On Thursday, July 7^th, the Appropriate Use Criteria website was updated with the following message. NOTICE: The payment penalty phase will not begin January 1, 2023 even if the PHE for COVID-19 ends in 2022. Until further notice, the educational and operations testing period will continue. CMS is unable to forecast when the payment penalty phase will begin.

This indefinite delay of the penalty phase replaces the old timeline (first January after the COVID PHE ends) and adds yet another layer of uncertainty to the Appropriate Use Criteria policy. While there is little we can say to fully eliminate this policy uncertainty, the AHRA Regulatory Affairs Committee wanted to provide a few key facts to help our members make informed decisions.

First, in June, the American Medical Association (AMA) passed a resolution that calls for either the full repeal of the AUC program, or legislative modifications to the program that can address the technical and workflow challenges that have contributed to the program’s delay. This resolution formally allows the AMA to lobby Congress to change the AUC statute.

Second, last year, Congress included non-binding language in their appropriations legislation asking the Centers for Medicare and Medicaid Services (CMS) to provide a report on AUC within 180 days. Congress then passed the final appropriations package for FY 22 in mid-March meaning that this report to the appropriations committee from CMS would be due in mid-September. This report could serve as the platform for CMS to explain ~ in detail ~ the difficulties they are having operationalizing the program.

Given these developments, the AHRA regulatory affairs committee has requested a meeting with CMS to better understand what comes next. We plan to engage with both the federal government and with other imaging stakeholder organizations to ensure that operational concerns are appropriately considered as AUC policy decisions are being made. We hope to provide some much needed clarity to our community as soon as we can.

Please visit AHRA Advocacy for more information on regulatory issues, legislation, AUC, and more!