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This week’s headlines:
Congressional action

SGR repeal legislation introduced
Last week, Reps. Allyson Schwartz (D-Pa.) and Joe Heck (R-Nev.) introduced legislation H.R. 5707, Medicare Physician Payment Innovation Act of 2012, which would repeal the sustainable growth rate (SGR) and replace it with stabilized Medicare payment rates over the next five years, during which Medicare would prepare to transition physicians to adopt new payment and delivery models. This legislation, which pays for the SGR repeal using war funding (Overseas Contingency Operations funding) that is available due to the drawdown of troops in Iraq and Afghanistan. Following the five year stability period, the bill would seek to eventually move Medicare from traditional fee-for-service to a range of alternative payment models. Beginning in 2018, physicians would transition into these new payment models. Those physicians remaining in traditional fee for service would be penalized on a progressive basis; the penalties would be effective starting in 2019. While the legislation does seek to move away from fee for service, it would include limited safe harbor language to protect physicians that do not fit into any of the new delivery models.

Last fall, Rep. Schwartz released a draft legislative proposal for replacing the SGR, and H.R. 5707 reflects feedback that Rep. Schwartz solicited from physician organizations last fall after the release of her previous proposal. That said, several physician organizations, while expressing appreciation for the efforts of Reps. Schwartz and Heck to address the SGR, have also voiced concerns about some of the bill’s provisions, including how alternatives to fee-for-service would be developed, how physicians would participate in the new delivery models, and the potential penalties for physicians who are unable to fit into one of the payment models. While the outlook for the legislation is uncertain, the AADA is closely reviewing H.R. 5707 to analyze the bill’s potential impact on dermatology. The AADA will continue to monitor this legislation and any future developments.

Senate Finance Committee holds physician payment roundtable
On May 10, the Senate Finance Committee held a roundtable discussion with four former Administrators of the Centers for Medicare and Medicaid Services and the Health Care Financing Administration (Gail Wilensky, Bruce Vladeck, Tom Scully, and Mark McClellan, MD, PhD) on Medicare physician payment reform. The four former administrators agreed on several points including the need to adopt bundled payments for physician services, with several of the panel members cautioning against tying the payments to hospital services and urging Congress to reform the Resource-Based Relative Value Scale (RBRVS). In particular, the administrators and the senators discussed the Relative Value Update Committee (RUC) and concerns about the “politics” of the RUC. It was noted, however, that CMS has full authority to reject a RUC recommendation.

The Finance Committee has solicited written recommendations, within one month, from each of the administrators on how best to address the short- and long-term reforms that should be made to Medicare physician payments.

House committee moves prescription drug and medical device legislation forward
Last week, the House Energy and Commerce Committee voted to unanimously pass H.R. 5651, the Food and Drug Administration Reform Act of 2012. This legislation reauthorizes user fee programs for prescription drugs and medical devices, establishes user fee programs for generic drugs and biosimilar biological products, makes changes to regulations regarding medical devices, and establishes requirements related to drug supply chain safety and drug shortages. The House of Representatives and Senate will be considering their respective authorization bills in the coming days and weeks with the goal of finalizing the legislation by the Fourth of July congressional recess.

One Voice Against Cancer Lobby Day calls for research funding support
On May 9, AADA advocacy staff joined forces with dozens of other physician and cancer group advocates to participate in the annual One Voice Against Cancer (OVAC) Lobby Day in Washington, DC. Advocates from OVAC member organizations gathered on the Hill and met with policymakers to address the importance of funding the CDC, NIH, and other health care related agencies. Working as a united front, the OVAC groups were able to impress upon members of Congress the negative effects that cuts would have on life-saving cancer research studies already underway and those planned for the future.

House passes budget reconciliation bill
On May 10, the House passed a budget reconciliation measure, H.R. 5652, along party lines with a vote of 218-199. Both sides of the aisle are working to avoid the $1.2 trillion in automatic cuts to Pentagon and domestic discretionary spending that are scheduled to begin in 2013 due to the failure of the supercommittee to reach a deficit reducing – plan last fall. H.R. 5652 would reduce the deficit by $243 billion by cutting funding to entitlement programs, such as Medicare, while cancelling the anticipated $72 billion in defense cuts. Due to the partisan nature of the legislation, the Senate has publicly stated it will not consider the bill while the White House threatened to veto.

Reps. Bilbray and Maloney introduce skin cancer research funding bill
Last week, Rep. Brian Bilbray (R-Calif.), along with Rep. Carolyn Maloney (D-N.Y.), introduced H.R. 5716, The Melanoma Research Act of 2012. The bill would divert the 10 percent tanning tax revenue to a Skin Cancer Research Fund within the National Institutes of Health. The fund would include research on melanoma, squamous cell carcinoma, basal cell carcinoma, Kaposi’s sarcoma, and actinic keratosis. Reps. Bilbray and Maloney have been dedicated supporters of skin cancer issues and the AADA will continue to work with them through the legislative process.

Federal agency focus

CMS is expected to delay pre-payment review demonstration project
The Academy has learned of a potential delay for the commencement of CMS’ new pre-payment review demonstration project. CMS previously announced this new Recovery Audit Contractor (RAC) initiative would begin next month and continue for three years. Instead, the Academy has learned the program will begin later in the summer. The Recovery Audit Prepayment Review Demonstration will allow Medicare Recovery Auditors (RACs) to review claims before they are paid to ensure that the provider complied with all Medicare payment rules. The RACs are slated to conduct prepayment reviews on certain types of claims that historically result in high rates of improper payments. The reviews will focus on seven states where CMS data indicates higher incidences of fraud and error associated with provider claims (Florida, California, Michigan, Texas, New York, Louisiana, and Illinois) and four states with high claims volumes for short inpatient hospital stays (Pennsylvania, Ohio, North Carolina, and Missouri) for a total of 11 states. The Academy, the AMA, and other specialty societies have strongly objected to the use of RAC contractors to conduct the pre-payment review process and have requested that CMS further apply all existing contractor regulations to RACs.

AADA comments on CMS’ proposal for EHR meaningful use
The Academy provided feedback to CMS on its proposed stage 2 requirements for health care providers who seek to attest to demonstrate meaningful use of certified Electronic Health Record (EHR) technology. In a recent letter to CMS, the Academy highlighted a number of measurements that it supports and indicated appreciation for the proposed one year delay, until 2014, for stage 2 of the meaningful use requirements. The Academy raised concerns with a number of proposed measurements, requested that CMS streamline the attestation requirements, and suggested that CMS provide feedback reports so that physicians could assess their prospective incentives or penalties. Additionally, the Academy strongly urged CMS to drop its proposals to expose physicians who fail to demonstrate meaningful use to financial penalties in 2015.

AADA issues statement on FDA’s decision to extend compliance deadline for sunscreen labels
The AADA issued a statement on May 11 saying it understands the Food and Drug Administration’s (FDA) decision to extend the compliance dates for the sunscreen labeling and testing requirements in the interest of protecting public health. The FDA extended compliance deadlines to Dec. 17, 2012, for products with annual sales greater than $25,000 and Dec. 17, 2013, for all other products.

Member accounts on cantharidin access sought
As highlighted in the July 2011 issue of Dermatology World, dermatologists have experienced difficulty accessing cantharidin. While the Food and Drug Administration has not recently taken any enforcement actions against the importation of cantharidin, the Academy continues to work with agency to rectify any access issues. Members are encouraged to submit a detailed account of any difficulties they encounter regarding access to cantharidin to Amanda Grimm, senior specialist, Regulatory Policy, at agrimm@aad.org.

Private payer activity

Dermatology and patient advocacy results in Novitas Solutions Mohs coverage policy change
Following months of targeted advocacy efforts from the dermatology community and patient advocates, on May 17 Novitas Solutions (formerly known as Highmark Medicare Services), JH Medicare contractor for Delaware, New Jersey, Pennsylvania, Maryland, and the District of Columbia, announced a significant change in its local coverage determination (LCD), which had proposed to deny coverage for any Mohs micrographic surgery performed on the trunk and extremities, even in cases where it would be clinically appropriate. Novitas has lifted the proposed blanket denial and agreed to cover Mohs surgery performed on the trunk and extremities for a number of basal cell carcinomas and squamous cell carcinomas and other tumors. The new LCD is slated to go into effect on July 9. The Academy collaborated with DermCAC representatives, as well as with the Pennsylvania Academy of Dermatology and Dermatologic Surgery, the Maryland Dermatology Society, the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, the American Society for Mohs Surgery, and the BCCN Life Support Network to achieve this result.

Novitas Solutions requires new EFT authorization agreement
The Centers for Medicare and Medicaid Services (CMS) has appointed Novitas Solutions Inc. as the new Medicare administrative contractor (MAC) for handling both Medicare Part A and B fee-for-service claims in the states of Louisiana, Arkansas, Mississippi, Texas, Oklahoma, Colorado, and New Mexico, also known as jurisdiction H (JH). Novitas announced that dermatology practices enrolled in electronic funds transfer (EFT) with Pinnacle Business Solutions Inc. (PBSI), which applies to those in Louisiana and Arkansas, should expect a letter from Novitas Solutions Inc. requesting a new CMS-588 EFT authorization agreement.

State policy roundup

Missouri tanning bill passes Senate committee unanimously
On May 9, the Missouri Senate General Laws Committee unanimously passed House Bill 1475. The legislation, which the AADA supported via written comments, would require a parent or guardian of any person younger than 17 years of age to annually appear in person at a tanning facility and sign an acknowledgement stating that he or she has read and understands the warnings given by the facility and consents to the minor’s use of a tanning device. The bill was sent to Senate President Pro-Tem Rob Mayer, following the Committee’s unanimous eight to zero vote. Sen. Mayer will decide if the bill will be added to the Senate calendar for debate and a vote, which must take place before the legislature adjourns for the year tonight.

Five states recognize May as Melanoma/Skin Cancer Detection and Prevention Month®
State legislators in five states have helped to raise awareness of skin health and sun safety this legislative session by recognizing May 2012 as Melanoma/Skin Cancer Detection and Prevention Month®. The Ohio House of Representatives passed House Bill 492; while policymakers in Arizona (SCR 1028), Delaware (SCR 38), Florida (HR 9047), and Pennsylvania (HR 680/SR 296) have passed chamber resolutions.

New Jersey tanning bill advances past first hurdle
On May 14, the New Jersey Assembly’s Women and Children Committee passed Assembly Bill 2142. The legislation would prohibit minors under the age of 18 from using indoor tanning devices. Prior to the hearing, the AADA, the Dermatological Society of New Jersey (DSNJ), and the American Society for Dermatologic Surgery Association (ASDSA) sent a joint letter urging the committee to protect New Jersey teens by supporting the bill. AADA member Robert Paull, MD, testified on the issue on behalf of all three organizations. A 2142 is awaiting action on the Assembly floor. New Jersey members are encouraged to visit the Dermatology Advocacy Network to send a customizable letter to their state assembly member.

Political affairs – SkinPAC

SkinPAC raises more than $100,000 in a week
SkinPAC, the American Academy of Dermatology’s political action committee, set a new fundraising record – it raised more than $100,000 in one week! This success was accomplished by a group of motivated Mohs surgeons who threw a private fundraiser during the American College of Mohs Surgery’s annual meeting in Chicago. The members of the reception host committee who made it all possible were Brett Coldiron, MD, Pat Davey, MD, Brent Moody, MD, and Ali Hendi, MD. AADA President Daniel Siegel, MD, also heavily promoted the event and was in attendance with his trimmer in hand. SkinPAC is well on its way to $1 million, with hopes to see AADA President Daniel Siegel, MD, fulfill his head-shave challenge.

SkinPAC’s political purpose is to solicit and receive contributions to be used to make political campaign expenditures to those candidates for federal elective office, and other federal political committees, who demonstrate understanding and interest in the views and goals of the American Academy of Dermatology Association.

Contributions to SkinPAC are not deductible as charitable contributions for federal income tax purposes. SkinPAC cannot accept contributions from corporate accounts. All AADA members have the right to refuse to contribute without reprisal. Federal law prohibits us from accepting contributions from foreign nationals. Federal law requires us to use our best efforts to collect and report the name, physical address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year.

Upcoming events

Register now for the 2012 AADA Legislative Conference, Sept 9 – 11, Washington, D.C.
The AADA is pleased to invite the entire Academy membership to register for the 2012 Legislative Conference, Sept. 9 – 11 at the Crystal Gateway Marriott, 10 minutes from the US Capitol. The Legislative Conference is a unique blend of didactic and interactive advocacy training sessions, political debate and the direct lobbying of your members of Congress. Conference attendees learn about critical health policy issues from national health policy experts, political insiders, and AADA advocacy leaders. A keynote address will be delivered by former CMS Administrator Mark McClellan, MD, PhD. However, the most powerful aspect of the Legislative Conference is your ability to build and strengthen personal relationships with your members of Congress and their staff.

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