Open enrollment for Medicare Advantage runs October 15 - December 7. If you see Medicare patients, encourage them to review all their options when considering which type of Medicare plan they want. If they are looking at Medicare Advantage plans, they need to know that all plans are not the same.
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Physicians should be aware that Humana’s Medicare Advantage plan has some of the most rigorous and strict prior authorization requirements when it comes to neuromodulation therapies like spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS).

Last December we alerted you to coverage issues around closed-loop SCS. Humana, Evicore, Cigna, and UPMC all had policies that characterized the therapy as “experimental, investigational and/or unproven.” Thanks to the efforts of the Multi-Society Pain Workgroup, Evicore and Cigna both revised their policies this spring. At the end of this summer, Humana followed suit but left the language in place for commercial coverage. Earlier this month, NANS led efforts with the MPW to issue this letter to Humana, urging them to follow the example of their Medicare Advantage plan to revise their policy.

The North American Neuromodulation Society (NANS) crafted a letter in response to the CMS Proposed Rule Making (Proposed Rule) on the revisions to Medicare payment policies under the Physician Payment Schedule (PFS) for calendar year (CY) 2025. The letter includes NANS' recommendations and comments regarding the CY 2025 Proposed Conversion Factor, Prior Authorization for Spinal Cord Stimulation (SCS), Telehealth Services under PFS.

According to the American Brain Coalition of which NANS is a member, Congressman Luttrell, co-chair of the Congressional Neuroscience Caucus, has submitted an amendment to the Rules Committee in favor of increasing funding for the BRAIN Initiative (H.R. 9029).

The U.S. Department of Health & Human Services Office of Civil Rights (OCR) has modified a Final Rule updating the HIPAA Privacy Rule. This rule prohibits the use or disclosure of reproductive protected health information (PHI) by covered entities, including hospitals, health plans, health care clearinghouses, and their business associates.

NANS joins national societies and state medical associations in urging Congress to prioritize and advance key bills and legislative proposals that provide greater financial stability to Medicare physicians and reform the Medicare Access and CHIP Reauthorization Act (MACRA).

On July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) released its Calendar Year (CY) 2025 Medicare Physician Fee Schedule (PFS) proposed rule, which includes proposals related to Medicare physician payment and the Quality Payment Program (QPP). The proposed rule has a 60-day comment period. Final regulations will be issued on or around November 1 and unless otherwise noted, policies will be effective on January 1, 2025.

NANS will be reviewing the proposed rule and submitting comments in advance of the September 9, 2024, deadline.

In March, we learned about Cigna’s Medical Coverage Policy, characterizing peripheral nerve stimulation (PNS) to treat chronic pain as “not medically necessary.” On behalf of 88,000 physician members in national medical societies, NANS leads the response [PDF letter] objecting to CIGNA’s depiction of the treatment as lacking medical necessity.