states have not yet been notified otherwise, the PHE is expected to be extended. CMS did release a document last week to aid healthcare providers in phasing out flexibilities allowed during the Public Health Emergency, entitled “Creating a Roadmap for the End of the COVID-19 Public Health Emergency.”
WISCA Legislative Affairs Report:Update on Proposed Medical Chaperone Rule
By Andrew Engel – WISCA Lobbyist (Hamilton Consulting)
As has been previously reported in the WISCA Advocacy Newsletter, WISCA submitted comments to the Wisconsin Medical Examining Board (MEB) detailing how compliance with the Board’s proposed “medical chaperone rule” could cost Wisconsin ASC’s tens of millions of dollars.
If you recall, the regulatory board was considering a new rule that would have required a medical chaperone be present in an exam room whenever a physician is performing an examination or procedure that involves the breast, genitals, or rectal area of a patient. In addition, the proposed rule would consider these types of exams conducted without a chaperone as unprofessional conduct.
At its meeting last month, the MEB decided to significantly pare back its proposed rule on medical chaperones, abandoning the requirement that ASC’s provide a separate chaperone to patients when requested. At their latest meeting, the MEB reviewed new draft language, which requires physicians and their employers to have a policy on medical chaperones and to make the policy readily available to affected patients. A Department of Safety and Professional Services (DSPS) staff attorney has said during MEB meetings that the policy could theoretically be as simple as “we don’t require the use of medical chaperones here.”
Following some discussion, the board made minor changes to the proposed language so that the rule does not specifically make either physicians or their employers responsible for posting the policy. It simply requires that a policy be made available to patients. MEB members did not want to make physicians responsible for what may be a failure of their employer to create or post a policy, while MEB lacks the authority to directly regulate hospitals and clinics.
A representative from the Wisconsin Medical Society thanked the board for listening to stakeholder input and crafting specific language that considers who bears the burden of the rule.
MEB members approved a motion allowing the board chair and DSPS staff to finalize the rule and submit it once again for public comment on its economic impact. The review is expected to be complete in a month or two, before the board’s October meeting.
DSPS Secretary Dawn Crim Leaving Evers Administration
Earlier in July, Wisconsin Department of Safety and Professional Services (DSPS) Secretary Dawn Crim announced that she will be leaving the Evers Administration on August 1, 2022. The State Medical Examining Board and the State Board of Nursing are housed within DSPS, which also processes nearly all occupational license applications in Wisconsin, including licenses for physicians, nurses, and other health care professionals. Earlier this year, DSPS implemented an online platform for health care occupational license applications. The agency will transition the remaining occupational licenses that they handle to their online platform in the future.
Governor Evers has announced that DSPS Assistant Deputy Secretary Dan Hereth will be the DSPS Secretary-designee upon Secretary Crim’s departure.
Association of Wisconsin Surgery Centers
563 Carter Court, Suite B Kimberly WI 54136
920-560-5627 I WISCA@badgerbay.co