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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 Proposed 2020 OPPS and PFS Rules

    On Monday, July 29, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2020 Outpatient Prospective Payment System (OPPS) proposed rule and the CY 2020 Physician Fee Schedule (PFS) and Quality Payment Program proposed rule.

    CMS states that the OPPS proposed rule puts forward price transparency requirements that will increase competition among all hospitals by requiring them to make pricing information publicly available.

    According the agency, the policy changes included under the proposed 2020 PFS rule align with the administration's aims to reduce providers' paperwork burden, remove unnecessary reporting measures, and reward clinicians for time spent with patients.

    The ACCC policy team is currently reviewing both proposed rules and will provide a more in-depth summary for ACCC members shortly.

    Posted 7/29/2019



  • ACCC Summary of RO Model Highlights Key Considerations

    On July 10, 2019, the Centers for Medicare & Medicaid Services (CMS) announced new details of a proposed bundled payment model for radiation oncology services (“RO Model”). As proposed, the model would make fundamental (but temporary) changes to the way that Medicare pays for radiation therapy in certain randomly chosen geographic areas. Under the proposed model, Medicare would pay providers a pre-determined, site-neutral bundled rate for most services provided in a 90-day episode of radiation therapy, rather than paying for each service individually. The proposed model would be mandatory for providers selected to participate and is intended to incentivize providers to deliver radiation therapy services more cost-effectively while maintaining or improving the quality of care delivered.

    The Association of Community Cancer Centers has released a summary of the proposed RO Model, including potential implications for providers and manufacturers offering radiation therapy services and products. The summary covers top-of-mind consideration for this model, as proposed, and outlines questions for further analysis going forward as ACCC works with stakeholders to further evaluate the proposal.

    Based on the proposed rule’s anticipated date of publication date in the Federal Register, comments on the proposal will be due September 16, 2019.

    Posted 7/16/2019



  • ACCC Joins In Comment Letter on Medicare NGS NCD

    The Association of Community Cancer Centers (ACCC) has joined with oncology stakeholder organizations in a comment letter to the Centers for Medicare & Medicaid Services (CMS) on National Coverage Determination (NCD) 90.2 for Next Generation Sequencing (NGS) for Medicare Beneficiaries with Advanced Cancer (CAG-00450R).

    Section 90.2 of NCD describes conditions of coverage for NGS. The section is being interpreted to apply to NGS tests for somatic and germline mutations. Additionally, Section 90.2 of the NCD states criteria that patients must meet to qualify for NGS testing, and stipulates specific requirements that the diagnostic laboratory test using NGS must meet.

    The comment letter to CMS cites specific concerns regarding the potentially deleterious effect of the Section 90.2 NCD on access to germline testing. The stakeholder letter recommends to CMS "that NCD 90.2 be revised to indicate that NGS-based germline genetic tests are exempt from the policy. This National Coverage Determination should specifically apply to somatic mutation testing and be renamed:

    National Coverage Determination (NCD90.2): Next Generation Sequencing (NGS) for Somatic."

    Read the comment letter.


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)

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: