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This week’s headlines:
Congressional action

Government shutdown: Medicare experiences few disruptions, cancer research halts
At press time, Congress was unable to pass a stop-gap funding measure by the start of the new fiscal year, causing the federal government to shut down on Tuesday, Oct. 1. However, the Centers for Medicare and Medicaid Services’ (CMS) Medicare program — which is not funded through federal appropriations — will experience few disruptions and claims will continue to be paid to Medicare providers. Additionally, activities related to the implementation of the Affordable Care Act — specifically, health insurance exchange enrollment — will progress as planned, and states will continue to receive funding for Medicaid and the Children’s Health Insurance Program. However, the U.S. Food and Drug Administration (FDA) will suspend its food safety, nutrition, and cosmetics activities until the government reopens. Additionally, the National Institutes of Health (NIH) Clinical Center is not allowed to accept new cancer patients, and research labs have been shut down. The AADA will continue to monitor these issues and provide updates. Congress will also have to rule on whether to raise the debt limit or allow the government to default on its debt by the Oct. 17 deadline. For more information, contact govtaffairs@aad.org.

House passes legislation strengthening oversight of drug compounders
In response to last year’s nationwide meningitis outbreak linked to tainted steroids, the U.S. House of Representatives passed HR 3204, the Drug Quality and Security Act, which would grant the U.S. Food and Drug Administration (FDA) more regulatory authority over prescription drug compounders, and create a uniform national standard for drug supply-chain security. The bill preserves and protects the practice of traditional compounding and provides for compounders of sterile drugs to voluntarily register as “outsourcing facilities” that would be subject to FDA regulations and inspection fees. The American Academy of Dermatology Association (AADA), with the support of the American Medical Association and other physician organizations, was instrumental in altering the bill’s language to ensure it would not interfere with the practice of medicine in a physician’s office. While not all of the AADA’s recommendations were accepted, several members stated for the official record that the bill is not intended to change physicians’ ability to compound drugs in their offices. Several key members of the House Energy & Commerce Committee committed to continue working with physician organizations and provide regulatory oversight in the event that unintended consequences threaten access to compounding drugs for patients. For more information, contact Christine O’Connor at coconnor@aad.org.

Dermatologists to Congress: repeal defective Medicare physician payment system
With a 24 percent across-the-board Medicare rate cut expected to go into effect on Jan. 1, 2014, dermatologists throughout the country have logged on to the Dermatology Advocacy Network (DAN) to call on their members of Congress to repeal Medicare’s flawed sustainable growth rate (SGR) formula. The House of Representatives is currently reviewing the Medicare Patient Access and Quality Improvement Act (HR 2810), which would repeal the SGR formula and replace it with a system focused on quality incentives and the development of alternative payment models. The American Academy of Dermatology Association (AADA) has responded to several congressional inquiries on SGR repeal. The AADA is calling on all members to log on to the AADA DAN and submit a letter urging their representatives and senators to repeal the SGR. Learn more about Medicare payment reform. For more information, contact Shawn Friesen at sfriesen@aad.org. For more information on how to get involved, or to share your congressional contacts, email grassroots@aad.org.

Take action: Oppose limits on pathology services
The Promoting Integrity in Medicare Act of 2013 (PIMA) would eliminate the exception to the Medicare Stark Law that allows physicians to provide advanced imaging, anatomic pathology, radiation therapy, and physical therapy services within their offices, and the American Academy of Dermatology Association (AADA) is mobilizing all members to log on to the AADA Dermatology Advocacy Network (DAN) to contact their members of Congress to oppose this legislation and preserve dermatologists’ ability to provide these important services to their patients. For more information, contact Christine O’Connor at coconnor@aad.org. For more information on how to get involved, or to share your congressional contacts, email grassroots@aad.org.

Payer advocacy

Novitas adds limits to Mohs Micrographic Surgery under its utilization guidelines
The American Academy of Dermatology Association (AADA) has learned that Medicare Administrative Contractor (MAC) JL Novitas Solutions, Inc. Local Coverage Determination L27503 has added a limiting 20 percentile for Mohs Micrographic Surgery (MMS) performed on the trunk and extremities listed under its Utilization Guidelines. In accordance with the Centers for Medicare and Medicaid Services Ruling 95-1 (V), Novitas has indicated that utilization of these services should be consistent with locally acceptable standards of practice. Also, providers with more than 20 percent of total MMS procedures reported as trunk and extremity (CPT codes 17313 and 17314) may be reviewed for documentation of medical necessity. The JL Novitas’ DermCACs have been advised of this change. For more information, contact ppm1@aad.org.

Cigna MAC for Ohio, Kentucky adds reporting requirements for Mohs Micrographic Surgery services
Cigna Government Service (CGS), a Medicare Administrative Contractor, has revised its Local Coverage Determination (LCD) L31877 for Jurisdiction 15 (Ohio and Kentucky), which requires providers to document medical necessity for Mohs Micrographic Surgery (MMS) performed on the trunk and extremities (17313, 17314). When billing for these procedures, providers are required to insert one or more of the qualifying terms in the notepad of the electronic claim, or CMS1500 item 19 on a paper claim. The documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures (e.g. positive biopsy). For more information, contact ppm1@aad.org.

United HealthCare terminating Florida specialists from Medicare Advantage network
United Healthcare (UHC) has been reducing the size of its Medicare Advantage (MA) network in Florida by terminating providers across specialties, including dermatologists. The American Academy of Dermatology Association (AADA) has learned that UHC-MA is narrowing its physician network across various medical specialties throughout most of Florida in an effort to meet performance benchmarks and management metrics established under Medicare’s Star Program, which would then allow UHC to qualify for incentive bonuses. It remains unclear what criteria UHC is using to narrow their MA network. The AADA has requested that UHC delay implementation of this program and is working with UHC to craft a resolution. In addition, AADA is collaborating with the Florida Medical Association (FMA), the Florida Society of Dermatology & Dermatologic Surgery (FSDDS), and the Florida Society of Dermatologic Surgeons (FSDS) to further investigate this issue. In the meantime, members can appeal the notice of termination with UHC-MA and advise patients on how they may be impacted by termination. With open enrollment starting Oct. 15, patients may be able to select alternate MA plans to retain access to their current physicians. For more information, contact Richard Martin at rmartin@aad.org.

State policy roundup

Individual enrollment in health insurance exchanges opens
As of Oct. 1, individuals without health care can enroll in state-based health insurance exchanges. As part of the Patient Protection and Affordable Care Act (ACA), states are required to provide Health Insurance Marketplaces where individuals without health care and small businesses can compare and enroll in various health insurance options. Coverage for both individuals and small businesses will start on Jan. 1, 2014. Small businesses can enroll starting on Nov. 1. Read about your state’s plan on the Centers for Medicare and Medicaid Services’ website. The American Academy of Dermatology Association has been monitoring this issue and will provide additional information as it learns more about the impact of these health insurance exchanges on the specialty. Read more in the Sept. 2012 issue of Dermatology World. For more information, contact govtaffairs@aad.org.

California halts legislation that would expand nurse practitioner scope of practice
After strong opposition from the California Medical Association and the American Medical Association (AMA) Scope of Practice Partnership (SOPP), the California legislature will not advance legislation (Senate Bill 491), that would allow nurse practitioners to operate without physician supervision at certain medical facilities. The American Academy of Dermatology Association is an active member in the AMA SOPP, advocating on behalf of physicians and patients at the state level to ensure that there are proper regulations in place that combat inappropriate scope of practice expansions. For more information, contact Lisa Albany at lalbany@aad.org.

Maryland looks to highlight cancer risks on indoor tanning parental consent forms
The Maryland Council on Cancer Control — armed with scientific evidence provided by the American Academy of Dermatology Association (AADA) — has advised the Maryland Department of Health and Mental Hygiene that there is a relationship between indoor tanning and skin cancer development, and that the under-18 parental consent form at indoor tanning salons should include language about the risks associated with indoor tanning, and warn that children under age 18 should not use indoor tanning devices. Read the AADA letter to the Council on the risks of indoor tanning. For more information, contact Lisa Albany at lalbany@aad.org.

AADA promotes National Healthy Skin Month
The American Academy of Dermatology Association (AADA) is assisting members and state dermatological societies in promoting November as National Healthy Skin 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 National Healthy Skin 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 at vhoughton@aad.org.

Engagement opportunities

Preserve dermatology’s voice in the house of medicine
Dermatology could lose a vote in the American Medical Association (AMA) House of Delegates (HOD), unless more members of the American Academy of Dermatology (AAD) join the AMA and designate the AAD as its specialty society by Jan. 1, 2014. The AMA recently conducted its five-year review of the AAD to determine the number of representatives it should receive in the HOD, and the number of AAD members in the AMA is down by several hundred. By joining the AMA or renewing your membership, you ensure the specialty’s presence and voice in affecting the house of medicine’s priorities. If dermatologists don’t maintain a strong presence in the AMA, the specialty will lose its voice in this important venue. Renew your AMA membership and designate the AAD as your primary organization of membership to ensure that dermatology has a voice in the house of medicine. Read more about the importance of the AMA HOD in the April 12 issue of the Member to Member e-newsletter.


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