CMS Proposes Further AUC Program Delay; ASNC Maintains Call for Repeal

In the recently released Medicare Physician Fee Schedule proposed rule, the Centers for Medicare & Medicaid Services (CMS) said it will delay the AUC Mandate another year. CMS is now aiming to initiate the program's penalty phase in 2023 and is seeking information from the public that may assist the agency as it works to ensure that only appropriate claims are subject to AUC claims-processing edits.
CMS is under a statutory mandate to implement the law with little wiggle room to make changes. Meanwhile, Congress has been relatively unconcerned with the delays despite the uncertainty it imposed on physicians and other clinicians who would be subjected to the law's requirements. ASNC's position on the law has remained unchanged since its enactment: The program is complex, administratively burdensome, unnecessary, unworkable, and should be repealed.

Repealing a statutorily mandated program is always difficult and in the case of the AUC Program could come with costs that Congress would need to offset. With the passing of time, however, congressional support for the program seems to have softened. Many congressional staff who were on Capitol Hill when the law was created are no longer there. Coupled with the ongoing implementation challenges and the changed healthcare payment and delivery environment since the law's passage in 2014, there is new opportunity for ASNC and other medical societies to advocate for the law's repeal or, at a minimum, to convince Congress to pause implementation and re-examine it.

In July, House lawmakers passed the FY2022 Labor, Health and Human Services, Education spending bill, which in its accompanying report included language calling for CMS to examine both AUC Program implementation and the impact of existing quality-improvement programs on appropriate use of advanced diagnostic imaging. The spending bill report language was shepherded by Representative Tim Ryan (D-OH). The spending bill report also directs CMS to consult with medical societies and other stakeholders. A report from CMS to Congress is due 180 days after enactment of the spending bill.

ASNC is continuing to hold meetings with key congressional offices and pushing for legislative language that repeals or creates a statutory delay of the program. We will keep you informed.