AACE Submits Comments on the 2020 Medicare Physician Fee Schedule Proposed Rule
AACE submitted a comment letter to the Centers for Medicare and Medicaid Services (CMS) on the proposed changes in the Medicare physician payment policies for calendar year 2020. The proposed rule would make extensive changes to the office/outpatient E/M visits codes and are consistent with proposals from the AMA CPT Editorial Panel. AACE believes the CMS proposal will support the delivery of complex and comprehensive care patients with metabolic disease require. The proposed 2020 Physician Fee Schedule includes the following positive changes for services starting January 1, 2021. CMS proposes to:
- Retain 5 levels of coding for established patients and reduce new patients to 4 levels
- Add a new CPT code for extended office visit time
- Require history and physical exams to be performed as medically appropriate and not require them for code level selection
- Allow physicians to select their E/M level based on medical decision making or time
- Implement a Medicare-specific add on code for office visits to describe the complexity associated with visits
Table 111 (on page 1187) of the proposed rule outlines the potential combined impact on these proposed payment policies on various specialties, with Endocrinology topping the list at 16%.
AACE Raises Awareness About Blood Glucose Testing System Accuracy
AACE, as a member of the Diabetes Advocacy Alliance (DAA), expressed concerns to HHS and FDA regarding accuracy issues with certain blood glucose testing systems and its potential implications for people with diabetes. Read more.
Legislation Introduced to Expand Access to DSMT
Leaders in both the U.S. House of Representatives and the U.S. Senate have introduced legislation to expand Medicare beneficiary access to diabetes self-management training services (DSMT). The “Expanding Access to Diabetes Self-Management Training Act” (H.R. 1840) was introduced in the House by Representatives Tom Reed (R-NY) and Diana DeGette (D-CO), the Co-Chairs of the House Diabetes Caucus. The Senate sponsors of companion legislation (S. 814) are Senators Jeanne Shaheen (D-NJ) and Susan Collins (R-ME). Read more information on the measure.
House and Senate Committees Hold Hearings on Insulin Costs
The House Energy and Commerce Subcommittee on Oversight and Investigations held two hearings on insulin prices. The first hearing April 2, 2019, convened stakeholder perspectives on the difficulties to afford insulin and patient impact and was followed by a second hearing on April 10, 2019, with testimony from insulin manufacturers and pharmacy benefit managers. The House Diabetes Caucus published a white paper in November 2018 on the topic of insulin pricing.
The Senate Select Committee on Aging held a hearing on May 8, 2018, “Insulin Access and Affordability: The Rising Cost of Treatment”. The Chair of the Aging Committee, Senator Susan Collins (R-ME), expressed concern about insulin costs and vowed that the Committee would try to untangle the complexity of the insulin supply chain to determine what is driving the cost so high and who is benefiting. Senator Collins is also the Co-Chair of the Senate Diabetes Caucus. View the hearing and read the hearing statements.
CMS Modifies Coverage Policy for CGMs
On June 11, 2018, the Centers for Medicare and Medicaid Services (CMS) announced that the current coverage policy for therapeutic Continuous Glucose Monitoring (CGM) for Medicare beneficiaries will be modified to benefit patients and support the use of CGMs in conjunction with a smartphone app, including the important data-sharing functions they provide for patients and their families. This issue has been an important AACE advocacy effort and the successful achievement is a win for AACE members and their patients!
The sharing of data is extremely valuable to adjust medications and to provide information-based decisions to enhance patient care and improve health outcomes. The existing policy ban on the use of smart technology devices in conjunction with a CGM receiver curtails the best practice and safety of our patients. As one of the AACE priority advocacy initiatives, this important CMS policy change will allow patients with diabetes to link their glucose data with family members and other caregivers. These shared alerts will have the potential to support patients on multiple levels in the event of unrecognized or severe hypoglycemia and hyperglycemia, with the potential to avoid unnecessary ambulance services, emergency room visits, and hospital admissions. Read the full CMS announcement.
House, Senate Bills to Improve Obesity Treatment
The Treat and Reduce Obesity Act of 2019 (S. 595/H.R. 1530) was introduced in early 2019 in the Senate and House by Senators Bill Cassidy (R-LA) and Tom Carper (D-DE) and Representatives Ron Kind (D-WI), Brett Guthrie (R-KY), Tom Reed (R-NY) and Raul Ruiz (D-CA), respectively. The measure aims to effectively treat and reduce obesity in older Americans by enhancing Medicare beneficiaries’ access to healthcare providers that are best suited to provide intensive behavioral therapy (IBT) and allowing Medicare Part D to cover FDA-approved obesity drugs.
AACE Submits Comments on the first MIPS Public Health Priority Set
AACE, as a member of the Obesity Care Advocacy Network, submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the omission of obesity in the first set of public health priorities being developed for the Merit-based Incentive Payment System (MIPS) and on the proposed coding and payment changes for Evaluation and Management (E&M) office codes.
AACE Comments on USPSTF Draft Recommendations on Behavioral Interventions for Weight Loss
AACE, as a member of the Obesity Care Advocacy Network (OCAN), sent a letter to the United States Preventive Services Task Force (USPSTF) provide comments on the recently released draft recommendations regarding “Weight Loss to Prevent Obesity-Related Morbidity and Mortality in Adults: Behavioral Interventions.”
DXA Bills Introduced in U.S. House, Senate
Congressional leaders have again introduced bills aimed at preserving access to osteoporosis testing for Medicare beneficiaries. S. 283 and H.R. 2693, the Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2019 could have a profound effect on the availability of preventative bone density screening by creating a floor reimbursement rate under Medicare for the dual-energy X-ray absorptiometry (DXA) test administered in a doctor’s office. Despite being recommended by the Centers for Medicare and Medicaid Services (CMS) as a critical preventive test in the “Welcome to Medicare” exam, the reimbursement rate for the DXA test administered in a doctor’s office has declined from $140 in 2006 to only $40 in 2019.
AACE Comments on USPSTF Draft Research Plan for Osteoporosis Screening
AACE, as a member of the Fracture Prevention Coalition, sent a letter to the United States Preventive Services Task Force (USPSTF) commending their work on and attention to the issue of screening for osteoporosis, as well as commenting on points within the recently released Draft Recommendation Statement on screening for osteoporosis
AACE Health Policy Position Statements
AACE Comments on HHS Blueprint to Lower Drug Prices
AACE submitted a comment letter to the Department of Health and Human Services (HHS) on American Patients First, the Administration’s blueprint for lowering drug prices and reducing out-of-pocket costs.
AACE Expresses Concerns on Prior Authorization and Step Therapy
AACE joined the AMA and other organizations in expressing concerns to the Centers for Medicare & Medicaid Services (CMS) Administrator regarding prior authorization and step therapy for Part B drugs in Medicare Advantage.
AACE Statement on Health System Reform
May 5, 2017 - The American Association of Clinical Endocrinologists (AACE) supports legislative efforts that seek to increase access to affordable health insurance for all Americans. As health system reform moves through the legislative process, we affirm our commitment to the following principles that ensure high quality healthcare for our patients:
- Access to affordable comprehensive healthcare, including continuity of care to prevent and treat chronic conditions such as diabetes, should be available to all individuals and their families over their lifetimes;
- Insurance market reforms that prevent discrimination against individuals and families based upon a current or pre-existing health condition, family history, race, gender identity or sexual orientation must be retained;
- Policies prohibiting health insurers from imposing annual and lifetime caps on benefits should be retained, and should continue to be applicable to both public and private insurance;
- Coverage for young adults under their parents’ insurance plans should be retained;
- Individuals must be empowered to control how their own healthcare dollars are spent;
- Health care should be provided in an accessible, comprehensive, culturally and linguistically appropriate manner.
AACE believes that healthcare policies should always be clinically based, and that treatment decisions should be made between physicians and their patients. We are committed to securing appropriate access to medical services so that AACE members can provide the highest quality of care to our patients with endocrine disorders.
AACE Expresses Concerns on Proposed FNA Cuts
AACE, along with the American Thyroid Association and Endocrine Society, submitted comments to the Centers for Medicare and Medicaid Services expressing concerns about proposed reductions for fine needle aspiration (FNA) included in the 2019 Medicare Physician Fee Schedule rule.
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