REGULATORY REVIEW


Medicare Payment Policy Advocacy for 2022 and Beyond ASCA advocates for improved beneficiary access, industry stability BY KARA NEWBURY


In early spring, ASCA Board President Michael Patterson and ASCA staff met virtually with the Cen- ters for Medicare & Med-


icaid Services (CMS) staff responsible for payment policies in ASCs. During this


policy


meeting, ASCA representatives discussed payment


changes


needed to increase access to ASCs for Medicare beneficiaries and stop the divergence in payments between ASCs and hospital outpatient departments (HOPD). ASCA meets


with these


career staff at least annually. While it helps lay the groundwork for our advo- cacy efforts, achieving needed pol- icy changes for our members requires much more than one meeting.


New Administration, New Priorities President Joe Biden was sworn in on January 20, and the president’s nomi- nee for the secretary of the US Depart- ment of Health and Human Services (HHS), Xavier Becerra, was not con- firmed until March 18 and an admin- istrator of CMS had not yet been con- firmed at press time. However, the career payment pol-


icy staff that ASCA met with have been working for months on the pay- ment rule that will impact ASC pay- ments in 2022. To meet statutory dead- lines for implementation of the final rates every year—60 days prior to the January 1 effective date—the pro- posed rule is typically drafted during the winter months. The language then must be approved by multiple levels of career and political appointees, includ- ing HHS leadership, the Office of Management and Budget (OMB) and the Office of Information and Regula- tory Affairs (OIRA) within the White House before the proposed rule is pub- licly released over the summer.


28 ASC FOCUS MAY 2021 | ascfocus.org


The new administration might want to put its imprint on payment rules this year, but due to the timing, significant policy changes in the 2022 rulemaking cycle are unlikely.


In addition, the priority for the pre-


sumptive new CMS administrator Chiq- uita Brooks-LaSure will likely be to ensure the long-term stability of health- care coverage under the Affordable Care Act (ACA), as she was instrumental during the implementation of the ACA under the Obama administration. ASCs are a relatively small player in the Medicare program, representing approximately 6 percent of the spend between ASCs and HOPDs. ASCA will, however, aggressively advo- cate for our members with the new administration since just a few policy


changes would help increase access to Medicare beneficiaries while allowing ASCs to continue saving the Medicare program billions of dollars annually. ASCA will prioritize the following regulatory policies in 2022 and beyond to ensure ASCs remain an integral part of the US healthcare market.


Encourage CMS to discontinue use of the ASC weight scalar. Fixing the ASC weight scalar remains ASCA’s top Medicare payment policy priority. CMS currently tries to contain costs to the Medicare system within silos instead of doing so across all set- tings offering the same outpatient sur- gical services. This means that if ASCs were to increase their Medicare vol- ume, the rates would remain stagnant


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