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This week’s headlines:
Congressional action

Congress passes FY 2013 stop-gap funding measure; developing 2014 budget resolutions
This week, Congress passed a stop-gap spending bill for fiscal year 2013 that freezes existing appropriations levels and includes the March 1 sequestration cuts. The bill includes $15 million for the Peer-Reviewed Cancer Research Program, which funds research for melanoma and other skin cancers, pediatric brain tumors within the field of childhood cancer research, genetic cancer research, pancreatic cancer, kidney cancer, blood cancer, colorectal cancer, mesothelioma, and listeria vaccine for infectious disease and cancer. Additionally, the National Institutes of Health (NIH) will receive an extra $71 million in funding. The bill will be sent to President Obama to sign before the March 27 deadline.

Additionally, the House and Senate are working on their respective fiscal year 2014 Budget Resolutions. The House Republican budget, which passed in the House Thursday morning but was rejected in the Senate, would cut the deficit over 10 years by $5.7 trillion by reducing spending on domestic programs, eliminating the Affordable Care Act, and overhauling the tax code. The Senate Democratic budget, which is expected to be finished this week, would reduce the deficit by $1.8 trillion over 10 years with an equal balance of spending cuts and tax increases, while sparing entitlement programs, and repealing the Sustainable Growth Rate formula. The American Academy of Dermatology Association (AADA) will continue to monitor this issue as more information is available. Contact the AADA Government Affairs Department with any comments or questions at govtaffairs@aad.org.

Medicare physician payment, incentive payment, and medical research cuts in effect April 1
Mandatory funding cuts to Medicare physician payments, medical research, and other cancer prevention and control programs are scheduled to go into effect on April 1. As previously reported, on March 1, Congress and the Administration failed to avoid the across-the-board spending cuts – known as sequestration – to all federally funding programs.

Medicare payments to physicians will be reduced by 2 percent. Additionally, funding at the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention will be cut 5.1 percent. This will result in a $1.5 billion cut to the NIH budget which could lead to 1,380 fewer research grants, a loss of up to 20,500 jobs, and a $3 billion decrease in economic activity. Cancer research funding will also be cut by $250 million, and electronic health record incentive payments will be cut by 2 percent.

AADA staff will continue to monitor these issues and provide updates as information becomes available about how Medicare physician fee changes will affect your practice. Contact the AADA Government Affairs Department with questions or comments at govtaffairs@aad.org.

AADA supports legislation to improve EHR implementation
In partnership with the American College of Surgeons, the American Academy of Dermatology Association (AADA) has signed on to a letter supporting HR 1331 — a bill that would improve the implementation of electronic health records (EHR). The legislation, introduced by Rep. Diane Black (R-Tenn.), is similar to a bill introduced in December 2012, and would implement reforms to the Medicare and Medicaid Electronic Health Records Incentive Program, ensuring that small practices are better-prepared to adopt EHRs.

Most notably, HR 1331 calls for the streamlining of program requirements so as to avoid unintended provider penalties. Additionally, the bill proposes the creation of a hardship exemption for solo practices and providers in or near retirement and establishes an appeals process before penalties are applied. Read the letter of support.

Under the eligible HITECH Act of 2009, health professionals are offered financial incentives for demonstrating “meaningful use” of EHR. Incentives are offered until 2015, after which penalties will be levied for failing to adhere to the program’s requirements. Learn more about adopting an EHR system through the AADA HIT-kit website.

Federal agency focus

New Medicare administration contractor selected for Illinois, Minnesota and Wisconsin
The Centers for Medicare and Medicaid Services (CMS) has awarded National Government Services, Inc. (NGS) the administration contract of Part A and B Medicare fee-for-service claims for Jurisdiction 6, which encompasses Illinois, Minnesota, and Wisconsin. This region is currently serviced by Wisconsin Physicians Services.

This change will go into effect on Sept. 7, and will impact only those dermatologists who provide services to Medicare beneficiaries in these states and are currently submitting claims to Wisconsin Physicians Services.

Important updates and information on the transition can be found at J6 NGS website as they become available. Read more information about the CMS Change Request. Contact Faith McNicholas at fmcnicholas@aad.org for more information.

Sequestration cuts will apply to Medicare claims after co-insurance and deductibles
The Centers for Medicare and Medicaid Services (CMS) released an email on March 8, detailing its plans to implement the 2 percent reduction in Medicare payment to physicians. According to the email, Medicare fee-for-service (FFS) claims with dates of service or dates of discharge on or after April 1, 2013, will incur the 2 percent reduction. This payment adjustment will be applied to claims after determining co-insurance, any applicable deductible, and any applicable Medicare secondary payment adjustments. While beneficiaries’ payments and deductibles and coinsurance are not subject to the 2 percent payment reduction, Medicare payment to beneficiaries for unassigned claims is subject to the reduction. Read more from CMS.

State policy roundup

Ten states hold indoor tanning legislation hearings
Several states have recently held hearings on legislation that would protect minors from the dangers of indoor tanning. Alabama House Bill (HB) 179, Connecticut Senate Bill (SB) 872, Illinois HB 188 and SB 2244, Maryland SB 488, North Carolina HB 18, Oregon HB 2896, Texas SB 329, and West Virginia SB 464 would prohibit the use of indoor tanning devices by minors under the age of 18. Idaho HB 268 would prohibit the use of indoor tanning devices by minors under the age of 16 and would require parental consent for minors ages 16 and 17. Missouri HB 47 would require that minors under the age of 17 provide in-person and written parental or guardian consent prior to the minor's use of an indoor tanning device.

The bills in Illinois (HB 188), North Carolina, Oregon and West Virginia have passed out of committee and continued on to pass their respective bodies. The bills are now being considered by the second chamber. Additionally, in North Carolina Rep. Mark Hollo — cosponsor for HB 18 — received a letter from the Centers for Disease Control and Prevention with highlights from the latest research on indoor tanning and its effects on adolescents with regard to skin cancer.

The bills in Missouri and Texas passed out of committee and will head to their respective floors for consideration. Idaho HB 268 passed out of committee, however, failed on the House floor. Alabama, Connecticut and Maryland are awaiting a committee vote. Several members of the American Academy of Dermatology testified in support of the bills. In Illinois, Judy Knox, MD testified in support of SB 2244. In Maryland, Larry Green, MD, and Margaret Weiss, MD, testified in support of SB 488; and in Alabama Jennifer Herrmann, MD, Elizabeth Martin, MD, and Vera Soong, MD, testified in support of HB 179.

The American Academy of Dermatology Association (AADA) has been providing assistance to state societies supporting legislation that would protect minors from the dangers of indoor tanning. Read more about the AADA’s state advocacy efforts. For more information, contact Kersten Burns at kburns@aad.org.

District of Columbia Department of Health institutes indoor tanning regulations
Effective immediately, the District of Columbia Department of Health has instituted regulations that protect minors from the dangers of indoor tanning. The final rule prohibits the use of indoor tanning devices by minors under the age of 14. It also institutes several tanning bed safety requirements — such as requiring the use of protective eye wear — and requires that minors ages 14 to 17 provide in-person and written parental or guardian consent prior to the minor's use of an indoor tanning device. Parents or guardians of minors ages 14 to 17 are also required to sign a warning statement in addition to an authorization form. For more information contact Kersten Burns at kburns@aad.org.

Texas attorney general prohibits indoor tanning health marketing claims
Texas Attorney General Greg Abbott has resolved that a Houston-based indoor tanning facility chain, Darque Tan, may not make marketing claims that associate indoor tanning with cancer prevention and other health benefits. The Texas Department of State Health Services found that Darque Tan had utilized a marketing campaign that claims that indoor tanning increases vitamin D levels thereby reducing cancer risks. Texas state law does not allow tanning bed salons to claim health benefits. Read more about the settlement agreement. For more information, contact Lisa Albany at lalbany@aad.org.

Oregon holds hearing on proposed office-based surgery regulations
Bert Tavelli, MD, president of the Oregon Dermatology Society (ODS) testified on behalf of the ODS and the American Academy of Dermatology Association (AADA) last week, to support changes made to proposed regulations to the Oregon Medical Board rules on the performance of office-based surgery and cosmetic procedures.

As originally proposed, the new regulations would require Basic Life Support certification and written informed consent for Level 1 procedures, specifically those performed under topical or local anesthesia. The AADA and ODS sent a letter opposing the new regulations, arguing that the rules exceed what is appropriate according to the level of anesthesia, and that the proposal is neither consistent with widely recognized principles for office-based surgery nor does it represent appropriate standards of care. The medical board issued a new set of proposed regulations, which included much of the language that the AADA and ODS requested in its comment letter. For more information, contact Lisa Albany at lalbany@aad.org.

Biosimilar bills pass in North Dakota, Virginia
Legislation regulating the dispensing of interchangeable biosimilars has passed in North Dakota and has been sent to Gov. Jack Dalrymple to sign into law, while similar legislation in Virginia was signed by Gov. Bob McDonnell. North Dakota Senate Bill (SB) 2190 and Virginia House Bill (HB) 1422 require any pharmacist who dispenses an interchangeable biosimilar to inform the patient prior to dispensing the biosimilar, provide notification of the substitution to the prescriber, and record the brand name or the product name and name of the manufacturer of the biosimilar on the record of dispensing and the prescription label.

The bills largely reflect the AADA’s position on the therapeutic substitution of biosimilar products. Read the AADA's comment letters on HB 1422 and SB 2190. To learn more about biosimilars and dermatology, review the AADA’s position statement on generic therapeutic and biosimilar substitution and read the August 2012 Dermatology World supplement article on psoriasis biosimilars. For more information, contact Lisa Albany at lalbany@aad.org.

AADA, state societies support Florida truth-in-advertising legislation
The American Academy of Dermatology Association (AADA), the Florida Society of Dermatologic Surgeons (FSDS), the Florida Society of Dermatology and Dermatologic Surgery (FSDDS), and the American Society for Dermatologic Surgery Association (ASDSA), have expressed strong support for Florida Senate Bill (SB) 612 which would prohibit medical professionals who are not medical doctors or doctors of osteopathy from using the title “Doctor” or “Dr.” in medical settings. In the letter of support, the group argued that SB 612 would provide Florida with simple mechanisms to improve transparency in services provided by health care professionals by prohibiting deceptive and misleading advertising that could hinder patient safety. For more information, contact Lisa Albany at lalbany@aad.org.

Utah passes biosimilar legislation
The Utah State Senate and House of Representatives have passed legislation that allows the substitution of interchangeable biosimilar products in the place of prescribed biological products. The prescriber must be notified no later than the third business day after dispensing. This bill amends the Pharmacy Practice Act, and has been sent to Gov. Gary Herbert to sign into law. Read more about the Utah biosimilar legislation. To learn more about biosimilars and dermatology review the AADA’s position statement on generic therapeutic and biosimilar substitution and read the August 2012 Dermatology World supplement article on psoriasis biosimilars. For more information, contact Lisa Albany at lalbany@aad.org.

Melanoma/Skin Cancer Detection and Prevention Month® advocacy resources available
The American Academy of Dermatology Association (AADA) is assisting members and state dermatological societies in promoting May as Melanoma/Skin Cancer Detection and Prevention Month® as a way to establish or enhance relationships with policymakers. State societies and members are encouraged to contact their governors and mayors to seek a proclamation raising awareness about skin disease.

Resources for members to discuss Melanoma/Skin Cancer Detection and Prevention Month® are available online in the AAD Media Relations Toolkit. Members and state societies who are interested in pursuing a mayoral or gubernatorial proclamation can contact Victoria Houghton for assistance.


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