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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 to Host Webinar Series on 2017 MIPS Feedback; 2018 Performance Categories

    The Centers for Medicare & Medicaid Services (CMS) will be hosting two "Office Hours" sessions over the next few weeks to provide a brief overview of the Merit-based Incentive Payment System (MIPS 2017) performance feedback and targeted review, answer frequently asked questions, and highlight available resources on performance feedback and targeted review. The two webinars will be held at the following times:

    If you are interested in submitting a question to be considered, please email CMSQualityTeam@ketchum.com. This email address is only for office hours questions; do not use this to submit a targeted review request. Space for these sessions is limited; register now to reserve your spot. The audio portion of the sessions will be broadcast through the web. Questions? Contact the Quality Payment Payment program at qpp@cms.hhs.gov.

    CMS is also hosting a series of webinars on the MIPS Performance Categories for Year 2 (2018) of the Quality Payment Program. The webinars will provide an overview on the Cost, Improvement Activities, and Quality performance categories for Year 2. CMS subject matter experts will cover topics including category requirements, scoring details, and data submission mechanisms. Below are details for these webinars:

    MIPS Cost Performance Category for Year 2 (2018) Overview Webinar

    MIPS Improvement Activities Performance Category for Year 2 (2018) Overview Webinar

    MIPS Quality Performance Category for Year 2 (2018) Overview Webinar

    The audio portion of these webinars will be broadcast through the web; you can listen to the presentation through your computer speakers. CMS will open the phone line for the Q&A portion, but if you are unable to hear audio through your computer speakers, please contact CMSQualityTeam@ketchum.com

    Posted 7/20/2018



  • ACCC Submits Comments to Administration's Drug Pricing Blueprint

    On July 16, the Association of Community Cancer Centers (ACCC) submitted comments to the Request for Information (RFI) included in the administration's Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs. The plan was released in May. 

    In its comments, ACCC expresses support for the overarching goal to "bend the cost curve by improving care, providing the right care at the right time, reducing over-treatment and under-treatment, and reducing hospital admissions and readmissions." However, ACCC cautions that "any policy solution to rein in drug costs must preserve patients' access to—and ability to afford—quality cancer care and, relatedly, mitigate any impact on already reduced payment rates for cancer providers."

    In brief, ACCC comments on the following concerns:

    • If HHS goes forward with revitalization of the Competitive Acquisition Program (CAP), there must be sufficient modifications to the program to preserve patient access to drugs, maintain provider flexibility, and permit providers to choose whether to participate based on whether participation in CAP will help them best serve their patients' needs, and not in response to punitive reimbursement cuts.
    • HHS should not impose Medicare Part D utilization management requirements on Medicare Part B drugs or move these drugs into Medicare Part D as doing so would reduce patient access and could increase costs to the Medicare program and patients. In addition, HHS should clarify how these changes would work in practice.
    • HHS should ensure that payment rates reflect the true costs of providing care at a particular site of service.
    • HHS should ensure that any proposals related to modifying the 340B Drug Pricing Program encourage all oncology providers to treat underserved patient populations.
    Read the ACCC Comment letter for a full discussion of these issues.

    Posted 7/16/2018

     



  • CMS Issues Proposed CY2019 Physician Fee Schedule & QPP Rule

    On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) released the CY 2019 Medicare Physician Fee Schedule (PFS) proposed rule. Included are proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare PFS on or after January 1, 2019.

    The agency's proposals for Year 3 of the Quality Payment Program (QPP) are incorporated under the CY2019 PFS proposed rule.

    Comments on the proposed rule are due by September 10, 2018.

    ACCC is currently analyzing the proposed rule and will provide an in-depth analysis for membership. 

    Read the CMS fact sheet on the 2019 PFS proposed rule.
    Read the CMS fact sheet on proposed QPP changes.


    CMS to Host Webinar on Proposed Rule for Year 3 QPP

    On Tuesday, July 17 from 1:00 - 2:30 PM ET, CMS will host a webinar on the proposed rule for Year 3 (2019) of the Quality Payment Program. CMS subject matter experts will:

    • Provide an overview of the proposed rule for Year 3 of the Quality Payment Program
    • Highlight key differences between Year 2 and proposed Year 3 requirements
    • Discuss the comment submission process
    • Provide additional resources

    Register here.

    Posted 7/12/2018



  • ACCC Submits Comments to CMS on NCA for CAR T Therapy

    On June 15, 2018, the Association of Community Cancer Centers submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the agency's opening of a National Coverage Analysis (NCA) for CAR T therapies for cancer. Currently, two CAR T-cell therapies are approved the U.S. Food and Drug Administration, Kymriah® (tisagenlecleucel) and Yescarta® (axicabtagene ciloleucel).  In comments its to the agency , ACCC urged that CMS:

    • Adopt a national coverage policy ensuring full Medicare coverage of CAR T therapies for their FDA-approved indications in all settings of care permitted by their labeling and REMS.
    • Allow Medicare Administrative Contractors (MACs) to cover FDA-approved CAR T therapies for indications listed in national compendia or supported by certain literature.
    • Clarify that the FDA-approved indications for CAR T therapies are covered by Medicare during the NCA process and complete that process as soon as possible to maintain uninterrupted patient access to these therapies.

    Additionally, ACCC expressed concern that the outcome of the NCA process may be stifling to innovation of CAR T therapies in the pipeline.

    Read ACCC Comment Letter

    Posted 6/20/2018



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)


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: