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Regulatory Affairs Latest News

Below are important regulatory news specifically for AHRA members from the AHRA Regulatory Affairs Committee. These articles will help imaging leaders stay educated about pertinent upcoming rules.

OPPS and PFS AHRA Member Summary

CMS Proposes Unbundling Diagnostic Radiopharmaceuticals and Extending Remote Direct Supervision
Imaging Provisions in the 2025 OPPS and PFS Proposed Rule

Every summer, the Centers for Medicare and Medicaid Services (CMS) releases the Hospital Outpatient Prospective Payment System (OPPS) and the Physician Fee Schedule (PFS) proposed rules. These two rules serve as the key vehicle for CMS to make major changes to regulations and payment policy in the outpatient space in addition to the annual work of establishing and adjusting rates for each payment system. While there are many provisions that will indirectly impact imaging, we wanted to highlight the following provisions which are most directly related to medical imaging management. 

Read more.

HHS Finalizes Section 1557 Nondiscrimination Rule for Healthcare Industry

The Department of Health and Human Services (HHS), through the Office of Civil Rights (OCR) recently released a final rule regarding section 1557 of the Affordable Care Act (ACA), titled Nondiscrimination in Health Programs and Activities.

Section 1557 “prohibits discrimination on the basis of race, color, national origin, sex, age, or disability” in specified health programs or activities. The rule contains a broad definition for “covered entities” which includes any healthcare provider that “receives Federal financial assistance” which in this case means any provider who receives reimbursement from Medicare, Medicaid, CHIP or any Affordable Care Act Marketplace plan.

Therefore, the requirements in this rule will apply to almost all health care providers.

Regulations implementing these nondiscrimination provisions were first implemented by the Obama Administration in 2016, subsequently relaxed by the Trump Administration in 2020, and are now being ratcheted back up by the Biden Administration with the issuance of this final rule.

In particular, the Biden final rule re-introduces specific patient notification requirements, expands nondiscrimination policies into telehealth/clinical decision support tools, and requires covered entities to both develop and train staff on Section 1557 policies and procedures.

While the full rule is broadly applicable to the healthcare industry, the following sections are the most immediate and relevant sections of the rule for providers.

Read more: Section 1557 Nondiscrimination Rule - May 15,2024

CMS to Sunset Codes Used in Rescinded AUC Program at the End of 2024

On February 15th, 2024 CMS released a communication to the Medicare Administrative Contractors (MACs) to clarify that G codes and modifier codes affiliated with the Appropriate Use Criteria (AUC) program will be terminated after December 31, 2024.

This action further operationalizes CMS’s final decision to fully rescind the AUC program.

If claims do still contain AUC information in CY 2024, it will not cause the claim to reject or return to provider but CMS is instructing all MACs to remove all national and local edits related to the AUC program on or after 1/1/2025.

The transmittal contains the full list of modifier codes and G codes that are set to be terminated in 2025.

CMS to Sunset Codes Used in Rescinded AUC Program at the End of 2024 - February 20, 2024