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FEDERAL | Specialty Medicine Expresses Concerns Over New CMS Requirements for Part B Drugs

Following the release of a Centers for Medicare & Medicaid Services (CMS) proposed rule, the Alliance of Specialty Medicine, of which ASPS is a member, submitted a letter to CMS regarding concerns with its enrollment requirements specific to ordering, certifying, referring or prescribing Part A and B items. While the American Medical Association (AMA) also sent a letter to CMS, which ASPS supported and signed on to, the Alliance letter focused on issues of importance to specialty medicine that were not covered by the AMA.

This new proposal is the result of fraud and abuse by providers within the Medicare system, which was estimated at 30 percent of U.S. health spending in 2009, or roughly $750 billion. While ASPS condemns such abuse of the system, it is also concerned that the proposal will not address fraud in a way that will meaningful prevent future abuses.

The CMS proposed rule would provide the agency with additional authority to deny or revoke a provider's or supplier's Medicare enrollment, as well as require physicians to be enrolled in Medicare in an approval status or valid opt-out to order, certify, refer or prescribe any Part A or B services. Given the fact that physicians are lawfully permitted to order, certify, refer or prescribe these items, this will only create additional barriers to care for our seniors. Furthermore, this will have extremely negative implications for ASPS members who are on-call for the hospital emergency department, as any orders, certifications, referrals, or prescriptions prescribed by an unenrolled provider would not be covered. This is in direct conflict with the Emergency Medical Treatment and Active Labor Act (EMTALA) and does little to improve the quality of patient care.

This proposal is duplicative of current safety mechanisms and increases bureaucracy within the program. It will create more barriers to care for America's seniors and the disabled and likely increase the administrative costs of the program, placing greater financial strain on the Medicare program. ASPS has concerns over increased liability caused by the proposed rule, which would exacerbate the already hostile medical liability climate in this county. Furthermore, ASPS believes that this proposal is a form of governmental coercion, as it forces physicians to either enroll in the Medicare program or be denied payment for providing treatment to Medicare beneficiaries.

For these reasons, the Alliance urged CMS to withdraw its proposal. However, ASPS understands that proposals are often accepted by the Department of Health prior to release and therefore the Alliance also requested that CMS provide appropriate exclusions in emergency situations and streamline requirements so that the regulatory burden is as minimal as possible to specialty physician practices and the beneficiaries they treat.