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Access, Payment & Reimbursement Reform

ACCC is committed to ensuring that cancer patients have access to the entire continuum of quality cancer care, including access to the most appropriate cancer therapies.

ACCC Joins Groups Expressing Concerns Over CMS' Interpretation of NCD for NGS
The Association of Community Cancer Centers (ACCC) joined with more than 60 organizations in a January 31, 2019, letter to CMS Administrator Seema Verma expressing concern over recent developments in the agency's interpretation of the National Coverage Determination (NCD) for Next Generation Sequencing (NGS) for Medicare Beneficiaries with Advanced Cancer.

An overarching concern is that, although the NCD was requested for a somatic-based test, the new interpretation will result in Medicare Administrative Contractors (MACs) applying the NCD's terms to both somatic and germline NGS-based testing for patients with cancer. As a result, patient access to medically necessary and relevant testing of germline mutations in patients with cancer would be restricted, as would NGS-based testing (both somatic and germline) for Medicare beneficiaries with early-stage cancer.

Read the Letter.

Posted 1/4/2019

ACCC Joins in Letter to CMS Expressing Concerns with Proposed Part D & MA Rule
The Association of Community Cancer Centers (ACCC) joined more than 30 stakeholder organizations in a January 25 letter to the Centers for Medicare & Medicaid Services (CMS) outlining concerns over the impact of the administration's proposed rule on Modernizing Part D and Medicare Advantage. The letter addresses the following issues addressed in the proposed rule:
- Providing plan flexibility to manage protected classes
- Application of step therapy for Part D drugs by Medicare Advantage plans
- Explanation of benefits requirements
- Changes to the definition of negotiated price
- Pharmacy price concessions in negotiated price.
Read the letter.

Posted 1/25/19

Coalition Letters

ACCC joined with 240 signers in the September 12, 2018, Part B Access for Seniors and Physicians (ASP) Coalition letter to Congressional leaders. The coalition letter voices stakeholder concerns over the August 7, 2018, memo from the Centers for Medicare and Medicaid Services (CMS) that rescinds long-standing policy and allows Medicare Advantage (MA) plans to implement step therapy to manage Part B drugs in circumstances where applicable starting in 2019.
Read the Letter

CMS CY 2018 OPPS Final Rule

On November 1, 2017, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule with comment period (CMS-1678-FC), which includes updates to the 2018 rates and quality provisions, and other policy changes. The final rule contains significant provisions that reduce payments to hospitals participating in the 340B Drug Pricing Program. Read the rule.

CMS CY 2018 Physician Fee Schedule Final Rule

On November 2, 2017, the Centers for Medicare & Medicaid Services (CMS) released the calendar year 2018 Physician Fee Schedule (PFS) rule. Read the final PFS rule.

Archived Webinar: What You Need to Know about CMS' Final 2018 OPPS & PFS Rules

Legal experts present a one-hour (ACCC members-only) discussion about the Centers for Medicare & Medicaid (CMS) final 2018 OPPS and PFS rules. The agency's proposals under the OPPS will bring significant changes to 2018 payments for 340B hospitals and new outpatient facilities. ACCC members can access the recorded webinar, presentation slides, and rule summaries for in-depth analysis of the final rule. [Login Required] Webinar originally presented on November 29, 2017.

Quality Payment Program (QPP)

CMS CY 2018 QPP final rule.
Read CMS fact sheet on the final rule here.
Read ACCC comment letter to CMS on proposed CY 2018 QPP rule (August 21, 2017) on proposed rule updating CY 2018 QPP.
Access ACCC webinar and summary [login required] of final QPP rule. Webinar originally presented on December 6, 2017.
Information on the Quality Payment Program is available here.

PQRS

Physician Quality Reporting System
Note: 2016 was the last program year for the Physician Quality Reporting System (PQRS). PQRS transitioned to the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program. The final data submission time frame for reporting 2016 PQRS quality data to avoid the 2018 PQRS downward payment adjustment was January through March 2017.

Inpatient Prospective Payment System

ACCC analysis of 2018 Inpatient Prospective Payment System (IPPS) final rule. Log in required.

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Access, Payment & Reimbursement Reform

ACCC Joins Groups Expressing Concerns Over CMS' Interpretation of NCD for NGS

ACCC Joins in Letter to CMS Expressing Concerns with Proposed Part D & MA Rule