February 2024

Contact Congress in Support of Stopping Medicare Payment Cuts in 2024

In the absence of Congressional action, the Centers for Medicare & Medicaid Services (CMS) implemented a 3.37% cut to physician services on January 1st as finalized in the Calendar Year 2024 Medicare Physician Fee Schedule (MPFS) final rule. ASH sent a letter in December 2023 urging Congress to consider several legislative solutions to prevent the pending pay cuts in the Medicare Physician Fee Schedule, ending this cycle of uncertainty and providing greater stability in the Medicare physician payment system. Congress failed to pass legislation mitigating or eliminating the cut, first in December and then again in January when a stop-gap spending bill to avoid a government shutdown was approved. The next opportunity for Congress to address the pay cut will be in early March when government funding expires and action will be required to avert a government shutdown through a final FY2024 funding bill or another continuing resolution. 

Despite their lack of success to date, Congressional champions are determined to advance a prospective pay fix, paying physicians at a higher rate going forward to account for the time the cut has been implemented. A retrospective pay fix is administratively burdensome because of the time it would take CMS to reprocess claims and the challenge for physicians to collect increased co-pays for services already delivered.

Representatives Greg Murphy (R-NC), Danny Davis (D-IL), Brad Wenstrup (R-OH), Michael Burgess (R-TX), Jimmy Panetta (D-CA), and Larry Bucshon (R-IN) introduced H.R. 6683, the Preserving Seniors’ Access to Physicians Act of 2023 to eliminate the full MPFS cut. The physician community is supporting this legislation, including ASH, other medical specialty societies, and the American Medical Association. 

Lawmakers need to hear from physicians about the direct impact of Medicare pay cuts on the ability to provide high-quality care to patients. Please take a moment and contact your Senators and Representative to tell them to cancel the cuts! Take Action.

Congress Seeks to Finish FY 2024 Funding with Start of FY 2025 Budget Process on Horizon

The federal government is currently operating under a temporary spending measure, or continuing resolution (CR), that will keep the government open while Congress continues its negotiations on a final fiscal year (FY) 2024 budget. Like the prior CR passed in November 2023, the current law sets up two staggered deadlines, with funding for some federal agencies, including the Food and Drug Administration (FDA), expiring on March 1, while funding for other agencies – including the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) – running through March 8.

Meanwhile, even as final FY 2024 spending remains in question, congressional leaders are preparing for the start of the FY 2025 budget process. President Biden recently announced that his FY 2025 budget proposal will be released March 11, days after his State of the Union address on March 7. The President’s budget proposal kicks off the annual appropriations process and outlines the administration’s priorities for the coming fiscal year. ASH will provide updates on the budget proposal’s provisions impacting hematology research and practice after it has been released.

ASH will continue to advocate with other members of the research and public health communities for the highest possible levels of federal funding for biomedical research and public health programs in FY 2024 and beyond. Grassroots support is critical to show your elected officials the importance of sustained and predictable public health funding. Visit the ASH Advocacy Center, enter your contact information, and click “Submit Email” to quickly and easily send a message to your elected officials about the importance of NIH, CDC, and other federal health programs.

CMMI Launches Cell & Gene Therapy Access Model

On Tuesday, January 30, the Centers for Medicare & Medicaid Services Innovation Center (CMMI) launched the Cell & Gene Therapy (CGT) Access Model for individuals with Sickle Cell Disease. The model aligns with several ASH policy priorities, including the ASH Sickle Cell Disease Initiative and access to care. Dr. Mohandas Narla, ASH President, issued the following statement: “ASH commends CMMI for taking this monumental step to promote access to novel gene therapies for individuals living with SCD. We voiced concerns regarding the high cost of these treatments and are glad to see CMS trying to address this issue with the development of this model.”

Read the press release to learn more.

CMS Finalizes Policies on Prior Authorization Nearly a Year After Proposed Rule was Released

On January 17, the Centers for Medicare & Medicaid Services (CMS) released a final rule that outlines policy changes to the prior authorization (PA) process for Medicare Advantage (MA) organizations, state Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) insurers on the Federally Facilitated Exchanges (FFEs). Medicare Fee-for-Service is not covered by the policies of this rule.

The provisions of the final rule streamline the PA process, alleviate administrative burden for providers, and apply only to PA for items and services. Drugs of any type are not covered by the rule. Additionally, the policies outlined in the rule are effective January 1, 2026, with some policies such as the requirements to update and improve application programming interfaces effective January 1, 2027. 

A summary of the rule with a comment comparison chart and ASH’s comment letter are available that provide additional detail.

ASH Joins Partners in Urging Supreme Court to Preserve FDA Authority

On January 30, ASH joined 24 other provider and patient organizations in sending an amicus brief urging the Supreme Court to reverse the Fifth Circuit’s decision in Alliance for Hippocratic Medicine et al. v the U.S Food and Drug Administration (FDA) et al., which calls into question the FDA’s approval of mifepristone. The joint statement also expressed serious concern regarding legal interference with the federal agency’s ability and authority to review and approve drugs that are critical to health care access for all Americans.  Additionally, a decision to uphold the lower court’s ruling sets a dangerous precedent that not only impacts access to the drug at the center of this case but jeopardizes patients’ ability to rely on FDA approval of any drug or the conditions of a drug’s use. 

Health Data, Technology, and Interoperability Final Rule Released

On January 9, the Office of the National Coordinator for Health Information Technology (ONC) and the Department of Health and Human Services published a final rule for Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing, denoted as HTI-1. ASH submitted a comment letter on the proposed rule supporting changes to the standards that health IT developers must adhere to when building decision support interventions. ASH also responded to an RFI in the proposal on issues related to establishing certification criteria that would support complementary and interoperable workflows between physicians and pharmacies, noting that interoperability is fundamental to decreasing physician burnout and reducing administrative burden.

Hematologic Drug Shortage Information Webpage 

ASH continues to update the Hematologic Drug Shortage Information webpage to keep members apprised of shortages of hematologic therapies and drugs in the United States. ASH actively works with Congress, federal agencies, and other stakeholders to ensure access to safe and effective hematologic drugs. Please email Government Relations and Public Health Programs Coordinator, Bethany Sheehan, if you are experiencing a shortage that is not listed. 

Nominations Now Open for the 2024 ASH Advocacy Leadership Institute 

Nominations are now open for the annual ASH Advocacy Leadership Institute (ALI)! The ALI is an intensive two-day program for ASH members to learn about health policy, the legislative process, and how to become engaged in the Society’s advocacy efforts. This year’s ALI will be held in-person on September 24-25, at the Society’s headquarters in Washington, DC. The first day of the program focuses on learning about the legislative process and how to be an effective advocate. Participants will then get the chance to turn their knowledge into action in support of hematology by traveling to Capitol Hill to meet with lawmakers. Nominations are being accepted through May 15, 2024. For more information visit the ALI website or email ASH Senior Manager, Legislative Advocacy, Tracy Roades.