April 2020 - AUA Public Policy Council Update for MAS

From the Chair

I want to use the opportunity of my last section report to express what an honor and a privilege it has been to work with and serve fellow AUA members these past four years. It is said that during adverse situations character is revealed and not created. I have seen this repeatedly from AUA staff and members alike, especially in the last four weeks. I want to recognize Dr. Kathy Shanley for her outstanding work and innovation on behalf of our organization, and welcome Dr. Eugene Rhee as the incoming chair. The AUA Public Policy team is in great hands. I wish all health and comfort as we navigate these trying times.

The COVID-19 pandemic is rapidly shifting how urologists live and practice. The AUA is working to help our members navigate the ever-evolving landscape of this pandemic, and has set up a COVID-19 Information Center on AUAnet.org. This center contains helpful links and information, including details on telehealth, clinical insights and more. Here are a few updates and a request for your help in gathering stories to better focus our future legislative actions concerning COVID-19.

We Need your Help!
Due to the unprecedented COVID-19 pandemic, there are many issues impacting physicians, patients, and the nation’s healthcare delivery system in general. To help us better direct future legislative actions, we are asking that you complete a short, 12-question survey that is located here: www.auacovid19survey.com.

As Congress continues to move quickly to address the COVID-19 pandemic, in particular now looking to pass a fourth relief package in the coming weeks, your stories will help to put focus on the various obstacles facing urologists and urologic professionals around the country.

State Advocacy Update: AUA Urges Maryland Governor to Sign Prostate Cancer Legislation
On April 13, the AUA sent a letter urging Maryland Governor Larry Hogan, to sign HB 852/SB 661. HB 852, was introduced by House Delegate Erek Barron (D-24) and specifically requires the state of Maryland to cover a digital rectal exam and a PSA test for men between 40 and 75 years old and men who are at high-risk of developing the disease. For a copy of the letter, please contact Andrea Oh at AOh@AUAnet.org.

As a reminder, the AUA collaborated with ZERO – The End of Prostate Cancer , Chesapeake Urology and MedChi: The Maryland State Medical Society in moving this bill forward. We will keep you updated on the Governors actions on this bill.

Telehealth Webinar: AUA Urology Telehealth Task Force Provides Practical Telehealth Tips

The COVID-19 pandemic has led to unprecedented times and changes the way urologists practice today while promoting good public health through social distancing. Drs. Jonathan Rubenstein, AUA Coding and Reimbursement Chair, and Chad Ellimoottil, both members of the AUA Urology Telehealth Task Force, focus on how to implement telehealth services in your practice. Visit the COVID-19 Information Center and choose the Telemedicine tab and click on the Telehealth in Urology Practice from A to Z icon to view this important information.

COVID-19: The Coronavirus Aid, Relief, and Economic Security (CARES) Act Enacted; AUA Advocates on a Wide-Range of Issues

The House and Senate recently passed H.R. 748, the CARES Act, which is the federal government’s third legislative package aimed at addressing the many public health and economic challenges posed by the COVID-19 outbreak. Among many other things in the $2.2 trillion package, the legislation made important modifications to the Small Business Administration (SBA) 7(a) program, which historically offers “loan” amounts to eligible small businesses in the United States. Previously, only for-profit entities were eligible for these loans. However, under the CARES Act, medical facilities such as hospitals, clinics, emergency outpatient facilities, and medical and dental laboratories are eligible. Convalescent and nursing homes are also eligible, provided they are licensed by the appropriate government agency and services rendered go beyond those of room and board.

While the loans offered under the original program were focused on traditional business development, the CARES Act modifies the program in several key ways, including:

Clarifying that businesses with up to 500 employees are eligible (for those with multiple locations, the 500-employee limit applies to each location;
Increasing the maximum 7(a) loan amount to $10 million;
Expanding allowable uses of 7(a) loans to include payroll support, such as paid sick or medial leave, employee salaries, mortgage payments, and any other debt obligations, and;
Providing a process for loan forgiveness for certain payroll costs as well as mortgage, rent, and utility obligations.

The CARES Act also establishes a $100 billion fund to support health care providers for costs associated with responding to the pandemic as well as lost revenues because of COVID-19. Providers are defined broadly in the legislation, to be further defined and qualified by the Secretary of Health and Human Services. The bill also includes more than $1 billion to support community health centers responding to the pandemic, and allows for accelerated payments to hospitals during the public health emergency. Recipients would have four months before they have to start paying down the loan and would have a calendar year to make payments without any interest.

The newly enacted law includes also contains several health policy provisions, most of which are tied to the COVID-19 response. These include provisions that:

Further expand telehealth access by:

removing a requirement that Medicare beneficiaries need to have had a face-to-face encounter with a provider during the past three years to be eligible for telehealth;
allowing high-deductible health plans to cover telehealth services pre-deductible;
allowing Federally Qualified Health Centers and Rural Health Centers to be originating sites; and
allowing for the use of telehealth to meet some hospice benefit requirements;

Reduce face-to-face monitoring requirements of the in-home dialysis benefit;
Temporarily eliminate the Medicare payment reduction (sequester) from May until the end of 2020 while adding an additional year to sequestration on the out-years;
Establish a 20 percent Medicare add-on payment for treating COVID-19 patients during the emergency;
Eliminate any Medicare Part B beneficiary cost-sharing for eventual COVID-19 vaccinations, and;
Require Medicare Prescription Drug (Part D) plans to furnish beneficiaries with 90-day refills if requested during the emergency.

AUA Advocacy on the CARES Act

The AUA joined numerous other groups – including the American Medical Association, Alliance of Specialty Medicine, and the American College of Surgeons’ Surgical Coalition – in sending multiple letters to congressional leadership requesting various provisions be included in the stimulus to help stave off the extreme challenges created by the coronavirus pandemic.

The letters covered a wide-range of issues, including protecting front-line physicians by ensuring they have the equipment they need, ensuring that Good Samaritans are protected when crossing state lines, preventing frivolous lawsuits as they relate to new perceived violations of HIPAA during expanded telehealth treatment, to promoting efficient access to necessary care through relieving prior authorization requirements, protecting physician practices through small business relief programs, and suspending the 2 percent annual Medicare budget sequester.

Visit the AUA’s COVID-19 Info Center for ongoing updates on how new legislation and policies affect you, your patients, and your practice.

National Insurance Updates

The following are national Medicare Administrative Contractor (MAC) and commercial insurance updates.

Aetna

Aetna has reviewed and updated its Pituitary Suppressive Agents medical policy with the addition of the following drugs to the list of drugs requiring prior authorization:

Lupaneta Pack
Lupron Oncology
Orilissa
Supprelin
Synarel
Triptodur
Zoladex