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NCCS Recommends Making COVID-19 Medicare Telehealth Coverage Expansion Permanent

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NCCS recently submitted a comment letter to the Centers for Medicare and Medicaid (CMS) regarding the Medicare physician fee schedule for calendar year 2021. The comment letter focuses on telehealth-related provisions of the proposed rule, as we are learning from our findings from our Telehealth Project that both patients and providers need more tools and strategies to maximize the benefits of telehealth. In the letter, we applaud CMS for expanding the list of services covered in Medicare telehealth services. We also recommend that the flexibilities granted during COVID-19 be permanent.

“…Patients shared that telehealth services offer convenience and lower costs associated with travel and time away from work and family. We are persuaded that a cancer care system combining telehealth services with face-to-face care can be of high quality, efficient, and responsive to the needs of patients. We will pursue legislative solutions in cases where CMS does not have adequate authority to extend regulatory flexibilities beyond the public health emergency.”

Read the entire comment letter below.
Download the Comment Letter [PDF] »

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October 5, 2020

The Honorable Seema Verma
Administrator
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Hubert H. Humphrey Building
200 Independence Avenue SW Washington, DC 20201

Submitted electronically at www.regulations.gov

Re: CMS-1734-P, Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2021

 

Dear Administrator Verma:

The National Coalition for Cancer Survivorship (NCCS) represents the 17 million cancer survivors in the United States in efforts to ensure access to quality cancer care for all. Our organization’s programs and policy efforts seek to improve the cancer care experience from diagnosis through treatment and long-term survivorship. We are pleased to offer comments on the proposed Medicare physician fee schedule for calendar year 2021, with a focus on telehealth-related provisions of the proposed rule.

Very early in the coronavirus pandemic, as cancer patients and providers were confronted with the challenges associated with providing and receiving cancer care safely, we undertook the NCCS Telehealth Project (www.canceradvocacy.org/telehealth) to obtain direction from cancer patients and survivors about strategies to maximize the benefits of telehealth and to obtain feedback from providers about the key patient themes and advice. In our comments on telehealth services in CY 2021, we will reference the findings of the project.

In previous cancer community comments on the interim final rules related to telehealth during the public health emergency, we commended the actions of the Centers for Medicare & Medicaid Services (CMS) to grant regulatory flexibilities to Medicare providers, consistent with legislation enacted early in the pandemic, so that they could provide telehealth services during the public health emergency. By waiving certain Medicare requirements for telehealth, the agency has helped protect cancer patient access to quality care.

The advice received from patients and survivors in the Telehealth Project persuades us that telehealth services should be available according to the CMS-granted flexibilities permanently and after the public health emergency. In addition to providing safety during the pandemic, especially for immune-compromised individuals, patients shared that telehealth services offer convenience and lower costs associated with travel and time away from work and family. We are persuaded that a cancer care system combining telehealth services with face-to-face care can be of high quality, efficient, and responsive to the needs of patients. We will pursue legislative solutions in cases where CMS does not have adequate authority to extend regulatory flexibilities beyond the public health emergency.

Telehealth

We have previously applauded the actions by Congress and subsequent actions by CMS to provide patients and providers flexibility related to telehealth services. In comments on the interim final rules released by CMS, we applauded the agency’s actions to loosen telehealth restrictions and to make regulatory changes that permit payment for telehealth services furnished in any geographic location in the country and to permit receipt of services in the patient’s home.

Additions to the Medicare Telehealth Services List for CY 2021
We support the efforts of CMS to add services to the list of covered Medicare telehealth services. In the case that regulatory flexibilities are extended, the addition of several of these services will be meaningful to cancer patients. CMS has identified services to be added on a Category 1, or permanent basis, because they are similar to services on the existing telehealth list and services to be added on a Category 2 (permanent) basis because there is demonstrated clinical benefit to those services. The agency has also proposed services as Category 3 services, for coverage through the end of the year in which the public health emergency ends. Finally, the agency has identified services that it does not recommend adding to the Medicare telehealth services but for which it is seeking advice for addition on a Category 3 or permanent basis.

The CMS recommendations for additions to the telehealth list and requests for advice represent a meaningful effort by CMS to strengthen Medicare telehealth services, although access after the public health emergency will require extension of the waivers of Medicare rules.

We will offer advice, according to the process outlined by CMS, for addition on a Category 2 basis for several telehealth services for CY 2022. We believe that we can establish a clinical benefit from these services. These recommendations will be based on the advice of the patients and survivors in the NCCS Telehealth Project and include:

  • Second-opinions and consultations, which will provide especially meaningful benefits to patients with rare cancers or complex co-morbidities, who may seek expert opinion at academic medical centers that are not close to where they live.
  • Multi-disciplinary telehealth visits that would include services of oncology nurses and other providers in addition to the services of the oncologist.
  • Palliative care consultations.
  • Evaluation and management services combined with follow-up navigation services, to ensure coordination of care and patient adherence to therapy.

The patients and survivors and the providers who participated in the Telehealth Project expressed concerns about the potential that telehealth services could exacerbate disparities in care, if underserved cancer patients do not have access to technology for telehealth care. On the other hand, they believed that ensuring access to technology for underserved patients could ensure telehealth access and boost overall quality of cancer care. To accomplish this, providers may be called on to provide access to technology as part of the cancer care process. We will offer more advice about that concept in the future; we believe that such efforts could be considered a practice expense for the purpose of establishing Medicare reimbursement rates.

Audio-Only Communication
The patients and providers participating in our project concluded that audio-only telehealth is generally inferior to telehealth that includes audio and video. However, both groups stressed that audio-only services are critically important during the public health emergency and will likely be important after the pandemic. Eliminating access to audio-only services may have a particularly severe impact on underserved patients who have no access to the technology necessary for audio-visual services. In addition, because cancer is a disease of the elderly who may not have technological access or expertise, eliminating audio-only services may have a particularly onerous impact on cancer patients.

We have suggested above that we will propose health system reform that would include supplying technology to patients who need it to receive telehealth services. However, we acknowledge that such a solution will not occur immediately. Even if we are successful in advancing this ambitious idea, there will be a transition period during which audio-only services will be necessary.

Through provisions of two interim final rules, CMS first established coverage and payment for audio-only services, which represented a significant change from previous Medicare coverage standards. The agency subsequently increased the reimbursement rate for audio-only services to equal the rate of in-person, established patient evaluation and management (E/M) services. These actions by the agency have been critically important to protecting access to care by cancer patients. We recommend that these policies be continued.

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We appreciate the opportunity to comment on telehealth services, including audio-only services.

Sincerely,

Shelley Signature
Shelley Fuld Nasso, MPP
Chief Executive Officer

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NCCS and Cancer Groups Make Recommendations to CMS Regarding Proposed 2021 Hospital Outpatient Prospective Payment System (OPPS)

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NCCS joined with other cancer patient and provider groups in a comment letter to the Centers for Medicare and Medicaid Services (CMS) regarding the proposed rule related to the hospital outpatient prospective payment system. Among the issues outlined in the letter is a concern about an additional reduction in payment for drugs in the 340B program, a program that helps hospitals who serve vulnerable and low-income patients access prescription drugs. The letter advises against another reduction and recommends that CMS work with the Health Resources and Services Administration to conduct an evaluation of the 340B.

Additionally, the comment letter commends CMS for addressing the date of service rule for cancer-related, protein-based laboratory testing and encourages the agency to consider the same exceptions to these tests for other diseases in future rulemaking efforts.

We commend CMS for its proposal to exclude certain cancer-related, protein-based Multianalyte Assays with Algorithmic Analyses (MAAAs) from the OPPS packaging policy. By excepting these cancer tests from the date-of-service policy and allowing them to be billed directly to Medicare by laboratories, delays in testing can be addressed and patient diagnosis treatment decision-making, and initiation of care can proceed without interruption or unreasonable delay.

Read the entire comment letter below.

Download the Comment Letter [PDF] »

CANCER LEADERSHIP COUNCIL

A PATIENT-CENTERED FORUM OF NATIONAL ADVOCACY ORGANIZATIONS
ADDRESSING PUBLIC POLICY ISSUES IN CANCER

October 5, 2020

The Honorable Seema Verma
Administrator
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Hubert H. Humphrey Building
200 Independence Avenue SW
Washington, DC 20201

RE: CMS-1736-P, Medicare Program: Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; New Categories for Hospital Outpatient Department Prior Authorization Process; Clinical Laboratory Fee Schedule; Laboratory Date of Service Policy; Overall Hospital Quality Star Rating Methodology; and Physician-Owned Hospitals

 
Dear Administrator Verma:

The undersigned organizations represent cancer patients, health care professionals, and researchers. We are pleased to have the opportunity to comment on the proposed rule related to the hospital outpatient prospective payment system, laboratory date of service policy, and other matters.

We note that our comments and advice are offered in the midst of a pandemic that has caused serious disruptions in the delivery of cancer care and has adversely affect access to cancer screening and routine care that might lead to cancer diagnosis. The effects on patients are serious, as they may suffer worsening of disease while treatment is delayed, or their cancer may be diagnosed at a later date and at a later stage. Both providers and patients have worked hard to address the challenges to delivering and receiving cancer care in the time of a pandemic, embracing telehealth services and ensuring proper use of personal protective equipment and other mitigation strategies to permit safe delivery of cancer care face-to-face. All the actions taken to address the pandemic bear costs, both in health terms and financially. We note this extraordinary time to suggest that reductions in reimbursement be approached with care. Additional challenges to the health care system may only serve to adversely affect patient access to quality care.

CY 2021 OPPS Payment Methodology for 340B Purchased Drugs

The Centers for Medicare & Medicaid Services (CMS) proposes to revise payment policy for outpatient drugs that are purchased under the 340B program. For calendar year (CY) 2018, CMS made a substantial change in payment for drugs purchased through the 340B Program. In place of the payment rate of ASP plus 6%, the agency set the Medicare payment rate at ASP minus22.5%. For calendar year 2019, this payment standard was extended to 340B drugs furnished by non-excepted off-campus provider-based departments.

The United States Court of Appeals for the District of Columbia, in a ruling on July 31, 2020, affirmed that CMS has the authority to reduce Medicare payment rates for 340B drugs reimbursed through the outpatient prospective payment system (OPPS).

CMS proposes for calendar year 2021 to further reduce Medicare payment for 340B drugs. For 2021 and years beyond, the agency proposes to adopt a rate of ASP minus 34.7 percent, with a 6 percent add-on amount for overhead and handling costs, for a proposed net rate of ASP minus 28.7 percent. The agency indicates that the proposed payment rate is based on data on drug acquisition costs in calendar year 2018 and 2019 that was collected through the Hospital Acquisition Cost Survey for 340B-Acquired Specified Covered Drugs.

We have serious reservations about relying on a survey that was undertaken in the middle of the pandemic as the basis for substantial reductions in payment for 340B drugs. According to CMS, only 7% of respondents answered the detail survey, 55% responded to the quick survey option, and 38% did not respond. We are not surprised that the response to this survey was not stronger, because hospitals were asked to respond at a time when their resources were dedicated to coronavirus pandemic response.

Our fundamental concern is that the reduced reimbursement rate that is based on a less-than-robust survey will adversely impact the vulnerable and low-income patients that the 340B program is intended to help and the institutions that serve those patients. The 340B program is of importance to institutions that serve a significant volume of cancer patients who depend significantly on drug therapies as part of their comprehensive cancer treatment.

We understand that there is interest in ensuring that the 340B program meets its original intent. Rather than apply additional reimbursement reductions to the program, we recommend that CMS, working with the Health Resources and Services Administration, undertake an evaluation of the 340B program to consider its alignment with the original goals and aims of the program. We also recommend that the evaluation focus on the appropriate size of the program and the kind of program safeguards that should be implemented. Reforms of the program should be considered after an evaluation of the program that engages all stakeholders. Another payment reduction will not serve the purpose of guaranteeing that the program operates to serve vulnerable patients in receipt of quality and affordable health care.

Laboratory Date of Service Rule

All of our organizations share the goal of ensuring that cancer patients receive care that is best for them and meets their needs and wishes. No matter the decision that cancer patients make about their care, appropriate and accurate diagnosis is critical to their decision-making. This includes access in timely and affordable fashion to clinical diagnostic laboratory tests.

We commend CMS for its proposal to exclude certain cancer-related, protein-based Multianalyte Assays with Algorithmic Analyses (MAAAs) from the OPPS packaging policy. By excepting these cancer tests from the date-of-service policy and allowing them to be billed directly to Medicare by laboratories, delays in testing can be addressed and patient diagnosis, treatment decision-making, and initiation of care can proceed without interruption or unreasonable delay.

Although cancer care providers and their patients have worked hard to address pandemic-related disruptions in care, we are concerned that delays and disruptions early in the pandemic and the impact of those delays on outcomes. There have been other disruptions related to cancer, including delays in screening that may result in diagnosis at a later stage of disease.

We are pleased that, at a time when the cancer community is working hard to address pandemic-related care disruptions, the agency has addressed the date of service rule at least for cancer-related, protein-based MAAAs. We encourage CMS to consider the same exceptions to MAAAs for other diseases in future rulemaking efforts.

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We appreciate the opportunity to comment on these issues that affect cancer patients’ access to quality care.

Sincerely,

Cancer Leadership Council
CancerCare
Fight Colorectal Cancer
Hematology/Oncology Pharmacy Association
LUNGevity Foundation
Lymphoma Research Foundation
National Coalition for Cancer Survivorship
Prevent Cancer Foundation
Susan G. Komen

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Health Care Roundup: Virtual Cancer Policy Roundtable; COVID-19 News; Coronavirus Resources for Survivors; More

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We aim to make the Health Care Roundup a concise, one-stop summary of what you need to know as we continue working together to make cancer care better for everyone. Your feedback is always welcome to make our content more useful to you. Please send comments to feedback@canceradvocacy.org.

Subscribe to our email list and receive these updates in your email box »

If you have any cancer-related questions or concerns about COVID-19, please reach us at www.canceradvocacy.org/contact.

HEALTH CARE HIGHLIGHTS

NCCS Hosts First-Ever Virtual Cancer Policy Roundtable

Last week, NCCS hosted its spring Cancer Policy Roundtable event, which convened patient advocates, providers, health care experts, and government agencies to discuss pressing issues in cancer care policy. NCCS has been hosting roundtables for 20 years, but given the public health crisis we are currently facing, this was the first virtual roundtable event. We are proud to say that it was a success, with over 200 attendees who heard from eleven dynamic experts in cancer care. You can view the sessions, handouts, and background materials here.

Additionally, NCCS will release a summary of the event soon. Also, check out this excellent article that features our roundtable keynote speaker, Dr. Otis Brawley.

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Health Care and the Coronavirus

Last week, a $2 trillion economic stimulus package was signed into law and now Congress is working on a fourth bill for coronavirus relief. This package is said to include increased protections and equipment for medical workers, expanded paid leave, new infrastructure investments, and additional funds for state and local governments.

It’s not just Congress that is busy addressing the public health crisis. Federal agencies, like CMS and FDA, are moving quickly to remove regulatory barriers to make it easier for health care providers to address the coronavirus pandemic. Earlier this week, the Centers for Medicaid and Medicare Services (CMS) announced a wide range of new policies – established by interim final rule and regulatory waivers – granting health care providers flexibility to meet the challenges of treating COVID-19. These policies will last for the length of the Public Health Emergency.

Part of the CMS rule includes flexibilities to boost hospital capacity and increase the medical workforce. The agency will let doctors and nurses care for patients in other settings — like ambulatory surgery centers, hotels and dormitories — to let hospitals separate infected patients from those who don’t have the virus. Medicare will pay lab technicians to travel to a homebound patient to test for COVID-19.

CMS will also pay for a wider range of telemedicine services, which includes allowing doctors to supervise their clinical staff remotely.

“Today, we're announcing that we're going to go even further and we're going to be paying doctors to make phone calls with their patients and provide care over the phone,” CMS Administrator Seema Verma announced at a COVID-19 Task Force press briefing Monday afternoon. “And we're getting rid of long-standing barriers to telehealth in the Medicare program, allowing emergency rooms to use telehealth and eliminating requirements that some visits be provided face-to-face.”

Patient Groups Urge Special Enrollment Period

POLITICO reported that the administration decided against opening a special enrollment period for Healthcare.gov, which would allow uninsured individuals to purchase plans outside of the open enrollment period.

NCCS joined with 28 patient & consumer groups to urge the administration to implement a special enrollment period as the nation fights to protect its citizens from this virus. The Affordable Care Act does allow for people who have lost employer-sponsored health insurance to enroll, which is important to the nearly 10 million people who filed unemployment claims in March.

Cancer Resources Available Now!

NCCS has heard from many survivors who feel uniquely vulnerable due to their history of cancer treatments. And we have heard from people currently in treatment, who are worried about delays in care and navigating a stressed health care system.

That's why we're partnering and consulting with experts to address the questions and concerns survivors have told us. Please bookmark this page, as it will be updated frequently.

Frequently Asked Questions from Cancer Survivors 
Below is a link that answers cancer survivors’ frequently asked clinical questions, submitted to NCCS, about COVID-19 from the American Society of Clinical Oncology (ASCO) Chief Medical Officer and Executive Vice President Dr. Richard Schilsky.

WHAT WE’RE LISTENING TO

All Coronavirus All the Time

Kaiser Health News

This week’s Kaiser Health News “What the Health?” podcast discusses changes in the U.S. health system brought on by the medical and economic needs during the coronavirus pandemic. The hosts also discuss how states are handling their own ACA insurance marketplaces and what the administration may or may not do regarding a special open enrollment period.

Read More »

WHAT WE’RE READING

As Coronavirus Strains Hospitals, Cancer Patients Face Treatment Delays, Uncertainty

National Public Radio

As hospitals across the country are forced to delay or cancel certain medical procedures in response to the surge in patients with COVID-19, those hard choices are disrupting care for some people with cancer.

Read More »

What Takes So Long? A Behind-The-Scenes Look At The Steps Involved in COVID-19 Testing

Kaiser Health News

The Food and Drug Administration is working to approve testing kits for COVID-19, but the process is much more complicated than you’d imagine.

Read More »

How Exercise Oncology Can Improve Cancer Outcome and Survivorship

ASCO Post

ASCO Post shared an interview with Kathryn Schmitz, PhD, MPH of the American College of Sports Medicine about the benefits of exercise for cancer survivors in reducing risk, speeding recovery, and improving quality of life.

Read More »

Related Posts

Coronavirus and Cancer Resources for Survivors

Health Care Roundup: COVID-19 Edition

NCCS Issue Statement HHS CMS

NCCS Expresses Opposition to CMS Healthy Adult Opportunity Guidance Permitting Medicaid Block Grants

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Department of Health and Human Services (HHS)

WASHINGTON, DC. (January 30, 2020) – The Centers for Medicare & Medicaid Services (CMS) earlier today announced a guidance to state Medicaid programs that encourages states to create a block grant program for the portion of their Medicaid program expanded under the Affordable Care Act. The National Coalition for Cancer Survivorship (NCCS) opposes the CMS action to permit Medicaid block grants because of their potential negative impact on people with cancer. NCCS issued the statement below on Medicaid block grants.

“The National Coalition for Cancer Survivorship (NCCS) represents people with all forms of cancer in efforts to ensure access to quality cancer care. NCCS objects to the guidance issued today, which would provide states advice on how to cap the Medicaid expansion program.

“Block grants or caps on Medicaid spending may have several results. States that implement Medicaid block grants will reduce their Medicaid rolls, reduce benefits for those who retain eligibility, increase cost-sharing, or reduce provider payments. Any of these actions, and certainly all of them combined, will eliminate access to care for some and affect the adequacy and quality of care for others. We do not believe that the flexibility of block grants can be utilized without affecting patients negatively.

“The Centers for Medicare & Medicaid Services (CMS) has named its new block grant program the Healthy Adult Opportunity and stated that it will provide states flexibility in providing care to adults under age 65 who are not eligible for Medicaid as a result of disability or in need of long-term care. The name of the program ignores the fact that adults who are on Medicaid expansion are ‘healthy’ only until they receive a cancer diagnosis or other serious diagnosis. At that point, they must have Medicaid benefits that are adequate and comprehensive so that they can receive the treatments they need to survive cancer. Such access may well not be available in a block grant program.

“We oppose the movement to Medicaid block grants, which will compromise access to quality cancer care for many enrolled in Medicaid expansion programs.”

Related Posts

Health Care Roundup: SCOTUS Prolongs ACA Lawsuit Review; Coping with Isolation; Medicaid Block Grants; The Nursing Shortage; More

Health Care Roundup: Drug Pricing Bill Advances; ACA Open Enrollment & Premium Data; Cancer Overdiagnosis; “Medicaid Haves and Have-Nots”; More

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NCCS Submits Comments to CMS on Oncology Care First Model

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Department of Health and Human Services (HHS)
The National Coalition for Cancer Survivorship (NCCS) submitted comments in response to an Informal Request for Information on the proposed Oncology Care First Model. This model was released by the Centers for Medicare and Medicaid Services (CMS).

The comments focus on concerns regarding adequate resources in the model to support high quality cancer care. The letter also identifies shortcomings in the model that could influence treatment choices or penalize practices if they are unable to remain in the model. “These potential shortcomings of the model must be addressed to ensure that the model meets its promise of fostering patient-centered care.”

Read the full comment letter below. View/download the letter in a new browser tab » [PDF]

Read more NCCS Policy Comments »

Related Posts

NCCS Joins with Cancer Leadership Council to Outline Concerns Regarding New “Step Therapy” Plan

NCCS Concerned That Proposed ACA Rule Changes Could Raise Costs for Patients and Disrupt Treatment

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Health Care Roundup: Drug Pricing Bill Advances; ACA Open Enrollment & Premium Data; Cancer Overdiagnosis; “Medicaid Haves and Have-Nots”; More

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We aim to make the Health Care Roundup a concise, one-stop summary of what you need to know as we continue working together to make cancer care better for everyone.Your feedback is always welcome to make our content more useful to you. Please send comments to feedback@canceradvocacy.org.

Subscribe to our email list and receive these updates in your email box »

HEALTH CARE HIGHLIGHTS

House Drug Pricing Bill Advances Out of Committee

The biggest health care news this week was the approval by the House Ways and Means Committee of H.R. 3, the Lower Drug Costs Now Act — Speaker Pelosi's drug pricing bill. The bill advanced along party lines, with opponents citing a recent report from the Congressional Budget Office (CBO) that said the plan would harm drug innovation and reduce the number of new drugs coming to the market. To address this concern, some Democrats are considering investing savings from H.R. 3 into the National Institutes of Health (NIH) to fund drug research. However, pharmaceutical industry lobbyists argue that NIH cannot replace private sector research and development.

The CBO score also showed that the plan would save Medicare $345 billion over the next decade, as a result of a provision that would allow the government to directly negotiate lower drug prices with private companies in Medicare’s Part D drug program. The bill will now head to the full House floor for a vote in the coming weeks. President Trump has not indicated whether he would support the bill, and Paige Winfield Cunningham of the Washington Post reports that Speaker Pelosi and President Trump are still working on a drug pricing deal. She writes, “Were the pair to arrive at any agreement on drug prices, it would be in the face of enormous odds.”

Meanwhile, on the Senate side, Senators Grassley (R-IA) and Wyden (D-OR) have introduced their own drug pricing plan — this one bipartisan. Their legislation would impose an out-of-pocket cap for beneficiaries and cap drug price increases at the rate of inflation. The Grassley-Wyden bill has the support of the President and has been described as “middle ground” by lawmakers. With the government funding deadline coming up in just a few weeks, this fall is sure to be busy in Washington.

CHART OF THE WEEK

With the ACA’s open enrollment starting November 1, Kaiser Family Foundation has a helpful fact sheet outlining health plan options and what’s covered through the ACA.

Thanks to the financial help that nearly 9 out of 10 HealthCare.gov customers receive, 1 out of 3 marketplace customers will have a plan available in 2020 with a premium of less than $10 per month, according to new data released this week by the Centers for Medicare and Medicaid Services (CMS). The vast majority will have a plan available for less than $100 per month. However, many consumers are not aware their premium costs could be that low.

Get America Covered created a chart outlining a knowledge gap among consumers between what they consider an affordable premium and what they expect coverage to actually cost:

Get America Covered Chart

Support NCCS while shopping on Amazon. A portion of your Amazon purchases will be donated to NCCS when you choose NCCS as your AmazonSmile charity. Get started »

IMPORTANT READS

Growing tumors in a dish, scientists try to personalize pancreatic cancer treatment

STAT News

Dr. Joseph Grossman is leading a study where pancreatic cancer cells are grown in lab dishes and are each dosed with different drugs in order to identify personalized treatment options for one of the deadliest cancers.

Read More »

State Border Splits Neighbors Into Medicaid Haves And Have-Nots

National Public Radio (NPR)

This article paints a personal picture of a national issue by illustrating the stories of people in neighboring states, one that chose to expand Medicaid and one that did not. A recent University of Michigan study found Medicaid expansion substantially reduced mortality rates from 2014 to 2017.

Read More »

Opinion: Blame rising cancer overdiagnosis on ‘irrational exuberance’ for early detection

STAT News Opinion

Even though overall mortality from cancer is falling, the overall incidence is rising. In this opinion piece, Dr. H. Gilbert Welch blames overdiagnosis — the diagnosis of cancers not destined to cause symptoms or death.

Read More »

Trump Is Trying Hard To Thwart Obamacare. How's That Going?

National Public Radio (NPR)

NPR outlines the five biggest changes made to the ACA during the Trump Administration, including the repeal of the individual mandate and attempts to repeal the entire law. Despite all these efforts, the ACA is still the law of the land and provides critical health coverage to millions of Americans.

Read More »

Related Posts

https://www.canceradvocacy.org/blog/health-care-roundup-oct-4-2019/

https://www.canceradvocacy.org/blog/health-care-roundup-sept-20-2019/

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Health Care Roundup: Medicare Payments for CAR-T; Cancer Screenings in Older Adults; Cancer and At-Home DNA Tests; End of Life Care; More

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We aim to make the Health Care Roundup a concise, one-stop summary of what you need to know as we continue working together to make cancer care better for everyone.Your feedback is always welcome to make our content more useful to you. Please send comments to feedback@canceradvocacy.org.

Subscribe to our email list and receive these updates in your email box each week »

HEALTH CARE HIGHLIGHTS

CMS Finalizes Medicare Payment Policies for CAR-T Therapies

CAR-T therapies, a cutting-edge type of immunotherapy, are seen by many as the next generation for cancer treatments. Of course, they are expensive and complicated to administer. The Centers for Medicare and Medicaid Services (CMS) recently announced long-awaited policies regarding payment for these treatments. CMS stated, “Medicare will pay for CAR-T therapies so long as they’re administered in health care facilities that follow the Food and Drug Administration’s special safety rules, known as risk evaluation and mitigation strategies, or REMS. Medicare will also pay for CAR-T even when it’s used to treat conditions that aren’t FDA-approved.” Read more on STAT News »

President to Unveil “Elaborate” Health Care Plan in September

The 2020 presidential race is well underway and will only heat up further this fall. There were rumors circling that President Trump wants to introduce health care initiatives that Republicans can use on the trail. Health care issues played a significant role in Democrats winning control of the House of Representatives in the 2018 elections. Those rumors appear to be true, as Bloomberg reports the president will announce an “elaborate” plan in a September speech. NCCS will continue to follow this and report what the plan entails and what it may mean for patients.

CHART OF THE WEEK

What Is Your State Doing to Affect Access to Adequate Health Insurance?

The Commonwealth Fund

In previous Health Care Roundups, NCCS has highlighted the numerous health care proposals by states that can impact access to coverage. We originally shared this interactive map by the Commonwealth Fund with you last October. Now newly updated, the map is a useful resource to quickly find what your own state is doing. As always, if you have questions or concerns about policies implemented or being pursued in your state, please contact NCCS at cpat@canceradvocacy.org to see how you can help.

Read More »

Support NCCS while shopping on Amazon. A portion of your Amazon purchases will be donated to NCCS when you choose NCCS as your AmazonSmile charity. Get started »

IMPORTANT READS

Op-Ed: In med school, a mission found me. But it will never be just a job — cancer and grief brought me to it

Los Angeles Times

A young woman’s fiancée died of cancer after incurring considerable medical debt from his cancer treatment. She went on to become an oncologist, and she shared the heartbreaking reality of not only losing her fiancée, but facing the financial toxicity as a result, in a graphic novel. It is a moving and powerful piece that encapsulates the physical, emotional, and financial costs of cancer.

Read More »

Cancer Treatment at the End of Life

New York Times

Continuing cancer treatment at the end of a life is a difficult topic and one that NCCS has been engaged in for many years to empower patients and educate providers. This is an insightful article that provides a caregiver’s perspective on making those difficult choices.

Read More »

Some people should stop being screened for cancer. Convincing them isn’t always easy

STAT News

Screening for cancer has long been a controversial topic, as there is an ongoing debate regarding the short- and long-term benefits of cancer screenings in older adults. This article, authored by a geriatrician and associate professor of medicine at Johns Hopkins University School of Medicine, provides a good overview of the issues that must be considered in this debate.

Read More »

Column: Why the short-term health plans Trump favors are cheap: They shortchange you on care

Los Angeles Times

NCCS has repeatedly voiced serious concerns about the dangerous implications of short-term health plans for cancer patients, survivors, or someone newly diagnosed with cancer. This article clearly outlines the basis for those concerns and reaches the obvious conclusion—they do not provide coverage for quality care.

Read More »

Researchers promote survivorship programs specific to Latino/a cancer patients

UNC Gillings School of Global Public Health

As survivorship programs continue to grow in locations across the country, this article highlights an important consideration: culturally tailored programs. Carmina G. Valle, PhD, assistant professor of nutrition at the UNC Gillings School of Global Public Health and her team adapted a survivorship program to cater to the needs of the Hispanic community. “Latino/a cancer survivors’ needs may differ from those of survivors from other populations, necessitating the development of evidence‐based, culturally appropriate cancer survivorship programs.”

To help increase participation and retention in these programs, it is important to ensure they meet the needs of individual patients as much as possible:

“Using materials that are not culturally adapted might result in non-participation in programs or use of materials,” says Valle. “For example, if nutrition information isn’t tailored to culturally relevant foods, populations may not invest in dietary changes.”

Read More »

23andMe had devastating news about my health. I wish a person had delivered it

STAT News

At-home DNA analyzing services are on the rise, providing consumers interesting insights into their ancestry and health. However, as is often the case with new technology, these insights come with serious implications. This article highlights one such instance, and raises the question of what types of guidelines are in place to protect consumers.

Read More »

Kathy Brandt, A Hospice Expert Who Invited The World Into Her Own Last Days With Cancer, Dies

Kaiser Health News

Kathy Brandt, a palliative care expert, died of a rare form of ovarian cancer on August 4. Since her diagnosis, she and her wife shared every detail of their experience. Dr. Kimberly Acquaviva, professor at the University of Virginia School of Nursing, shared:

“My wife @Kathy_Brandt is a hospice and palliative care professional, as am I. She decided early on that she wanted us to share her dying process — all of it — publicly so that she could keep educating people about death and dying until her last breath.”

Read More »

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https://www.canceradvocacy.org/blog/health-care-roundup-june-21-2019/

https://www.canceradvocacy.org/blog/health-care-roundup-august-2-2019/

NCCS Policy Comments HHS bldg

NCCS Concerned That Proposed ACA Rule Changes Could Raise Costs for Patients and Disrupt Treatment

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Department of Health and Human Services (HHS)
NCCS and member organizations of the Cancer Leadership Council (CLC) submitted comments to the Department of Health and Human Services (HHS) in response to the agency’s Notice of Benefits and Payment Parameters for 2020. The Notice contains rules and provisions that will apply to the individual market (the Affordable Care Act marketplace), and small group health insurance markets. The letter states NCCS’ concerns about specific provisions that may threaten cancer patients’ access to quality health care.

Below are the specific provisions for which NCCS provided comments:

  • NCCS urges CMS to reject any movement away from automatic re-enrollment for consumers in ACA marketplace plans. Automatic re-enrollment makes enrollment in health insurance more convenient and is consistent with private insurance practices.
  • NCCS opposes making post-enrollment assistance optional for ACA navigators, as cancer care is complex and patients benefit from assistance in utilizing their insurance to pay for their care.
  • NCCS opposes mid-year formulary changes that may change the cost-sharing for certain drugs. These formulary changes may put cancer patients at risk of disruption of their treatment plan and loss of access to the drugs recommended by their care team.
  • NCCS cautions against the proposed change to the manner in which the premium adjustment factor is calculated. This could result in consumers facing higher maximum cost-sharing amounts and higher premiums. We urge CMS to retain the current methodology for calculation of premium adjustment factor and thereby retaining important protections for consumers.

Read the full letter below.

Download the letter in PDF

CANCER LEADERSHIP COUNCIL

A PATIENT-CENTERED FORUM OF NATIONAL ADVOCACY ORGANIZATIONS
ADDRESSING PUBLIC POLICY ISSUES IN CANCER

February 19, 2019

Seema Verma
Administrator
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Hubert H. Humphrey Building
200 Independence Avenue, SW
Washington, DC 20201

RE: CMS-9926-P, Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2020

Dear Administrator Verma:

The undersigned organizations represent people with cancer who need adequate and affordable insurance to ensure access to quality and timely cancer care. We are writing to share our concerns about provisions of the Notice of Benefit and Payment Parameters for 2020 that may threaten cancer patients’ access to quality care. We urge reconsideration of certain provisions of the proposal.

Automatic Re-Enrollment

The Centers for Medicare & Medicaid Services (CMS) does not propose ending automatic re-enrollment in 2020 but asks for comment on terminating the policy of automatic re-enrollment of consumers in exchange plans, beginning with plan year 2021. We urge the agency to reject any movement away from automatic enrollment. As the agency states, automatic re-enrollment makes enrolling in health insurance more convenient for the consumer and is consistent with private insurance practices. In our experience, the assurance that consumers will be enrolled in a plan at the end of open enrollment affords a protection that is important to cancer patients.

Some of our organizations offer assistance to patients as they evaluate their plan options, to help those patients select coverage adequate for their cancer care needs. We know firsthand that this selection process is not easy and materials about plan options are not always useful. As the agency notes, enrollment materials should be designed to be consumer-friendly so that consumers understand the value of the plans they are considering. CMS signals a commitment to assisting with that design. We also support the efforts of CMS to “explore ways to increase the interoperability of patient-mediated health care data across health care programs, including in coverage purchased through the Exchanges.” Even if there is success in improving the materials available to consumers to support solid plan selection, we do not think that success would justify elimination of automatic re-enrollment.

The agency suggests that automatic re-enrollment makes consumers less aware of their plan options, blocks action to update their coverage and premium tax credit eligibility, and leads to unrecoverable federal spending if premium assistance is miscalculated. We agree that all these shortcomings of the enrollment process should be addressed. However, we do not believe that eliminating automatic re-enrollment would solve these problems.

The Role of Navigators

The proposed rule would make the provision of post-enrollment assistance by navigators in the federally facilitated exchanges an optional activity. We understand that reductions in funding
for navigators have placed strains on the system. However, we believe the solution is to provide adequate resources for navigators instead of reconsidering the allowable activities of navigators.

In our experience, cancer patients face significant difficulties in understanding their health insurance coverage and how to use it most effectively to pay for quality cancer care. Cancer
patients confront challenges related to network limits, coverage and payment standards for different elements of cancer care, and formulary issues. All these issues may affect the choices and options for care available to them. Cancer care is typically complex and interdisciplinary, and patients benefit from assistance in utilizing their insurance to pay for their care. We urge a
continuation of the requirement that navigators provide post-enrollment assistance.

Mid-Year Formulary Changes

CMS proposes to permit plans to make mid-year formulary changes to introduce new generic drugs to their formularies. Plans would be permitted to move the brand name drug for which a new generic drug is added to the formulary to a higher tier or drop the brand name drug from the formulary. Plan enrollees would be given a 60-day notice regarding mid-year formulary changes.

Mid-year formulary changes may put cancer patients at risk of disruption of their treatment plan and loss of access to the drugs recommended by their care team. We recommend that several patient protections be incorporated into this proposal. Patients who are utilizing a brand name drug for which a generic is introduced should not be required to switch to the generic drug without the recommendation of their care team. In connection with other drug pricing proposals discussed or advanced by this administration, this protection has been recommended. We urge that it be included in this proposal. The plan should also provide at least 90 and preferably 120 days of notice of a formulary change. For patients already utilizing a brand name drug, this would be a lesser protection than permitting them to remain on current therapy. However, this 90-day or 120-day timeline should be included for all consumers, to permit them to plan their treatment with full knowledge of the current formulary. There must also be an efficient exceptions process, in the situations where a health care provider believes that the brand name should be utilized in place of the generic added to the formulary.

Calculation of Premium Adjustment Factor

The agency has proposed to change the manner in which the premium adjustment factor is calculated. Under the agency proposal, National Health Expenditure Account (NHEA) estimates for all types of health insurance (except Medigap plans) would be included in the calculation. This contrasts to the premium adjustment factor calculation of past years, which has been based on employer-sponsored insurance rates. The agency suggests that the change in the calculation will more closely reflect the premium trends for all individuals in the private insurance market since 2013.

It seems that the agency is making this change in the calculation to save federal funds and because it has determined to forgo policy changes to address so-called silver loading in 2020. We are concerned about the proposed calculation of premium adjustment factor, because of its significant financial effects on consumers and because it would result in a loss of insurance coverage. CMS details the impact of the proposed changes in the premium adjustment factor calculation, including: 1) a higher maximum annual limitation on cost-sharing, 2) higher employer shared responsibility payment amounts, and 3) fewer employed individuals qualifying for the Advanced Premium Tax Credit, or APTC. In addition, CMS anticipates that the Department of the Treasury and the Internal Revenue Services will adopt the same premium measure, which would result in a decrease in the premium tax credit for which consumers would qualify and increase the contribution that consumers must make. The agency also predicts that the premium adjustment factor calculation will result in premium increases for exchange plans, in turn causing healthier enrollees not to purchase insurance on the exchanges.

Although the agency goal of reducing federal expenditures may be realized through this revised premium adjustment factor calculation, the corresponding impact on consumers will be significant and negative, as they face higher maximum cost-sharing amounts and higher premiums, in some cases resulting in decisions to forgo coverage.

We understand that the agency has considered a change to calculating the premium adjustment factor in the past but has rejected the change. We urge the agency to follow this example for 2020, by retaining the current methodology for calculation of premium adjustment factor and thereby retaining important protections for consumers.

If the change in the calculation is an indirect way of addressing silver loading, we recommend instead that the agency pursue a solution to payment of cost-sharing reductions and then address silver loading. We object to the change in the premium adjustment factor calculation because of the adverse effects of the change on consumers.

We appreciate the opportunity to comment on the proposed Notice of Benefit and Payment Parameters for 2020. We look forward to changes in the final notice, so that it more clearly reflects the needs of consumers who are seeking insurance coverage that protects their access to quality health care.

Sincerely,

Cancer Leadership Council
CancerCare
Cancer Support Community
The Children’s Cause for Cancer Advocacy
Fight Colorectal Cancer
International Myeloma Foundation
Leukemia & Lymphoma Society
LUNGevity Foundation
Lymphoma Research Foundation
National Coalition for Cancer Survivorship
Ovarian Cancer Research Alliance
Prevent Cancer Foundation
Susan G. Komen

Cancer Leadership Council
2446 39th Street NW, Washington, D.C. 20007 · Phone: 202-333-4041 · www.cancerleadership.org

# # #

Read more NCCS Policy Comments »

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https://www.canceradvocacy.org/policy-comments/nccs-clc-recommendations-fda-biosimilar-action-plan/

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Health Care Roundup: Health Care Spending; Survivorship Care Delivery; Metastatic BC at NY Fashion Week; Susan Gubar on Financial Toxicity; More

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In order to bring you the latest cancer-related health care policy and news, we at NCCS combined our ACA Updates and What Caught Our Eye (WCOE) content into a weekly email and blog post. We aim to make the Health Care Roundup a concise, one-stop summary of what you need to know as we continue working together to make cancer care better for everyone.Your feedback is always welcome to make our content more useful to you. Please send comments to feedback@canceradvocacy.org.

Subscribe to our email list and receive these updates in your email box each week »

HEALTH CARE HIGHLIGHTS

Medicare Spending, Surprise Billing, Drug Pricing

This week, the Centers for Medicare and Medicaid Services (CMS) published new health care spending projections for the United States. Unsurprisingly, Medicare spending growth is projected to outpace that of other payers in the coming decade due to enrollment growth and higher use of services. See a breakdown of the projections here.

On Wednesday, six hospital groups laid out an eight-point plan for dealing with surprise medical billing, a concept that has gained popularity among both parties in Congress. The plan was sent to Congressional leaders and included popular proposals like ensuring patients aren’t stuck with exorbitant bills. The groups also stated they want patients to have adequate provider networks.

Next week, the Senate Financial Services Committee will hold another hearing on the topic of drug prices, this time with seven CEOs of major pharmaceutical companies. To watch the hearing on Wednesday, visit the live stream.

CHART OF THE WEEK

CMS Estimates Annual U.S. Health Care Spending to Hit $5.96 Trillion by 2027

Morning Consult

As mentioned above, CMS projects the United States will spend $5.96 trillion on health care costs in 2027. These fiscal pressures could impact cancer care delivery, especially in Medicare, considering more baby boomers will move into Medicare and a majority of cancer diagnoses are in adults 65 and older.

Morning Consult Poll

Chart: Morning Consult

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IMPORTANT READS

Personalized Risk-Stratified Cancer Follow-Up Care: Its Potential for Healthier Survivors, Happier Clinicians, and Lower Costs

Journal of the National Cancer Institute

This commentary piece was written by Deborah K. Mayer, PhD, RN, AOCN, FAAN, interim director of the National Cancer Institute’s Office of Cancer Survivorship, and Catherine M. Alfano, PhD, vice president of survivorship at the American Cancer Society. In the piece, they discuss the changing approaches to delivering survivorship care, considering there will be more cancer survivors with fewer oncologists to treat them.

Read More »

The Financial Toxicity of Illness

New York Times Well Blog

In Susan Gubar’s latest thoughtful piece, she sets her focus on the devastating effects of financial toxicity for patients, saying, “cancer treatment escalates the possibility of penury, and treatment-produced fiscal catastrophes are tied to cancer deaths.” She examines the dilemma we as individuals and as a society face of where to draw the line between treatment costs and benefit.

Read More »

Why Do Only Eight Percent Of Cancer Patients In The U.S. Participate In Clinical Trials?

Forbes

It’s well known that very few patients participate in clinical trials in America, for a variety of reasons. A new study looks further into what some of those reasons are, with some interesting results.

“Most of the time it’s not up to the patient. Instead, structural and clinical barriers are the reasons more than 3 out of 4 patients do not participate in trials,” said Dr. Joseph Unger, who led the research.

Read More »

'Not Letting It Define Us' — Walking The Runway With Metastatic Breast Cancer

National Public Radio (NPR)

Last week, the third annual #Cancerland fashion show took place at New York Fashion Week. Two dozen models, all living with metastatic breast cancer, walked the runway. The event benefitted METAvivor, a metastatic breast cancer organization, and all the proceeds will be put toward research.

Rebekah Howerton described why she participated:

“We are changing the narrative from what is now currently in many ways a terminal disease to a chronic disease that women are living with. We are living our lives. We are working. We are moms. We are very normal in many ways.”

Read More »

Related Posts

Health Care Roundup: New Health Care Bills; NCCS Co-Founder Susie Leigh on Life After Cancer; Oncology Care Model; Racial Disparities; More

Health Care Roundup: Drug Pricing; Cancer Deaths Rise Globally; Health Care Champion John Dingell Remembered; Treatment at Home; “Survivor” Debate

NCCS Starburst 250px

House Votes to Intervene in ACA Lawsuit; Drug Pricing News; Colon Cancer Rates Rising in Young Adults; More

/in , , , , , , /by
In order to bring you the latest cancer-related health care policy and news, we at NCCS combined our ACA Updates and What Caught Our Eye (WCOE) content into a weekly email and blog post. We aim to make this a concise, one-stop summary of what you need to know as we continue working together to make cancer care better for everyone.Your feedback is always welcome to make our content more useful to you. Please send comments to feedback@canceradvocacy.org.

Subscribe to our email list and receive these updates in your email box each week »

HEALTH CARE HIGHLIGHT

ACA Resolution and Drug Pricing

This week, the House of Representatives voted to formally intervene in Texas v. United States, the lawsuit seeking to invalidate the Affordable Care Act (ACA). With support from three Republican members, it passed by a vote of 235-192. The resolution now heads to the Senate where Republican leaders will likely not bring it up for a vote.

This vote follows passage of last week’s provision authorizing the House legal counsel to defend the law. The case was filed last year, when 20 Republican Attorneys General filed a lawsuit challenging the constitutionality of the ACA, arguing that because the individual coverage mandate was essentially eliminated by Congress in the Tax Cuts and Job Reform Act, the rest of the law cannot stand on its own. Read NCCS' official statement on the matter »

In addition, drug pricing dominated the news this week. Early in the new year, Health Affairs reviewed prescription drug policy in 2018 and analyzed what to expect in 2019. On January 1, drug makers raised the price of more than 250 medications by an average of 6.3 percent. Yesterday, Sen. Bernie Sanders (VT) and Rep. Elijah Cummings (MD-7) introduced legislation aimed at reducing drug prices. The legislative package included several provisions, including tying U.S. median drug prices to those in several other countries and allowing the HHS Secretary to negotiate Medicare Part D prices.

CHART OF THE WEEK

Cancer in America Is Way Down, For the Wealthy Anyway

Bloomberg News

On Tuesday, the American Cancer Society released its annual Cancer Facts and Figures. Good news made headlines that cancer deaths have been dropping since the early 1990s, as much as 27 percent between 1991 and 2016. However, the report also notes, “Although the racial gap in cancer mortality is slowly narrowing, socioeconomic inequalities are widening, with the most notable gaps for the most preventable cancers.” Read More »


Chart: Bloomberg News

Support NCCS while shopping on Amazon. A portion of your Amazon purchases will be donated to NCCS when you choose NCCS as your AmazonSmile charity. Get started »

IMPORTANT READS

Companies Spent Nearly $30 Billion in One Year Marketing Medical Products to Americans

Los Angeles Times

Referring to a study published in the Journal of the American Medical Association, this article highlights the increase of annual spending on direct-to-consumer marketing of healthcare. “Drug makers and other healthcare companies spent almost $30 billion in a single year to influence the medical choices made by Americans and steer them toward treatments that were newer, vastly more expensive and sometimes risker than their tried-and-true alternatives, new research shows.”

Read More »

Colorectal Cancer is Killing More 20-to 30-year olds. We have no clue about why.

Vox

“It’s one of the mysteries that has puzzled cancer epidemiologists: Why are younger and younger people becoming sick with colorectal cancer?”

Read More »

Drug Giant Eli Lilly to Purchase Tiny Startup in $8B Deal To Get Access To Company’s Cancer Treatments

Kaiser Health News

Eli Lilly purchased Loxo Oncology, Inc., a Stamford, Connecticut-based biotechnology company that is developing cancer treatments that target a tumor’s genetic markers.

Read More »

Giant drug deal: Bristol-Myers Squibb buying Celgene for $74 billion

New York Business Journal

Bristol-Myers Squibb (BMS) Co. purchased Celgene Corp. in a deal worth $74 billion. BMS noted the acquisition will strengthen its cancer and inflammatory disease drug product. This continues the recent trend of mergers in the biopharmaceutical industry. It remains to be seen if and how these mergers will impact patients and their access to new and effective drugs.

Read More »

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NCCS Statement on District Court Ruling Affordable Care Act Unconstitutional

NCCS Health Care Roundup: Gov’t Shutdown Threat; NCCS Webinar; Analysis of 8 Democratic Universal Health Care Plans; More

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