Legislative Action Center
Together we can help key policy makers at the federal and local levels better understand how their decisions on policy and legislation impact community oncology care. State and federal legislation can have a real impact on your bottom line, and ultimately how you deliver care, which is why it's so important that ACCC members bring their on-the-frontline perspectives to the legislative process.
2016 Cancer Policy Landscape
Transitioning Payments in Medicare
CMS Releases MACRA Final Rule
On October 14, 2016, the Department of Health & Human Services (HHS) finalized the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, which replaces the flawed Sustainable Growth Rate (SGR). The new payment system under MACRA creates two pathways for clinicians to choose from to transition from a fee-for-service reimbursement system to one that uses alternative payment models that reward quality of care over quantity of services. Read the final rule and executive summary from CMS here.
The final MACRA rule paves the way for physician payment reform in Medicare. While the final rule allows for increased flexibility on 2017 reporting, providers are still required to report measures in several different categories under the new Quality Payment Program (QPP) to receive payment updates in future years.
MACRA: What You Need to Know About the Final Rule
Originally held on November 3, 2016
Hear experts from Hogan Lovells US LLP outline the oncology-specific measures eligible for reporting under the new QPP and learn how to prepare for QPP reporting in 2017 and beyond.
The passage of H.R. 2, Medicare Access and CHIP Reauthorization Act (MACRA) in April 2015, brought an end to the Sustainable Growth Rate and years of short-term legislative fixes to prevent significant reductions in provider payment rates. The Quality Payment Program (QPP), as required under MACRA, also ushered in a new reimbursement system for Part B providers, transitioning Medicare payments to a dual track payment system that will require providers to choose between two reimbursement tracks: the Merit-Based Incentive Payment System (MIPS) and "Advanced" Alternative Payment Models (APMs).
For more information, CMS launched a website for physicians that explains the program and allows you to explore and identify different measures that are most meaningful to your practice.
Call to Action: ACCC Strongly Opposes Proposed Part B
Drug Payment Model
On March 8, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to test new models for how Medicare Part B pays for prescription drugs.
Under the proposal, CMS will choose a group of Part B providers based on Primary Care Service Areas (PCSAs), and instead of paying physicians and hospital outpatient departments for drugs at the current ASP +6 percent, the model would drop the add-on payment to 2.5 percent plus a flat fee payment of $16.80 per drug per day to test whether this "changes prescribing incentives and leads to improved quality and value." Read CMS fact sheet here.
ACCC is deeply concerned that this proposed model will place undue burden on both patients and providers, and significantly hamper providers' ability to provide critical cancer care services in their communities.
On April 5, ACCC held a members-only conference call providing an in-depth look at the proposed five year, two-phase demonstration project. Access a recording of the conference call and presentation slides here (log-in required).
A recent impact analysis from Avalere finds seven of the 10 drugs that would constitute the largest reduction in reimbursement are used to treat cancer. An impact statement from PhRMA shows effects by region.
ACCC Speaks Out
ACCC joined with 60 oncology stakeholder groups in a letter to CMS asking the agency to withdraw its proposal. On March 17 ACCC, together with more than 300 state and national organizations, sent a letter to Congress asking policymakers not to move forward with the CMS Part B Drug Payment Model proposal.
ACCC is also partnering with HOPA, ONS, and AOSW to express concerns about the proposal.
ACCC joined with HOPA and AOSW in a April 14 letter expressing appreciation to Vice President Joe Biden for his commitment to cancer research through the Cancer Moonshot Initiative, while also calling his attention to stakeholder concerns about the potential impact of the proposed Medicare Part B Drug Payment Model on patients and providers.
ACCC Submits Comments to CMS
ACCC is dedicated to passing legislation at the state and federal level that would require health insurance plans to cover orally administered chemotherapy at the same rate as IV-infused counterparts.
On June 11, 2015, the Cancer Drug Coverage Parity Act of 2015, HR 2739/S 1566, was introduced and would eliminate the disparity in patient out-of-pocket costs between oral and intravenous chemotherapy, ensuring that cancer patients have access to needed treatments.
ACCC urges its members to Ask your legislator to support oral parity.
Federal legislation is needed in addition to state legislation, to ensure all insurance policies provide parity for oral treatments. ERISA plans and others fall outside of state regulation. Oral chemotherapy may provide an easier, less intrusive way to fight various types of cancer, but unless Congress acts to create reimbursement equity between oral and IV-infused treatments, most patients will not be able to afford these oral treatment regimens.
State Legislation:ACCC has also worked with a coalition to pass state oral parity laws. Thirty-nine states have now passed such legislation. Please visit our coalition website for a detailed map of state laws.
Even though state laws are currently being passed, federal legislation is still required for two important reasons:
- Language of the laws varies across the states and only federal legislation will ensure the same protections for all patients; and
- State laws only impact state-regulated plans. Federal legislation is needed to cover self-insured plans (ERISA).
- Read ACCC’s press release on the passage of MACRA
- Read our ACCCBuzz blog, SGR is Over: What Does it Mean for Providers?
MACRA encourages providers to participate in Alternative Payment Models, such as the Oncology Care Model. Visit our Oncology Care Model Resource Center to see if this payment system suits your practice.
ACCC supports the development of additional Alternative Payment Models. For example, Congresswoman McMorris Rodgers recently introduced H.R. 1934, legislation that would create the Oncology Medical Home demonstration project under Medicare. ACCC supports this effort to better coordinate patient care; read our support letter here.
Prompt Pay Discount
Because Medicare reimburses using average sales price (ASP), the discount that is customarily provided to drug distributors by manufacturers when they pay promptly for drugs (Prompt Pay Discount) is not passed on to the providers who buy the drugs to give directly to their patients. Result: providers miss about 2 percent of the intended reimbursement on all drugs. Failure to exclude prompt pay discounts from the calculation of ASP threatens the current distribution model for specialty products and artificially lowers Part B reimbursement for physicians and other providers.