“I’m just a bill. Yes, I’m only a bill. And I’m sitting here on Capitol Hill…” the School House Rock jingle of a cartoon-filled Saturday morning childhood only tells half the story. Our friend, the bill, bemoans the lengthy process associated with legislative language crafting, committee vetting, congressional debate and the fear of a veto, but in the end, the little fella achieves his dream of becoming a law.
What the bill neglects to share is the regulatory process that takes place once it becomes a law. No longer is our friend the bill engaging with members of Congress, but rather the bill, now a law, is subject to a regulatory process that is led by the federal agency responsible for the implementation of the law and the development of regulatory policy.
The Centers for Medicare and Medicaid Services (CMS), within the Department of Health and Human Services (HHS), is tasked with the regulatory policy associated with legislative changes impacting the Medicare and Medicaid programs. Congressional action has resulted in regulatory policy covering a range of health care initiatives, including regular and irregular issuance of regulations involving radiation oncology.
ASTRO regularly monitors CMS regulatory proposals so that it can advocate on behalf of the specialty when policy changes are under consideration that impact radiation oncology, directly or indirectly. Notices of Proposed Rule Making (NPRM) are issued throughout the year, enabling ASTRO and members of the public the opportunity to review policy changes and submit comments to inform decision making with a public comment period. Final rules are subsequently issued that outline the Agency’s policy decisions, including feedback in response to the public comment period.
ASTRO’s Comment Letter Process
ASTRO’s internal process involves multiple steps that are managed by the Health Policy Council. The Health Policy Council constantly discusses policy issues in response to or anticipation of regulatory proposals. Once a proposed rule is issued, ASTRO staff quickly issues a summary of key points impacting radiation oncology to the council. For payment rules, this includes an analysis of code-by-code reimbursement impact. The broader membership is provided a summary via ASTROgram.
The next step is the development of a comment letter. ASTRO staff drafts a comment letter that is circulated within the Health Policy Committee. The committee provide suggestions and assists staff with refining responses to key issues impacting the specialty.
Next, the Health Policy Council leaders review the letter, which is also reviewed by the Governmental Relations Council leaders to ensure consistency with legislative initiatives. ASTRO staff also engages on issues of common interest with stakeholder groups, including the American Medical Association, American College of Radiology, American Association of Medical Physicists and others.
Once the letter has circulated and been approved through Health Policy and Government Relations Council leadership, it is finalized by the Chair of ASTRO’s Board of Directors and signed. Finally, the letter is submitted to CMS in response to the NPRM, posted on ASTRO’s website and highlighted in ASTROgram. In many cases, ASTRO arranges a meeting with CMS to discuss the issues in more detail.
How do I get involved?
The best way to get involved is to join the Health Policy Council as a member. ASTRO is always looking for more volunteers and leaders from different practice settings and backgrounds. Another way to engage is through active monitoring of ASTROgrams for information about NPRMs, including summaries and comment letters.
While the cadence of many NPRM and final rules vary from year-to-year, the Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment (HOPPS) rules follow a fairly regular schedule. The NPRM for each rule is usually issued in July, with a comment period that ends around Labor Day and a final rule issued in November. Members who want to know more about the NPRM content should read ASTRO’s rule summary and reach out with any questions or recommendations about the proposed policy changes. ASTRO also hosts a session on key NPRMs and other health policy topics during the Annual Meeting.
ASTRO is always happy to hear from members interested in engaging in this important process that can have a dramatic impact on the field. Reach out to the health policy team for more information.
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