News & Advocacy
Legislative Affairs: Build Back Better Healthcare Provisions in Limbo; Bipartisan Prior Authorization Legislation; DXA Reimbursement Bill
posted: January 3, 2022
Build Back Better Healthcare Provisions in Limbo
U.S. Sen. Joe Manchin’s objections to the nearly $2 trillion social spending bill is forcing Democrats to try to pare down major healthcare policies in the package, which could result in dropping key provisions that increase residency slots and add hearing benefits to traditional Medicare. Senate Finance Committee Chairman Ron Wyden expressed disappointment with Sen. Manchin’s position and outlined several healthcare policies that could still be addressed, including giving Medicare the power to negotiate prices for a small subset of drugs in Parts B and D and capping out-of-pocket drug costs at $2,000 a year.
The ACR previously warned Senators of the “unintended consequences” of those seemingly still viable drug pricing provisions. In a grassroots call to action, the ACR pointed out that price concessions granted “after the point of sale could result in providers being reimbursed less than the amount they paid to acquire the drug initially.” Failure to modify the bill would force providers to suspend the in-office administration of the medications, thus restricting patient access and ultimately increasing costs.
Senate Introduces Bipartisan Prior Authorization Legislation
On October 20, 2021, a group of bipartisan United States Senators introduced S. 3018, the Improving Seniors’ Timely Access to Care Act. The legislation attempts to improve timely access to quality care for seniors on Medicare Advantage by establishing an electronic prior authorization process to streamline approvals and denials; establish national standards for clinical documents that would reduce administrative burdens; create a process for real-time decisions for certain items and services that are routinely approved; increase transparency to improve communication channels and utilization between MA plans, health care providers, and patients; and require beneficiary protections to serve seniors first. A version of this legislation was introduced in the House of Representatives in May 2021 (H.R. 3173).
Bipartisan DXA Bill Under Consideration in Congress
To increase access to Dual-energy X-ray absorptiometry (DXA) testing, the bipartisan Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act (H.R. 3517/S. 1943) has been introduced to set a $98 floor for Medicare reimbursement for DXA testing. Heretofore, declining reimbursement rates have made DXA increasingly difficult to provide, resulting in limited patient access to this preventive measure. According to the ACR, “[at] the current Medicare reimbursement rate—which has dropped 70% since 2006—it is not economically feasible for many doctors to maintain DXA equipment and administer these tests. This is problematic since Medicare beneficiaries who receive a DXA bone density test have 35% fewer hip fractures and 22% fewer other fragility fractures.” The ACR continues, “By setting a reimbursement floor for DXA, this legislation can drastically reduce the incidence of, and costs and disability associated with, osteoporotic fractures.