Washington Watch Weekly - January 29, 2021 | ASCRS
Washington Watch

Washington Watch Weekly - January 29, 2021

Biden Administration Freezes All Pending Rules and Regulations Including the Most Favored Nations (MFN) Model

All rules, guidance, or other agency action that did not take effect prior to noon on January 20, will be subject to review by the new administration before taking effect. If the regulations raise questions of “fact, law, or policy,” the current agencies can further delay the effective dates and consult with the Office of Management and Budget (OMB) on further options.

More than 20 actions from the U.S. Department of Health and Human Services (HHS) are now on hold. Among other rules, the regulatory pause includes the Medicare Coverage of Innovative Technology (MCIT) rule, the Implementation of Executive Order on Access to Affordable Life-Saving Medications rule, the Secure Electronic Prior Authorization for Medicare Part D rule, the Reducing Provider and Patient Burden by Improving Prior Authorization Processes rule, the Promoting Patients’ Electronic Access to Health Information rule, the MFN Model, changes to the Stark Law and Anti-Kickback Statute, and the Medicare Rebate rule.

President Biden’s Top Economic Advisor Meets with Bipartisan Lawmakers to Discuss $1.9 Trillion COVID-19 Stimulus Proposal; Democrats Lay Groundwork for Using Reconciliation Process

Recently, Brian Deese, the President’s top economic advisor, met with a bipartisan group of lawmakers to discuss the administration’s $1.9 trillion COVID-19 stimulus proposal. While the President’s goal is for the plan to pass in a bipartisan manner, there are a growing number of Senate Republicans who have expressed concerns about the size of the package.

While at this time the plan does not have the support of even one Republican, some GOP lawmakers have indicated that common ground could be reached through negotiations. With the 50-50 split in the Senate, they would need the support of at least ten Senate Republicans to pass the bill under regular order. Key Democratic congressional leaders have been encouraging the President to use his executive authority to provide economic relief if there is a delay in the passage of the legislation. Lawmakers are aiming for a March 14 deadline to pass the relief bill.

Democrats have the option of employing a budgetary maneuver known as reconciliation to avoid a Senate filibuster and pass some of their top priorities, like the COVID-19 relief bill. The reconciliation process is limited to measures that have a budgetary impact and allows for legislation to be passed with a simple majority if a bill cannot get the 60 votes necessary to succeed through regular order. The Senate Parliamentarian is responsible for determining whether legislation complies with the Senate rules of reconciliation (especially the Byrd rule to determine germaneness).

This week, House Speaker Nancy Pelosi (D-CA) and Senate Majority Leader Chuck Schumer (D-NY) gave indications they are ready to begin next week with the budget reconciliation process for a filibuster proof COVID-19 relief package. They separately indicated they would bring the fiscal 2021 budget resolution to the floor in both chambers as a backstop if there is no bipartisan agreement with the Republicans.

Cataract and Glaucoma Surgical Codes’ Values Reviewed by RUC

This month, the AMA/Specialty Society Relative Value Scale Update Committee (RUC) reviewed surgical values, including glaucoma and cataract procedures. The Academy presented member survey data collected by the AAO, ASCRS, and the American Glaucoma Society in 2020 for revaluation of several ophthalmic procedure codes at the RUC’s January meeting. Parag Parekh, MD, Chairman of the ASCRS Government Relations Committee, was also in attendance. The presentation relied on this data to recommend appropriate work values for these codes.

The data collected included time and intensity of physician work for these surgical procedures from randomly selected ophthalmologists. Existing canaloplasty codes CPT 66175 and 66175 were targeted because claims were increasing, and they had not been valued in the decade since they were introduced.

In addition, the RUC valued a new CPT code for placement of a drug-eluting implant into the lacrimal canaliculus and two new codes for placement of a trabecular meshwork aqueous drainage device combined with either standard or complex cataract surgery.

Although the Centers for Medicare & Medicaid Services will make the final decision on values, the surveys completed by ophthalmologists and the valuation process employed by the RUC are highly influential. CMS usually accepts the RUC-recommended values. The more members that complete the surveys, the stronger the data presented to the RUC and CMS. Because time is a key component of work value, it is critical that members are accurate in their time estimates when completing surveys, including all of the work done so as not to shortchange the value of a procedure.

CMS will publish the CPT code numbers for the new procedures and the values for all of those that were reviewed in January in the 2022 proposed Medicare physician fee schedule rule later this summer. They will include dilation of aqueous outflow canal, cataract removal with drainage device and lacrimal canaliculus drug eluting implant insertion.

ASCRS and the ophthalmology community will comment before the rule is finalized. ASCRS thanks all the ophthalmologists who completed the member survey. A high return rate on the surveys improves the accuracy of the data.

Preview Period for 2019 Quality Payment Program (QPP) Performance Now Open

The Preview Period for doctors and clinicians opened on January 25, 2021. You can now preview your 2019 Quality Payment Program (QPP) performance information before it will appear on clinician and group profile pages on Medicare Care Compare and in the Provider Data Catalog (PDC). You can access the secured Preview through the QPP website.

Please refer to the resources below on how to preview your information:

To learn more about the 2019 QPP performance information that is available for preview, as well as the 2018 clinician utilization data that will be added to the PDC, download these documents from the Care Compare: Doctors and Clinicians Initiative page:

Accountable Care Organizations (ACOs) can preview their performance information via their 2019 MIPS Performance Feedback Reports. A list of ACO performance information targeted for public reporting is available on the Care Compare: Doctors and Clinicians Initiative page.

The Preview Period will close on March 25, 2021 at 8 p.m. ET (5 p.m. PT).

Please note the 2019 QPP performance information is targeted for public reporting in 2021 and will be added to Care Compare and/or the PDC after all Targeted Reviews are completed. If you have an open Targeted Review request, you will still be able to preview your 2019 Quality Payment Program performance information during the Doctors and Clinicians Preview Period.

If you have any questions about public reporting for doctors and clinicians or the Doctors and Clinicians Preview Period, please contact us at QPP@cms.hhs.gov.

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