CMS Delays Start of Radiation Oncology Alternative Payment Model Yet Again
By Marty Stempniak | April 7, 2022
The Centers for Medicare & Medicaid Services has delayed the controversial Radiation Oncology Alternative Payment Model yet again, cancer care advocates revealed on Wednesday.
The mandatory bundled payment initiative was slated to kick off on Jan. 1, 2023, following numerous delays. However, the agency has now deferred the launch to a yet-to-be determined date, which will be decided through future rulemaking.
Lawmakers and the American Society for Radiation Oncology (ASTRO) have pushed for the postponement. The latter praised the delay on April 6 while also emphasizing it is still “committed to value-based care in radiation oncology.”
“ASTRO remains hopeful that during this process, CMS also makes the adjustments recommended by Congress and the broad coalition of stakeholders within the radiation oncology community as we remain concerned that the model in its current form is too punitive for clinics,” Board of Directors Chair Laura A. Dawson, MD, said in a statement. “We believe that the modifications proposed by ASTRO and the radiation oncology community will ensure successful participation among physicians and facilities and produce significant savings for the Medicare program,” she added later.
Eighty-five members of Congress joined the society and others in pushing CMS to quash “draconian” cuts to radiation oncologist pay via the RO model and Medicare fee schedule last year. The recommended fixes included reducing the model’s “excessive” discount factor and not penalizing providers in the fee schedule. They also advocated for a “Health Equity Achievement in Radiation Therapy” payment in the RO Model to support wraparound services such as patient care navigation.
To read more, go to Radiology Business.
American College of Radiology, Patient Advocacy Groups Urge Feds to Fix CTC Coverage Gap
By Marty Stempniak | April 7, 2022
The American College of Radiology and five patient advocacy groups are urging the federal government to fix a longstanding lack of coverage for colon cancer screening via CT.
ACR and others including the Colorectal Cancer Alliance have submitted a formal national coverage determination request, asking the Centers for Medicare & Medicaid Services to address this issue. CTC is the only primary cancer screening test endorsed by the U.S. Preventative Services Task Force and American Cancer Society but not covered by Medicare or traditional Medicaid, they wrote Tuesday.
Colorectal cancer disproportionately impacts communities of color, and those involved believe “virtual colonoscopy” could help address hurdles attached to the traditional testing method.
“The need for a driver or car transportation, the need to take a day off from work, and the need for anesthesia or sedation for someone with a fear based in cultural background are all important barriers to screening that may be faced by someone outside of the majority,” ACR and others wrote to Joseph Chin, MD, deputy director of CMS’ Coverage and Analysis Group, on April 5. “The opportunity for prevention through a direct visualization test should not be off the table of options. Lack of Medicare and Medicaid coverage for CTC is a contributor to inequities in healthcare for colorectal cancer screening.”
Cancer care advocates are asking the agency to reconsider a 2009 determination, declining to cover screening via computed tomography colonography. They note that new information has emerged since then, including updated USPSTF guidance (lowering the recommended
screening age), President Biden’s relaunched call to quash cancer, and evidence that colorectal cancer hits minority populations harder.
Others signing the request to Chin included the Colon Cancer Coalition, the Prevent Cancer Foundation, the Blue Hat Foundation and the Black Women’s Health Imperative. ACR also sent a second letter to Health and Human Services Secretary Xavier Becerra asking him to exercise his authority to deem CTC as a covered screening service in the Medicare program.
To read more, go to Radiology Business.
Providers Given Chance to Request Extra PRF Reporting Time
By Maya Goldman | April 6, 2022
Providers that didn’t report on Provider Relief Fund money they received in the first round because of “extenuating circumstances” have an opportunity to request additional time, the Health Resources and Services Administration announced Wednesday.
Severe illnesses or deaths of employees responsible for reporting, natural disasters that damaged records or technology near the end of the reporting period, internal miscommunication about reporting and failures to click “submit” count as extenuating circumstances that warrant extra time to report after the deadline, according to HRSA.
Providers that didn’t have correct email or mailing addresses on file and subsidiaries that didn’t report targeted distributions are also eligible for the extension.
The original Period 1 reporting deadline was Sept. 30, but funding recipients got a 60-day grace period until Nov. 30, plus an additional week in December, to provide the required information.
HRSA informed noncompliant providers last month that they’d need to repay undocumented Provider Relief Funds within 30 days of that notice.
The American Medical Association and other provider groups last week urged the agency to reopen the portal for another 60 days.
To read more, go to Modern Healthcare.
Change Healthcare, UnitedHealth Extend Healthcare Merger Deadline
By Victoria Bailey | April 5, 2022
Change Healthcare and UnitedHealth Group’s diversified health services company, Optum, have announced that they will extend their healthcare merger agreement to December 31, 2022.
UnitedHealth Group first announced plans for Optum to acquire Change Healthcare in January 2021.
In a proposed transaction valued at $8 billion, the merger aimed to combine Change Healthcare’s revenue cycle management technologies with Optum’s services to ease clinician workflow, improve provider access to clinical data, and streamline payment processes.
The companies had expected to finalize the deal in the second half of 2021, but the transaction hit a series of roadblocks.
Most recently, the Antitrust Division of the Department of Justice (DOJ) filed a civil lawsuit to block the merger deal. The complaint stated that the transaction would hurt competition in the commercial health insurance and healthcare technology markets.
DOJ claimed that UnitedHealth Group would gain access to rival payer information, giving the health plan an unfair market advantage. Additionally, the merger would eliminate UnitedHealth Group’s only significant rival for first-pass claims editing technology, allowing the payer to develop a monopoly share in the market.
Change Healthcare and Optum said that DOJ’s attempt to block the merger is “without merit and serves only to delay improving the experience and outcomes for all participants in the health system.”
Since the initial merger announcement, the companies had pushed the deadline to April 2022, but have now extended it to December 2022.
“The extended agreement reflects our firm belief in the potential of our combination to improve healthcare and in our commitment to contesting the meritless legal challenge to this merger,” the companies said in a joint statement.
Change Healthcare and Optum plan to detail the benefits of the merger deal at a two-week trial scheduled to begin on August 1.
To read more, go to Revcycle Intelligence.
Providers Brace for Financial Hits as COVID-19 Uninsured Fund Ends
By Nona Tepper | April 4, 2022
Safety-net hospitals, federally qualified health centers and laboratories may have to cut staff and hours and limit patient access if Congress and President Joe Biden cannot come to an agreement over further COVID-19 pandemic relief.
The COVID-19 Uninsured Program is an early casualty of the budget impasse between lawmakers and the White House, which initially requested $22.5 billion for ongoing COVID-19 response. Laws enacted by Biden and by President Donald Trump authorized this program,
which began in 2020, to ensure providers be paid for administering COVID-19 care to U.S. residents without health coverage, who number an estimated 28 million.
The federal government has paid out more than $17 billion to providers for testing, treating and vaccinating the uninsured. The Health Resources and Services Administration ran out of money for the program March 22 and stopped reimbursing providers for COVID-19 testing and treatment. Starting Tuesday, HRSA will no longer pay providers for vaccinating uninsured individuals.
“If we’re put in a position of having to chase payment that might not materialize, then it becomes more a question of, ‘As a lab, do I continue to offer this service?'” said Tom Sparkman, senior vice president of government affairs and policy at the American Clinical Laboratory Association.
Last year, the trade association’s members performed 8 million tests on uninsured patients, Sparkman said. During the omicron wave in January and February, these labs performed 1 million tests on patients who lacked coverage.
Without reimbursement, Curative will no longer be able to offer free testing in some of the 18 states where it operates in, a spokesperson wrote in an email. The company debuted in early 2020 with a focus on sepsis patients, but pivoted to COVID-19 testing when the pandemic started. Curative did not respond to interview requests about the policy’s financial impact or where it will no longer provide no-cost testing to uninsured people.
Quest Diagnostics will begin charging uninsured individuals $100 per test, the company announced. In 2021, COVID-19 testing accounted for one-fifth, or $2.8 billion, of the company’s $10.8 billion in revenue.
To read more, go to Modern Healthcare.
State-based ACA Exchanges Make Backup Plans In Case Congress Fails to Act on Enhanced ACA Subsidies
By Robert King | April 1, 2022
The Biden administration and states across the country celebrated record-breaking enrollment gains for the Affordable Care Act (ACA) this year.
But state-run exchanges are eyeing backup plans for outreach and marketing in case Congress doesn’t extend beyond this year a major driver for those enrollment gains: enhanced income-based subsidies. Some officials have warned that people could drop off coverage—and consumers may shift to less-generous plans—if Congress doesn’t act in time.
“If we are still in this stage of uncertainty, we will have to anticipate either outcome and ramp up planning efforts … with both scenarios in mind,” said Zachary Sherman, executive director of the exchange called Pennie, in an interview with Fierce Healthcare.
Sherman said Pennsylvania’s exchange signed up more than 110,000 new customers compared to the last open enrollment, and 35,000 of those customers are getting subsidies that they typically would not be eligible for.
The American Rescue Plan’s (ARP’s) enhanced subsidies ensured that anyone making more than 400% above the federal poverty level wouldn’t pay more than 8.5% of their income on healthcare. Previously, that was the cutoff for eligibility for income-based subsidies. The enhancements also ensured that some consumers qualified for zero premiums or $10 a month premiums.
According to a recent Assistant Secretary for Planning and Evaluation report, an estimated 3.4 million Americans currently insured in the individual market would lose coverage and become uninsured if the ARP’s premium tax credit provisions are not extended beyond 2022. Kaiser Family Foundation determined premiums would more than double for many.
Pennie isn’t the only exchange that saw massive gains thanks to the subsidies.
Washington’s exchange saw nearly 60,000 residents sign up for coverage for 2022, and 73% of all customers were eligible for subsidies, up from 61% in 2021, the exchange told Fierce Healthcare.
It added that over 100,000 of the exchange customers (42% of total enrollment) pay $100 or less a month, compared to 29% before the ARP was signed into law.
Customers signing up on state-run exchanges saw average premium savings of 7% to 47% for 2022, according to a report from the National Association for State Health Policy. The report added that at least eight exchanges had 20% or more of their customers paying less than $25 a month for coverage.
Overall, there were 14.5 million people who signed up for coverage for 2022 when considering both the state-run exchanges and the federally run HealthCare.gov, a record number. Now, though, states are grappling with how many people could lose coverage if the extra subsidies go away.
To read more, go to Fierce Healthcare.