Advocacy Update: AUC Mandate Penalty Phase Delayed 'Until Further Notice'

On July 7, in concert with the release of the CY2023 Medicare Physician Fee Schedule proposed rule, the Centers for Medicare & Medicaid Services (CMS) issued a notice stating that the payment penalty phase of the Appropriate Use Criteria (AUC) Program will not begin until further notice. The announcement further explained that CMS is not able to forecast when the penalty phase of the program will begin.
What Does It Mean? 
CMS's announcement means that clinicians will not be expected to meet the requirements of the AUC Mandate by January 1, 2023 (or the January 1 following the end of the COVID-19 public health emergency). The AUC Mandate affects all advanced imaging services across every specialty. 

The delay in the penalty phase also means the education and operations testing period is left in place. This testing is voluntary and is intended for clinicians to familiarize themselves with the program. Clinicians who do not consult AUC for an advanced imaging order will not be penalized by nonpayment for the service.  

ASNC is pleased with this significant change in direction and credits the request to CMS from Congress earlier this year asking for a report on the implementation status of the AUC Mandate, including implementation challenges and successes. Since 2014 when the AUC Mandate law was passed, ASNC has been clear in its view that AUC are important for optimizing patient care but tying clinicians to a restrictive, complex program that adds costs and administrative burden to physicians is not the way to incentivize appropriate use.

“CMS' announcement that the penalty phase of the AUC Mandate will not be implemented until further notice is a victory for all clinicians who have been explaining to CMS and Congress why the program is inflexible, costly and unnecessary, ” says ASNC President Dennis A. Calnon, MD, MASNC. “ASNC will continue to foster the development of AUC and will encourage members to use them in ways that can be easily integrated into their existing workflow.”

CMS Announcement Follows 8 Years of ASNC Advocacy
Since the Protecting Access to Medicare Act created the AUC Mandate in 2014, ASNC has led multiple coalitions pushing for the modification or repeal of the program. Recently, an ASNC-led letter signed by 44 medical societies urged CMS to comply with the 2022 Labor, Health and Human Services, Education, and Related Agencies Funding Bill language requesting a report from the agency on the implementation of the mandate. The coalition also asked CMS to consult with stakeholders, including medical professional societies and developers of AUC and clinical guidelines, when formulating its report to Congress.

ASNC and other groups also persuaded the American Medical Association (AMA) House of Delegates to change AMA policy and direct the AMA to engage with Congress to modify the AUC Program.

More Work to Do
Last week's decision to delay the AUC Mandate's penalty phase is a major victory for clinicians; however, the AUC Mandate will continue to loom until Congress repeals or modifies the law. ASNC will continue advocating for a permanent solution. Stay tuned for updates.