American College of Mohs Surgery Issues Public Comment on Centers for Medicare & Medicaid Services Proposed Rule

Targeted News Service

WASHINGTON, Aug. 4 -- Brent Moody, chair of the Public Policy Committee, and Howard Rogers, chair of the Private Sector Advocacy Task Force, at the American College of Mohs Surgery, Milwaukee, Wisconsin, have issued a public comment on the Centers for Medicare and Medicaid Services proposed rule entitled "Patient Protection and Affordable Care Act: Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond Proposed Rule". The comment was written and posted on July 28, 2021:

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The American College of Mohs Surgery (ACMS) represents more than 1,500 Mohs micrographic surgeons who have successfully completed extensive fellowship-training in Mohs micrographic surgery following their dermatology residency training. Mohs Micrographic Surgery is the most effective and efficient treatment for advanced or difficult to treat skin cancers. In line with its mission, the Mohs College sets and promotes the highest standards of patient care relating to Mohs micrographic surgery.

We appreciate the opportunity to provide feedback regarding the federal government approach to network adequacy reviews in Marketplace plans.

Background

Mohs micrographic surgeons and their patients face a growing epidemic of skin cancer, where one in five Americans will develop skin cancer in their lifetime./1

Yet, Exchange plans continue to limit patient access to integrated, coordinated, high-quality, and cost-effective skin cancer care and treatment options by eliminating fellowship-trained Mohs surgeons from their provider networks. This worsened when CMS finalized its Market Stabilization final rule and relinquished responsibility for establishing and enforcing network adequacy standards at the federal level, deferring this activity to accrediting organizations and the States. We continue to believe this is a flawed approach.

Federal Approach to Ensuring Network Adequacy

For the past several years, ACMS has been working to address challenges with narrowing networks in health plans - including in Medicare Advantage (MA) - through a variety of federal, state and private sector advocacy efforts. Those efforts include:

* Working with CMS to establish a Micrographic Dermatologic Surgery (MDS) specialty designation for use in Medicare;

* Conceptualizing plan-level quality measures to promote adequate networks in Exchange and Medicare Advantage (MA) plans, including a "physicians experience survey"; and,

* Working directly with plans and their consultants (e.g., Optum, McKesson) to revise cost and quality algorithms used to make network determinations, which have inappropriately compared Mohs micrographic surgeons to that of general Dermatologists, causing them to appear "expensive."

While these have been useful exercises, there is a need for federal requirements that compel plans to ensure network access to specialty and subspecialty providers. Therefore, and consistent with our coalition partner, the Alliance of Specialty Medicine, we offer the below recommendations for addressing network adequacy.

* Return to quantitative network adequacy standards for Marketplace (and MA) plans, including specific standards for specialties and subspecialties;

* Require Marketplace (and MA) plans to account for all specialty and subspecialty designation taxonomy codes to meet network adequacy requirements

- For Mohs surgeons, this would be either CMS' Medicare specialty code MDS D7 or the Health Care Provider Taxonomy Code: Level III, Area of Specialization: MOHS-Micrographic Surgery (207DN0101X));

* Ensure that implementation of provisions in the No Surprises Act that plans maintain accurate, real-time provider directories apply to plans in the Marketplace (and MA);

* Require Marketplace (and MA) plans to provide reasonable notice regarding termination of a provider's in-network status, detailed information on the cause for termination, and options for re-entering the network; and,

* Develop QHP QRS measures (and MA Star Rating measures) that tie network adequacy ratings to health plan quality scores (and MA incentive payments).

Thank you for the opportunity to provide continued input on this important issue. Should you have any questions, please contact Emily L. Graham, RHIA, CCS-P, at [email protected].

Sincerely,

Brent Moody, MD, FACMS, Chair, ACMS Public Policy Committee

Howard Rogers, MD, Chair, ACMS Private Sector Advocacy Task Force

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Footnote:

1/ Stern, RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol 2010; 146(3):279-282.

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The proposed rule can be viewed at: https://www.regulations.gov/document/CMS-2021-0113-0002

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