Federal Government Affairs News and Notes:

Wednesday, May 08, 2024 12:17 PM | WiSCA (Administrator)

WISCA works closely with our national association partner – the Ambulatory Surgery Center Association (ASCA) – on advocacy and other issues important to our members. In fact, the WISCA Government Affairs Team joinsCLproductsupport@wheda.com a national ASCA state chapter call twice a month for a federal regulatory and legislative briefing and closely follows their published Government Affairs Updates. Here is the latest federal government affairs news from ASCA:

  • ASCA Comments on CMS Prior Authorization Demonstration Project: On Tuesday, April 16, ASCA submitted comments in response to the Centers for Medicare & Medicaid Services’ (CMS) proposed prior authorization demonstration project for ASCs. ASCA also submitted sign-on letters with 27 states and 16 specialty organizations supporting our comments. CLICK HERE to view the state chapter letter, which WISCA signed-on to. ASCA opposes the demonstration because it will create an undue burden for ASCs with no clear benefit to Medicare or its beneficiaries.
    • CMS’ Supporting Statement Part B, which provides more information on the proposed prior authorization demonstration project for ASCs, includes 40 codes that would be subject to prior authorization in the demonstration project. CMS indicated that data “from 2019 to 2021 shows these services have experienced significant increases in utilization in the ASC setting” and that it “selected the targeted services for inclusion in this demonstration, based upon problematic events, data, trends, and potential billing behavior impacts of the OPD [hospital outpatient department] Prior Authorization Program which requires prior authorization as a condition of payment for these services.”
    • ASCA’s analysis of the codes, however, determined that only one of the 40 codes, J0585, saw an increase from 2019 to 2021, and only a modest increase of 1.5 percent during that time frame. In addition, five of the codes—15847, 36474, 36476, 36479 and 36483—have a payment indicator N1, meaning they are not separately payable in the ASC setting. Since surgery centers do not receive reimbursement, it does not make sense to include them in a prior authorization demonstration.
    • As ASCA previously reported, the states proposed for inclusion in the demonstration are Arizona, California, Florida, Georgia, Maryland, New York, Ohio, Pennsylvania, Tennessee and Texas. The 40 codes fall within the following categories: 1) Blepharoplasty, Blepharoptosis Repair, and Brow Ptosis Repair; 2) Botulinum Toxin Injection; 3) Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (Including Lipectomy), and related services; 4) Rhinoplasty, and related services; and 5) Vein Ablation, and related services.
  • FTC Non-Compete Rule: On Tuesday, April 23, the Federal Trade Commission (FTC) announced a final rule titled the “Non-Compete Clause Rule” that bans new noncompete clauses on or after the effective date of the final rule. The FTC specified that noncompete clauses are an “unfair method of competition” and, therefore, a violation of Section 5 of the FTC Act. Existing noncompetes “can remain in force” for senior executives, but existing noncompetes “with other workers are not enforceable after the effective date” of the final rule.
    • Last January, the FTC first proposed to ban noncompete clauses, and ASCA submitted comments raising concerns with this proposal. The FTC voted 3 to 2 to issue the final rule that defined a noncompete clause as “a term or condition of employment that prohibits a worker from, penalizes a worker for, or functions to prevent a worker from (1) seeking or accepting work in the United States with a different person where such work would begin after the conclusion of the employment that includes the term or condition; or (2) operating a business in the United States after the conclusion of the employment that includes the term or condition.” The Commission indicated that the “final rule will increase competition and efficiency in healthcare markets, as workers at for-profit healthcare entities will be able to spin off new practices or work for different employers where their productivity is greater.”
    • The final rule will become effective 120 days after publication in the Federal Register. Once the rule is effective, market participants can report information about a suspected violation of the rule to the Bureau of Competition by emailing noncompete@ftc.gov.

Association of Wisconsin Surgery Centers
563 Carter Court, Suite B Kimberly WI 54136
920-560-5627 I WISCA@badgerbay.co

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