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COVID-19 Advocacy

In response to the COVID-19 public health emergency (PHE), ASTRO has been continuing its advocacy efforts for our members. The information on this page contains various policy and financial resources specific to advocacy efforts related to COVID-19 designed to assist practices as they continue to care for patients during the pandemic.

Financial Assistance
 COVID-19 Telehealth Coding and Related Policies
 COVID-19 Webcasts
 Advocacy Letters and Statements

Financial Assistance

Information on Use of CARES Act Provider Relief Funds

The Provider Relief Fund was established by the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act. The $175 billion relief fund is designated to provide financial support to providers impacted by COVID-19 resulting in either necessary expenses or declines in revenue attributable to the coronavirus. Of the $175 billion in relief funding thus far, $50 billion was set aside for healthcare providers and distributed in two tranches as part of its general allocation distribution. The first $30 billion was disbursed on April 10 and automatically deposited into the accounts of providers who frequently deliver services to Medicare beneficiaries. The remaining $20 billion was disbursed beginning on April 24 and included an application process for others requesting additional funds.

H.R. 748, Coronavirus Aid, Relief and Economic Security Act (CARES ACT)

Last week Congress passed, and the President signed, the Coronavirus Aid, Relief and Economic Security Act (CARES ACT). This legislation is intended to provide economic relief and stabilize at risk individuals, families and businesses. Certain economic relief provisions in the act may require regulatory guidance from federal agencies such as the Department of Labor, Department of Treasury, Department of Health and Human Services and the Internal Revenue Service.

Attestation Deadline Extended for Provider Relief Fund Recipients

Physicians who have received a payment through the Provider Relief Funds authorized under the CARES Act have 45-days from payment receipt to sign an attestation through a Department of Health and Human Services (HHS) portal. Should a provider not wish to comply with the Terms and Conditions for receiving the relief funds, they must contact HHS within the same 45-day period and remit the full payment. For more information on the Provider Relief Fund, see What's Happening in Washington.

New Main Street Lending Program Announced

The Federal Reserve and the U.S. Treasury have announced their intent to implement the Main Street Lending Program which will provide liquidity to lenders to support mid-sized businesses with 500-10,000 employees. Congress stated their intent for the program in the CARES ACT. While many program details are yet to be announced, Congress indicated their intent to have lenders who provide loans under this program to cap interest on those loans at an annualized interest rate at 2% per annum and include a period of at least 6 months in which no principal or interest shall be due. For more details, see What's Happening in Washington.

ASTRO Supports Additional Financial Remedies for Physicians

ASTRO has joined the American Medical Association and 136 other organizations representing America’s physicians to urge Congress to take additional steps to preserve the viability of physician practices. These steps include amending the current structure of the Accelerated and Advance Payment Program, increased funding for the Payroll Protection Program (PPP) and establishing direct financial support for practices of all sizes. For more details on the recommendations included in the letter, see What’s Happening in Washington.

ASTRO COVID-19 Financial Impact Calculator

ASTRO has developed a COVID-19 Financial Impact Calculator for freestanding and hospital-based practices to complete. These tools are designed to help practices make decisions regarding whether to pursue CMS Advanced and Accelerated payments, small business loans or other financial remedies to address significant reductions in revenue due to COVID-19. ASTRO welcomes any feedback that practices are willing to share regarding the financial impact of COVID-19. Sharing information regarding the financial impact of the COVID-19 public health emergency will help ASTRO advocate for additional financial remedies and resources to help practices secure sound financial footing moving forward.

COVID-19 Telehealth Coding and Related Policies

COVID-19 Second Interim Final Rule with Comment Period (IFC) Summary

On April 30, 2020, the Centers for Medicare and Medicaid Services (CMS) issued the Medicare and Medicaid Programs; Basic Health Program and Exchanges; Additional Policy and Regulatory Revisions in Response to the COVID-19 PHE and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program, interim final rule with comment period (IFC).  The IFC increases reimbursement for telephone evaluation and management (E/M) services, provides additional guidance on the selection of E/M levels, defines a subregulatory process for updating the Medicare telehealth list, and includes guidance for hospital services accompanying a professional service furnished via telehealth.

COVID-19 Telehealth Coding Guidance

The Centers for Medicare and Medicaid Services (CMS) has issued two guidance documents regarding the use of telehealth during the COVID-19 public health emergency (PHE). On March 17, CMS announced a temporary expansion of telehealth coverage for health care services which authorized CMS to waive certain traditional Medicare telehealth requirements, increasing access to telehealth services as part of a nation-wide effort to mitigate the COVID-19 pandemic in the United States. Medicare will now pay for certain patient visits rendered via telehealth, reducing the need for patients to appear in-person at clinics and hospitals. 

COVID-19 Interim Final Rule Summary

On March 30, 2020, the Centers for Medicare and Medicaid Services (CMS) issued the Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency final rule, setting important policies addressing the COVID-19 PHE. The final rule extends telehealth flexibilities to OTVs as part of CPT code 77427, relaxes supervision requirements in all sites of service and establishes separate payment for Medicare telephone evaluation and management (E/M) Services.

Private Payer COVID-19 Policies

ASTRO has compiled recent changes private payers have made to telehealth and prior authorization policies for the COVID-19 PHE, which will be updated on a regular basis.

Additionally, ASTRO has compiled a list of private payers below who are offering a form of accelerated payments during the COVID-19 PHE.

ASTRO seeks federal COVID-19 help for radiation oncology

As ASTRO members grapple with major changes and disruptions due to COVID-19, ASTRO is advocating with federal agencies and payers for flexibility and support for radiation oncology clinics. In recent days, ASTRO has written CMS seeking: A delay from the expected July 1, 2020 implementation for the Radiation Oncology Model (RO Model); A temporary relaxation of supervision guidelines for hospital and freestanding radiation oncology centers; A delay in the March 31 Merit-Based Incentive Payment System (MIPS) reporting deadline.

ASTRO letter to payers, CMS and ROBMs regarding prior auth

March 19, ASTRO sent letters urging payers, CMS and radiation oncology benefit managers to suspend radiation therapy prior authorization requirements in an effort to reduce administrative burden during the COVID-19 public health emergency.

ASTRO letter to CMS regarding telehealth services 

ASTRO sent a letter to CMS Administrator Seema Verma urgently requesting the CMS extend flexibilities to face-to-face interactions that may take place during the process of care that are not included in the three distinct types of telehealth services outlined in the 1135 Waiver that became effective on March 6. Specifically, ASTRO asked that CMS extend telehealth flexibilities to in-person, face-to-face interactions associated with radiation oncology on-treatment visits (OTVs) under CPT Code 77427.

COVID-19 Webcasts

ASTRO Webcast Series: CMS Directives in response to COVID-19

In response to the COVID-19 public health emergency, the Centers for Medicare and Medicaid Services (CMS) has announced various policy changes and financial resources designed to assist practices as they continue to care for patients during the pandemic. In addition to COVID-19 guidance articles, ASTRO has created a series of webcasts to provide physicians with additional information about these policies.

Advocacy Letters and Statements

ASTRO sends letter detailing COVID-19 impact on radiation oncology

On May 4, ASTRO sent a letter to Congressional leadership detailing the dire conditions facing America’s radiation oncology care providers and their patients in order to guide the next phase of COVID-19 related legislation. The letter includes data from ASTRO recent national impact survey, which illustrates the current and future obstacles to radiation oncology practices. For more details, see What's Happening in Washington.

ASTRO supports effort to provide more mental health resources

ASTRO has joined 53 organizations in supporting Congressional efforts to provide mental health resources for health care workers. Rep. Raja Krishnamoorthi (D-IL-8) led a bipartisan letter signed by 90 members of Congress, calling for the consideration of funding of mental health resources for health care workers. For more information, see What's Happening in Washington.

ASTRO joins call for clinical trial policy changes

ASTRO has joined 76 organizations representing patients, researchers, physicians, survivors, and their families, in signing a letter to congressional leadership regarding proposals from Title IV of the 21st Century Cures 2.0 concept paper recently released by Representatives Diana DeGette and Fred Upton. The organizations urge Congress to include the proposed clinical trial policies in future legislation aimed at further addressing the COVID-19 public health crisis. For more information, see What's Happening in Washington.

ASTRO supports Representatives' letter urging relief for researchers

ASTRO has joined organizations representing those throughout the health care industry in urging Congress to include emergency funding for scientific and medical researchers in the next COVID-19 relief package. In a letter to congressional leadership led by Rep. Diana DeGette and Rep. Frank Upton, the organizations detail the burden of pandemic-triggered shutdowns on American research laboratories. To help alleviate this financial weight, they urge Congress to include $26 billion in research focused funding in the next relief package. For more on the letter, see What's Happening in Washington.

ASTRO joins call for bridge funding for research

ASTRO has joined 120 organizations in signing a letter to congressional leadership urging the inclusion of at least $2 billion of bridge funding in future COVID-19 relief legislation to assure the future viability of stalled research projects supported by non-profit organizations, voluntary health associations, science societies, and foundations. For more information on the letter, see What's Happening in Washington.

ASTRO urges block to E/M code changes

ASTRO joined 45 physician representing organizations in urging Congressional leadership to block payment cuts associated with evaluation and management (E/M) code changes slated for implementation on Jan. 1, 2021. In a letter sent April 17, the organizations noted that now is not the time to implement any payment policy changes that will exacerbate the financial instability of healthcare providers’ practices. For more information, see What's Happening in Washington.

Connect with your Senators and Representatives on Virtual Town Halls

Senators and Representatives across the country are ramping up their efforts to connect to their constituents by hosting virtual town halls. These events offer a great opportunity to hear updates on the crisis directly from them and to make sure your voice is heard. Follow the link to use Town Hall Project to find the events your Senators and Representatives are hosting. 

ASTRO urges HHS to give emergency funding for physicians

ASTRO joined 138 organizations representing America’s physicians in a letter to HHS Secretary Alex Azar urging immediate financial assistance for physicians on the front lines of the COVID-19 pandemic, those providing ongoing care for patients with chronic conditions and urgent needs, and those incurring significant financial losses due to postponement of non-essential procedures and visits. The letter details the significant sacrifices being made by health care professionals nationwide and calls for HHS to provide one month of revenues to each physician (MD or DO), nurse practitioner and physician assistant enrolled in Medicare or Medicaid.

Medical Association Congressional request letter for inclusion of associations and non-profits in any "stimulus" packages

ASTRO has joined 23 non-profit medical and dental associations in signing on to a letter to congressional leadership urging them to include associations, nonprofits and other tax-exempt organizations in any federal aid packages or supplemental appropriations measures triggered by the COVID-19 pandemic. The letter specifically details the impact of COVID-19 prompted event cancellations on these associations’ abilities to meet their core missions of scientific and clinical education.

CMSS statement on PPE

The Council of Medical Specialty Societies (CMSS) posted a statement on their site urging action to ensure safer working conditions for physicians and other health care professionals on the frontline of direct patient care.

CMSS letter on social distancing

The Council of Medical Specialty Societies (CMSS), sent a letter to President Trump, Vice President Pence and Ambassador Brix expressing their continued support of travel and gathering restrictions and encouraging federal, state and local governments to only set a date for lifting nationwide social distancing restrictions consistent with assessments by public health and medical experts.

CMSS email to Ambassador Birx

The Council of Medical Specialty Societies (CMSS), which includes 46 specialty societies representing more than 800,000 U.S. physicians sent an email to Ambassador Deborah Leah Birx, MD, who serves as the response coordinator for the White House Coronavirus Task Force as of March 2020.

In response to the administration’s request for recommendations, this email outlines specific issues across the entire CMSS membership that require immediate response.

ASTRO letter to Congressional leadership for inclusion of provisions in COVID-19 stimulus package

ASTRO has joined 128 organizations representing America’s physicians in urging Congressional leadership to include provisions to help physicians sustain their practices and continue to provide the best possible care in the final COVID-19 triggered “stimulus” legislation. The provisions center specifically on tax relief, no-interest loans, direct payments, payment for virtual visits (including phone calls) and other measures. They also include a push for Congress to take all possible actions to ensure health care worker access to critically necessary personal protective equipment.

ASTRO cosigned letter to HHS requesting scheduled correspondences 

ASTRO joined 20 other organizations representing front-line physicians in a request to the U.S. Department of Health and Human Services to create a mechanism for providing the organizations with regular, timely and relevant COVID-19 information to communicate to our members. The organizations recommend a twice weekly conference call including an appropriate public health representative from the Administration to establish robust lines of communication that ensure an effective and well-coordinated response to treat and protect the American people.

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