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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 Announces Exceptions & Extensions for Quality Reporting Requirements

    In response to the COVID-19 health emergency, the Centers for Medicare & Medicaid Services (CMS) on March 22 announced exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs.

    Read agency statement (includes extensions for upcoming measure reporting and submission deadlines).

    CMS states: "For those programs with data submission deadlines in April and May 2020, submission of those data will be optional, based on the facility’s choice to report. In addition, no data reflecting services provided January 1, 2020 through June 30, 2020 will be used in CMS’s calculations for the Medicare quality reporting and value-based purchasing programs."

    Posted 3/23/2020


  • ACCC Responds to CMMI RFI on Oncology Care First Model

    On Dec. 12, 2019, the Association of Community Cancer Centers (ACCC) provided comments to the Center for Medicare and Medicaid Innovation's informal Request for Information on its potential Oncology Care First Model. Applauding CMMI for making the OCF Model voluntary and envisioning a multi-payer model, ACCC urged CMMI to:

    • make significant changes to the risk tracks for purposes of performance-based payment episodes,

    • structure the prospective payment for care management and certain other services as a supplemental payment,

    • provide more detail on the methodology for the novel therapy adjustment and ensure that the final adjustment adequately accounts for the cost of innovative and often life-saving new therapies, and

    • provide more details and future opportunities to comment on the OCF before finalizing the Model.
    Learn more and read comment letter. 

    Posted 12/19/2019

     


  • CMS Issues RFI on Oncology Care First Model

    Late Friday, Nov. 1, the Center for Medicare and Medicaid Innovation (the Innovation Center) released an informal Request for Information (RFI), on value-based payment to support high-quality oncology care. In the Nov. 1 announcement the Innovation Center stated they hope to gather feedback during today's Public Listening Session that will outline a potential Oncology Care First (OCF) Model. 

    The Innovation Center stated Friday at the Nov. 4 Public Listening Session and in submitted written feedback, they hope to solicit stakeholder input on the following targeted topics:

    1. The potential OCF Model would seek to improve health outcomes and quality of care for Medicare beneficiaries with cancer. How could the potential model support participants’ care transformation through practice redesign activities? Specifically, how could the potential model build on lessons learned from the implementation of the practice redesign activities included in the Oncology Care Model (OCM)? What revisions or additions should be made to the OCM practice redesign activities in the potential model?
    2. We welcome feedback on the potential payment methodology, including the structure and design of the monthly population payment and the performance-based payment. We are considering the inclusion of additional services in the monthly population payment, such as imaging or lab services, and seek feedback on adding these or other services to the monthly population payment.
    3. We encourage feedback on the conceptualized risk arrangements, in particular, how a downside risk arrangement might be best constructed in terms of the level of risk.

    We invite feedback on the interest of physician group practices (PGPs) and hospital outpatient departments (HOPDs) in participating in a potential OCF Model. We are particularly interested in hearing from PGPs and HOPDs about the conceptualized participation eligibility parameters (e.g., the grouping concept), and whether they think that meeting those parameters would be feasible. We also invite feedback from potential payer partners, including commercial payers and state Medicaid agencies. We welcome suggestions about the model concept that would better incentivize participation in the potential model.

    CMMI Public Listening Session on Potential Oncology Payment Model
    Monday, Nov. 4, 2019
    1:00 to 4:00 PM     EST

    Registration for the Public Listening Session is required. There are three ways to participate: in person, via livestream video, or via teleconference. REGISTER HERE.

    Posted 11/04/19


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 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: