U.S. Rep. Tom Emmer (R-MN) wants to know what’s causing the ongoing implementation delays of the appropriate use criteria (AUC) program, which will streamline the diagnostic imaging process for Medicare patients and prevent them from undergoing duplicative or unnecessary imaging procedures.
The AUC program is authorized under Section 218(b) of the Protecting Access to Medicare Act (PAMA) of 2014, a law designed to ensure that Medicare recipients receive suitable advanced imaging services, including computed tomography (CT), positron emission tomography (PET), magnetic resonance imaging (MRI), and nuclear medicine, according to an Oct. 24 letter that Rep. Emmer sent to U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra and the Center for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure.
Specifically, Section 218(b) of PAMA directs the HHS Secretary to establish the AUC program with a relevant clinical decision support mechanism for practitioners to determine when advanced imaging services are appropriate to meet a patient’s needs, wrote the congressman.
“It has now been over eight years since PAMA was enacted, and a Section 218(b) AUC program still has not been implemented,” Rep. Emmer wrote.
In a related statement, Rep. Emmer pointed out that imaging services can be an invaluable diagnostic tool for patients suffering from everything from a fractured bone to cancer. “Without evidence-based guidance, providers are at risk of wasting precious time, money, and resources on improper testing,” he said. “The Biden administration must stop dragging their feet and finally implement the AUC program.”
In his letter, the lawmaker also noted that the CMS in July announced it was no longer committed to a previous implementation deadline of Jan. 1, 2023, for the AUC program, nor for the year following the cessation of the current COVID-19 public health emergency. A new timeline for implementation has yet to be announced.
“Further delays threaten to compromise patient health and will undoubtedly contribute to wasteful Medicare spending,” wrote Rep. Emmer, who asked Becerra and Brooks-LaSure to divulge whether CMS has considered a new timeline for implementing the AUC program, and, if not, why the continuing delays persist.