In recent guidance from the Centers for Medicare and Medicaid Services (CMS) on the unwinding of the COVID-19 public health emergency (PHE), CMS explained that certain in-office ancillary service exception (IOASE) waivers would end, including a waiver that allowed physician offices to bill for Part D outpatient prescription drugs that they mail or deliver to a beneficiary’s home. 

According to the CMS guidance, as of May 12, 2023, “…a physician practice will no longer be able to rely on the in-office ancillary services exception to bill for Part D drugs that are mailed or delivered to a beneficiary’s home…” and that “…physician practices that wish to mail or deliver Part D drugs to beneficiaries’ homes would need to satisfy all requirements of an applicable exception to the physician self-referral law other than the in-office ancillary services exception (see 42 CFR Part 411 Subpart J).”

As concerns about access to medications have been raised, the guidance states that “CMS will closely monitor patient complaints to watch for any issues affecting patient access,” and highlights how “…Medicare beneficiaries will still be able to get the outpatient prescription drugs they need through their Part D plans’ networks of mail order and other pharmacies.”

Through the support of an advocacy grant from CSRO, members of the North Carolina Rheumatology Association (NCRA) participated in their first Advocacy Day, which was held on Tuesday, May 23.

After a briefing from CSRO government affairs staff Brian Henderson and Hannah Rice from the North Carolina Medical Society, the group (pictured left) held live, in-person meetings with North Carolina Representatives and Senators to discuss NCRA’s two top priority issues; prior authorization and urging Senators to support HB649 which would strengthen requirements for prior authorization, as well as the SAVES act.

Attendees were able to learn more about how healthcare policies and laws in the state are shaped and share their personal experiences with legislators to educate and create much-needed awareness about the impact these policies have on their patients and practices – special thanks to Dr. Firas Kassab for his efforts in organizing this event. The day was a success, and NCRA is eager to host more Advocacy Days moving forward!

Learn how to expand infusion suite services and increase market share on June 14 during the second seminar in CSRO's new Business of Rheumatology series.

Attendees will receive insights on how to successfully provide infusion services to patients of other specialties from a panel of experts with experience in managing this element of a practice's business, hosted by CSRO President Gary Feldman, MD:

• Moderator: Madelaine Feldman, MD – The Rheumatology Group
• Adrienne Hollander, MD – Arthritis, Rheumatic & Bone Disease Associates
• Angel Magar, MBA – Arizona Arthritis & Rheumatology Associates, P.C.
• Brian Nyquist, MPH – National Infusion Center Association

CSRO's Vice President of Advocacy & Government Affairs, Dr. Madelaine Feldman, explains some of the issues patients with self-funded plans are facing when it comes to things like specialty pharmacy mandates, commonly referred to as "white bagging".

Read more in the latest edition of Rheum for Action, CSRO's advocacy column produced in partnership with Rheumatology News (PDF available here).

The National Organization of Rheumatology Management (NORM) offers various AAPC-CRHC webinars throughout the year. Below are upcoming summer dates, and a full listing of NORM webinars can be found here:

Modifier Changes That Impact Your Injections and Infusion Flow Sheet for Rheumatology

• Monday, June 6 – 12:15 PM ET
• Thursday, June 8 – 3:15 PM ET

Determining Compliance Program Effectiveness: Exploring Federal Guidance and Compliance Issues that can Fly Under the Radar (1.5 Credit Hours)

• Tuesday, August 1 – 12:15 PM ET
• Thursday, August 3 – 3:15 PM ET

Do you have activities you'd like us to share? Send us an email at info@csro.info.

What's Happening in the Capitol

In recent weeks, several of the bills that CSRO has advocated for have seen legislative activity. For example, the Safe Step Act was adopted by the Senate Health, Education, Labor and Pensions (HELP) Committee as an amendment to a bill to reform the pharmacy benefit manager (PBM) industry. The underlying PBM-focused legislation was not as strong as CSRO would have liked because it creates a pass-through of PBM-obtained price concessions to the payer rather than to the patient. However, we were encouraged to see the Committee’s focus on the topic, as well as its strong bipartisan support for meaningful reform of step therapy protocols.

On the House side, there has been significant focus on PBM reform as well: a recent markup by the Energy and Commerce Committee’s Health Subcommittee featured several transparency and pharmacy-focused initiatives, as well as a discussion focused on the concept of delinking. Delinking is a policy to sever any connection between PBM revenues and drug list prices, and have the PBM be paid for its services via a flat fee instead. Although the concept has not advanced yet in either chamber, it has been introduced and is being discussed in both the House and the Senate. Finally, on May 23, the House Oversight & Investigations Committee held a hearing entitled The Role of PBMs in Prescription Drug Markets, Part I: Self-Interest or Health Care?, which featured physicians as well as a representative from a small, fully transparent PBM.

What's Happening in the States

CSRO tracks legislative activity relevant to the rheumatology community and their patients. Check out the list below to see the status of CSRO priority bills from the past two weeks, and click here to view a full status report.

Be sure to check out our interactive legislative map tool for additional details.

CALIFORNIA

Rebate Pass Through

• SB 873: Approved by Appropriations committee

Biomarker Testing

• SB 496: Approved by Appropriations committee

Gold Card

• SB 598: Approved by Appropriations committee 

COLORADO

Accumulators

• SB 195: Transmitted to the Governor

GEORGIA

Biomarker Testing

• HB 85: Signed by the Governor

LOUISIANA

Biomarker Testing

• SB 104: Passed by the House, referred to Senate Insurance committee

MARYLAND

Step Therapy

• SB 515: Signed by the Governor
• HB 785: Signed by the Governor

MISSOURI

Non-medical Switching

• HB 324: Referred to Insurance Policy committee

White Bagging

• HB 198: Dropped from the informal perfection calendar

MONTANA

Gold Card

• SB 380: Signed by the Governor 

NEVADA

Step Therapy

• SB 194: Approved by the Assembly with amendments, to Senate for concurrence

NEW YORK

Biomarker Testing

• A1673: Approved by Insurance committee and referred to Ways and Means committee
• S1196: Approved by Insurance committee and referred to Finance committee

PBM and Rebate Aggregator Transparency

• S6738: Referred to Insurance committee
• A7304: Reported by committee and referred to Codes committee

NORTH DAKOTA

Accumulators

• HB 1413: Amended to non-mandatory study committee and signed by the Governor

OHIO

Accumulators

• HB 177: Introduced and referred to Insurance committee

OKLAHOMA

Biomarker Testing

• SB 513: Transmitted to the Governor

RHODE ISLAND

Accumulators

• S799: Committee recommends passage

TEXAS

Accumulators

• HB 999: Passed by the Senate, enrolled in the House

Biomarker Testing

• SB 989: Transmitted to the Governor

White Bagging

• HB 1647: Transmitted to the Governor

Last week, the Massachusetts Joint Committee on Financial Services convened to hear testimony on several health-related bills, including legislation to pass a percentage of rebates back to patients. Dr. Sharon Stotsky, President of the Massachusetts, Maine, and New Hampshire Rheumatology Association, which is a member of the CSRO, presented virtually in support of the bill.

Both H978 and S612 would provide much needed financial relief for Massachusetts’ chronically ill patients by passing through at least 80% of the estimated rebates received by an insurance carrier to help lower the patient’s cost share at the point-of-sale. The legislation currently awaits a vote in committee before moving to the chamber floor – learn more about these and other bills by visiting CSRO's Map Tool.

Business of Rheumatology: June 14, 2023

Learn about ways to expand infusion suite services at the next installment in CSRO's virtual seminar series to help support rheumatology practices.

Virtual Advocacy Day: July 13, 2023

Advocate alongside CSRO as we host live conversations with health care leaders from the U.S. Senate and U.S. House of Representatives.

Advocacy Conference: August 25-27, 2023

Join us in Austin for our Advocacy Conference and celebration of our 20th Anniversary! 

Action Center

Use CSRO's convenient online platform to easily find out who your elected officials are and engage with them directly

Advocacy Council

Amplify your voice by assembling with other like-minded individuals to enhance CSRO’s advocacy initiatives.

Legislative Map Tool

Find your state on our interactive map tool to learn about current or proposed policy and ways you can take action to make an impact.

Payer Issues Reporting Form

Request assistance with any payer relation issues that may be impacting your patients or office.

Policy Correspondence

Easily access all of CSRO’s policy letters submitted to payers, state, and federal governments as an informational resource.

CSRO is a 501c3 nonprofit organization that has remained dedicated to ensuring access to the highest quality care since 2003 – donate today.

Questions?

Please visit the CSRO website for other news and updates, and do not hesitate to contact us with any questions at info@csro.info.