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This week’s headlines:
Congressional action

President’s budget would halt sequester, freeze Medicare payments, cut graduate medical education funding
Last week, President Barack Obama released a proposed budget for fiscal year 2014 (FY14) that outlined the President’s budget priorities for 2014. While the budget does not have the force of law, its proposals will be watched closely as the President and Congress consider budget and policy issues in the coming months. The President’s budget would remove the across-the-board sequestration cuts that went into effect on April 1, and it would invest in several of the Administration’s priorities such as Affordable Care Act implementation and medical research. The proposal would also institute a 10-year freeze in Medicare physician payments, averting cuts required by the sustainable growth rate formula. However, the proposal would cut $11 billion in funding for graduate medical education.

Although the President’s proposed budget does not have the force of law, it will be used to help shape the FY14 appropriations process. For more information, contact AADA Government Affairs at govtaffairs@aad.org.

AADA requests almost $33 billion in FY14 medical research funding
The American Academy of Dermatology Association (AADA) has sent letters to the chairmen and ranking members of both the House and Senate Appropriations Subcommittees on Labor, Health and Human Services, and Education, requesting approximately $33 billion in funding for medical research in fiscal year (FY) 2014. Speaking on behalf of dermatologists on the front lines fighting skin cancer and treating numerous skin diseases, the AADA urged Congress’ support for medical research that builds on past innovations, fosters momentum in scientific research, and advances medical knowledge.

Specifically, the AADA requested $32 billion (an increase of 3.7 percent from FY 2012) for the National Institutes of Health, including $5.2 billion for the National Cancer Institute (an increase of 2.7 percent from FY 2012); $541 million (an increase of 9.3 percent from FY 2012) for the National Institute of Arthritis and Musculoskeletal and Skin Diseases; and $5 million (a $3 million increase from FY 2012) for the National Skin Cancer Prevention Education Program at the Centers for Disease Control and Prevention. Read the AADA’s letter to Sens. Tom Harkin (D-Iowa) and Jerry Moran (R-Kan.), and Reps. Jack Kingston (R-Ga.) and Rosa DeLauro (D-Conn.). For more information, contact Christine O’Connor at coconnor@aad.org.

AADA expresses support for Tavenner as next CMS administrator
Last week, the American Academy of Dermatology Association (AADA) sent a letter of support to Sens. Max Baucus (D-Mont.) and Orrin Hatch (R-Utah) — the respective Chair and Ranking Member of the Senate Finance Committee — regarding the nomination of Marilyn Tavenner as the next administrator of the Centers for Medicare and Medicaid Services (CMS). The AADA sent the letter in advance of the Senate Finance Committee’s April 9 hearing. Citing Tavenner’s unique ability to draw bipartisan support from congressional leaders and the health care community, the AADA reiterated that Tavenner is well-positioned to lead CMS as a key agency for the implementation of the new health care reforms under the Affordable Care Act. Tavenner has served as acting administrator for CMS since 2011. Read the AADA’s letter of support.

AADA responds to latest Medicare physician payment reform proposal
In response to a request for comment, the American Academy of Dermatology Association (AADA) has sent recommendations to the House Ways and Means Committee and the Energy and Commerce Committee regarding a second draft of their recent proposal to reform the Medicare payment system and repeal the sustainable growth rate (SGR) formula, which is used to calculate Medicare physician payments. Without congressional action, the SGR would require Medicare payments to be cut an estimated 24.4 percent on Jan. 1, 2014.

In responding to the proposal, the AADA again stressed the need to maintain Fee-For-Service (FFS) as an option for physician practices and specialties that do not necessarily fit into various alternative payment models. The AADA also reiterated its position that when determining policy that affects the physician community, it should be physicians themselves and the relevant specialties that should be consulted as the experts in the care they provide. Read more about the AADA’s recommendations on SGR reform. For more information, contact the AADA at govtaffairs@aad.org.

AADA supports bill strengthening Medicare patients’ access to care
Last week, the American Academy of Dermatology Association (AADA) signed on to a coalition letter supporting legislation that would allow Medicare patients to access the physician of their choice. Rep. Tom Price, MD (R-Ga.), introduced the Medicare Patient Empowerment Act (H.R. 1310), which would ensure that Medicare beneficiaries and physicians are able to freely contract for covered Medicare services without penalty, while at the same time providing important beneficiary protections.

Under current law, Medicare beneficiaries that choose to see physicians who are outside Medicare are unable to submit their claims to Medicare and are required to pay the physician's charge entirely out of pocket as Medicare does not pay any part of the charge. In addition, physicians who care for Medicare beneficiaries under private contracts must "opt out" of the Medicare program for two years, during which time Medicare is not allowed to reimburse the physician for any services which would otherwise be covered by Medicare.

If enacted, H.R. 1310 would significantly strengthen Medicare patients’ access to care. Read the AADA letter of support. For more information, contact Whitney Tyler at wtyler@aad.org.

Federal agency focus

CMS to begin denying Medicare claims for certain non-enrolled providers May 1
Effective May 1, 2013, the Centers for Medicare and Medicaid Services (CMS) will begin denying claims from billing physicians if the ordering/referring physician or health care provider listed on the claim is not enrolled in Medicare or does not have a valid opt-out affidavit on file with their local Medicare contractor. Specifically, the referring physician needs to have current Medicare enrollment records and are of a specialty that is eligible to order or refer in the Medicare program. Non-physician providers (such as dentists, residents, chiropractors, etc.) may not be enrolled as a specialty that can refer. Providers who have officially opted out of Medicare are not required to enroll in Medicare for purposes of the ordering and referring enrollment requirement. Visit the CMS ordering/referring Web page to find out if you have secured a valid opt-out affidavit. Learn more about Medicare enrollment. For more information, contact ppm1@aad.org.

AADA expresses concern over physician fee studies
The American Academy of Dermatology Association (AADA) recently met with the Centers for Medicare and Medicaid Services and the Office of the Assistant Secretary for Planning and Evaluation at the American Medical Association to address and learn more about ongoing contract work between the Urban Institute, Social and Scientific Systems, Inc., and the Rand Corporation related to assessing physician time patterns and payments under the Medicare Fee Schedule.

The AADA submitted comments in response to the Department of Health and Human Services’ (HHS) Information Collection Request on one of the ongoing physician fee studies, which may survey dermatology code 17000: Destruction Premalignant Lesion. The AADA highlighted numerous flaws in the study methodologies and expressed concern about the HHS’s lack of transparency regarding the depth and breadth of these studies.

The AADA will continue to investigate and monitor this issue and will provide updates as more information becomes available. For more information, contact Richard Martin at rmartin@aad.org.

FDA finds safety problems at 30 specialized pharmacies
In the wake of the recent fungal meningitis outbreak that was traced to tainted methylprednisolone acetate steroid injections at the New England Compounding Center (NECC), the Food and Drug Administration (FDA) has found potentially dangerous safety problems at 30 other specialized pharmacies that produce sterile drug products. Notably, several facilities were cited for having inappropriate conditions for sterile processing and engaging in other practices that create risk of contamination. Read more about the FDA pharmacy inspections.

Several of the pharmacies have voluntarily recalled their products, and others temporarily suspended production of their products until the deficiencies are corrected. View a list of the recently inspected specialized pharmacies. The FDA plans to take aggressive action based on the results of these safety inspections and will work with state boards of pharmacy to ensure that the appropriate enforcement measures are taken.

Since the outbreak of fungal meningitis other groups have been investigating the levels of state board oversight of compounding pharmacies. In November 2012, Reps. Edward J. Markey (D-Mass.), Henry A. Waxman (D-Calif.), John Dingell (D-Mich.), Frank Pallone (D-N.J.) and Diana DeGette (D-Colo.) launched an investigation to examine how state boards of pharmacies oversee compounding pharmacies, requesting detailed information from all boards on their regulatory and information collection processes. Read the full analysis from this investigation and report.

The AADA will continue to monitor this issue and provide updates as they become available. For more information, contact Amanda Grimm at agrimm@add.org.

CMS clarifies Place of Service national policy
The Centers for Medicare and Medicaid Services (CMS) has released a revised national policy, effective April 1, 2013, for Place of Service (POS) code assignments for all services paid under the Medicare physician fee schedule and certain services provided by independent labs. The revised CMS policy states that if the professional interpretation is furnished at an unusual and infrequent location, such as a hotel, the locality of the professional interpretation is determined based on the Medicare-enrolled location where the interpreting physician most commonly practices. The address and zip code of this practice location is entered in ‘Item 32’ on the CMS 1500 claim form, or its electronic equivalent. Read more information on specific CMS policy changes to POS code assignments.

The American Academy of Dermatology Association (AADA) is concerned that CMS has not provided enough information on whether or not there are any limitations to what are considered acceptable “unusual locations” and is currently seeking further clarification from CMS. The AADA will continue to monitor this issue and provide updates as they become available. For questions about the correct POS code to use, contact your local Medicare carrier.

State policy roundup

AADA supports truth in advertising legislation in Iowa, Michigan, Nevada
The American Academy of Dermatology Association (AADA) and the Iowa Dermatological Society have sent letters in support of truth in advertising legislation, House File 418 and Senate File 373. The AADA also sent letters supporting similar legislation in Michigan, House Bill 4524, and in Nevada, Senate Bill 211.

The legislation in all three states would require that all advertisements for health care services identify the type of professional license held by the health care professional. In addition, all health care professionals would be required to wear a name tag that clearly identifies the type of license held during all patient encounters. In its letters, the AADA reiterated its position that those who regulate and deliver medical care have an obligation to inform the public of the qualifications and limitations of the persons providing their care prior to treatment. All providers should identify or disclose their degree or field of study, any board-certifications, and licensure to each patient. Read the AADA’s position statement on truth in advertising and professional credential disclosure. For more information, contact the AADA’s Lisa Albany.

Indoor tanning legislation moves forward in Missouri and Texas; Maine override attempt fails
Legislation that would protect minors from the dangers of indoor tanning are moving forward in Missouri and Texas. Missouri House Bill (HB) 47 has passed the House and will now go to the state Senate. House Bill 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 Texas Senate passed Senate Bill 329, which would prohibit the use of indoor tanning devices by minors under 18. Similar legislation in the House, HB 598, was heard in committee this week.

As previously reported, Maine Gov. Paul LePage has vetoed legislation that would ban minors under the age of 18 from using indoor tanning devices, arguing that current law — which requires parents to provide consent in order for minors to use tanning devices — is sufficient and that the decision should be made by parents and not the government. The Maine Senate attempted to override Gov. LePage’s veto but unfortunately fell short by five votes. Read the American Academy of Dermatology Association’s (AADA) letters of support for these bills.

The 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.

Minnesota dermatologists succeed in preventing cosmetic procedures tax
After receiving an opposition letter from the Minnesota Dermatological Society (MDS), the American Academy of Dermatology Association (AADA), and the American Society for Dermatologic Surgery Association (ASDSA), the Senate Taxes Committee removed a provision in a recent tax reform division report that would have levied a tax on elective cosmetic medical procedures. Read the tax reform division report.

Arguing that the distinction between cosmetic and reconstructive is not always clear, the MDS, AADA, and ASDSA reiterated that such a tax not only invades patient privacy and is difficult to administer, but could cost the state more revenue than it generates from the tax. Read the MDS, AADA, and ASDSA letter of opposition. For more information, contact Lisa Albany at lalbany@aad.org.

AADA supports biosimilar legislation in Colorado, Maryland
The American Academy of Dermatology Association (AADA) has sent letters of support for biosimilar bills in Colorado and Maryland. Colorado House Bill (HB) 1121 and Maryland HB 781 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 AADA worked with the Colorado Dermatologic Society and the Maryland Dermatologic Society to develop and send a letter of support for each bill.

The bills largely reflect the AADA’s position on the therapeutic substitution of biosimilar products. The letters recommended that the bills be amended to shorten the notification from five days to 24 hours prior to dispensing, in order to ensure patient safety. Read the AADA and state society letters of support for HB 1121 and HB 781. 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.

Upcoming events

Register for the 2013 AADA Legislative Conference
Registration for the 2013 AADA Legislative Conference is now open. The American Academy of Dermatology Association (AADA) is pleased to invite the entire Academy membership to attend the 2013 AADA Legislative Conference on Sept. 8-10, in the heart of Washington, D.C. This conference offers the unique opportunity to hear from health policy experts, discuss dermatology issues with colleagues, attend advocacy training taught by D.C. insiders, and become the trusted and influential voice your members of Congress can rely on. Conference attendees learn about critical health policy issues from national health policy experts, political insiders, and AADA advocacy leaders. Visit the conference Web page to learn more and register for this premier event. For more information, contact Blake McDonald at bmcdonald@aad.org.

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