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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.

  • CMS Releases Final Rule to the Radiation Oncology Model

    On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) released the CY 2022 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems final rule (CMS-1753-F). This announcement includes the finalized modifications to the Radiation Oncology (RO) Model.

    The RO Model is set to begin January 1, 2022, and end December 31, 2026. The proposed rule includes the summarized modifications below:

    • Adjustment to the pricing methodology (updated baseline period is 2017 to 2019 and lowered discounts to 3.5 and 4.5) for the professional component and technical component, respectively
    • Removal of brachytherapy from included modalities
    • Removal of liver cancer from included cancer types
    • Finalization of cases in which a beneficiary switches from traditional fee-for-service (FFS) to Medicare Advantage during an episode and before treatment is complete. CMS will consider this an incomplete episode and radiation therapy services will be paid under FFS.
    • Modification to the current Pennsylvania Rural Health Model (PARHM) overlap policy to only exclude hospitals participating in the model, no just PARHM-eligible hospitals
    • Addition of an overlap policy for the Community Track of the CHART Model
    • Addition of an extreme and uncontrollable circumstances policy.

    For additional information on the RO Model and CMS' final rules, visit the RO Model website or read more on thefinal rule. For questions on the model or for participants needing their model ID, contact RadiationTherapy@cms.hhs.gov.

    Posted 11/3/2021



  • CMS Announces RO Model Updates

    The Centers for Medicare & Medicaid Services (CMS) announced its intent to delay the Radiation Oncology (RO) Model to July 1, 2021. The delay is included in the 2021 Hospital Outpatient Prospective Payment (OPPS) Final Rule (CMS-1736-FC) as an interim final rule with a comment period.

    Due to the delay, the following changes have been made to the RO Model:

    • The first performance year (PY) will be from July 1 to Dec. 21, 2021.
    • The model performance period will be 4.5 years.
    • CMS expects the Model to qualify as an Advanced Alternative Payment Model (APM) and a Merit-Based Incentive Payment System (MIPS) under the CMS Quality Payment Program (QPP) beginning in the PY2.
    • Certified Electronic Health Record Technology will be a requirement starting in PY2.
    • The individual practitioner list will still be required in PY1, but it will only be used for QPP in PY1 to assign an automatic 50 percent score for the Improvement Activity performance category in MIPS for RO participants.
    • RO participants must, beginning in PY2, collect quality measures data from Jan. 1, 2022, through Dec. 31, 2022, and submit in March 2023.
    • The collection period for clinical data elements will begin on Jan. 1, 2022. The first submission of the clinical data elements for Jan. 1, 2022, through June 30, 2022, will be due in July 2022.
    • A CMS-approved contractor will administer the CAHPS® Cancer Care Survey for Radiation Therapy beginning in October 2021 instead of April 2021.

    An updated version of the RO Model FAQs to reflect these changes is available.

    RO Model Billing Webinar Update
    This webinar has also been postponed to Jan. 13, 2021. Call in information for this webinar can be found here.

    For any questions not answered in this update, you can reach out via email to CMS at: radiationtherapy@cms.hhs.gov. Additional information about the RO Model, including all changes, can be found on its website.

    Posted 12/3/2020

     



  • CMS Announces Resources + Office Hours for RO Model Participants

    The Centers for Medicare & Medicaid Services (CMS) has released resources and reminders to help those participating in the Radiation Oncology (RO) Model. These resources include help with accessing and navigating the Radiation Oncology Administrative Portal (ROAP).

    Upcoming Changes to the ROAP:

    • Access to multiple RO Model IDs
    • Low volume opt-out
    • Ability to edit your profile information.

    If you haven't already done so, CMS encourages you to register for ROAP as soon as possible. To register for ROAP, you will need your Model ID, Taxpayer Identification Number (TIN) for physician group practices and freestanding radiation therapy centers or CMS Certification Number (CCN) for Hospital Outpatient Departments, first name, last name, and email address of the designated primary contact in the appropriate fields.

    If you do not know your Model ID, please contact the CMS Helpdesk (1.888.734.6433, option 5). Hospital Outpatient Departments should email or call with their CMS Certification Number (CCN), so it can provide the correct Model ID; physician group practices and freestanding radiation therapy centers should call the Helpdesk with their practice’s Taxpayer Identification Number (TIN) to retrieve the correct Model ID.

    ROAP Office Hours
    RO participants can call into standing office hours that have been set up for troubleshooting ROAP login issues. Office hour dates and times include:

    • Tuesday, December 1 at 12:00 PM EST
    • Thursday, December 3 at 12:00 PM EST

    More dates are to be determined after Dec. 3, 2020. To join an office hour, join the Zoom meeting by following the link or by entering the Meeting ID (160 189 1276) and password (881584) on Zoom.

    For additional information about the RO Model, please visit its website. Or read the ROAP User Manual and ROAP FAQs.

    Posted 12/1/2020

     



Coalition Letters

ACCC has collaborated with American Cancer Society Action Network (ASC CAN) and 13 other stakeholder organizations in a March 16, 2020, collaborative letter responding to ClinicalTrials.gov's request for information to guide their modernization process. Among the recommendations:

  • Improve website functionality to better facilitate trial matching.
  • Enable easy site-agnostic trial screening.
  • Make search by cancer type, cancer subtype and cancer stage/grade via separate fields available.
  • Integrate the ability to search by biomarker status, which may identify a subtype for some cancers, and is increasingly important in clinical trial matching.
  • Include links to disease-site-specific patient advocacy websites, and more.

Read the Letter

ACCC joined in a February 18, 2020, coalition letter to congressional leadership urging that Congress include the bipartisan Clinical Treatment Act (H.R. 913) in the Healthcare Extenders Package that is likely to pass this spring.

Passage of the Clinical Treatment Act would guarantee that routine care costs of clinical trial participation would be covered for Medicaid beneficiaries with a life-threatening condition. Currently, Medicaid is not federally required to cover these clinical trial associated costs.

Because these costs only encompass non-experimental costs of treating patients (e.g., doctor's visits and lab work) on clinical trials, the Clinical Treatment Act would not significantly affect overall cost to Medicaid programs.
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 RequiredWebinar originally presented on November 29, 2017.

Quality Payment Program (QPP)

PQRS

Inpatient Prospective Payment System

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

Archive of ACCC Comment Letters on CMS Physician Fee Schedule:

Archive of ACCC Comment Letters to CMS on Recent OPPS Proposed Rules: