Policy Perspectives, March 2018

By Content Administrator posted 24 days ago

  

By Stephanie Farnia, ASBMT Director of Health Policy and Strategic Relations

Every year, it’s the same cycle. A month of exceptional franticness leading up to Tandem, a fantastic time seeing colleagues for a week of brainstorming, planning and learning, enjoying the 12 hours of relief on the day I travel home and then recognizing the rising feeling of panic the next day when I look at the notes I took regarding projects we need to begin or complete in the next year. But I have to say – despite the exhaustion of Tandem week for ASBMT staff, it is the highlight of my year to see all of you “IRL” (as the kids say) and get the chance to catch up on work and family. And if a little dancing happens as well, all the better!

Volunteers Sought:

  • ASH/ASCO Carrier Advisory Committee Representatives: ASH and ASCO have a joint committee called the Carrier Advisory Committee, meaning that the individuals advise the local Medicare Administrative Contractor (MAC) on Hematology/Oncology issues. These volunteers are assigned at the state level and may have several brief interactions with their MAC medical director a year. Additionally, in July, CAC representatives are invited into ASCO headquarters for an in-person meeting with the MAC medical directors on relevant Hem/Onc issues. Last year, Dr. Komanduri presented to this group about CAR-T and the need for coverage of lymphoma as a HCT indication. This is a great opportunity to build or strengthen your local relationship with the MAC in your area and is a low time commitment.

ASH & ASCO are attempting to involve more transplant and cell therapy physicians in the committee and have reached out to ASBMT to fill representative slots for the following states:

  • Arizona
  • Arkansas
  • Idaho
  • Indiana
  • Maine
  • Minnesota
  • Missouri
  • Montana
  • New Hampshire
  • New York
  • North Carolina
  • Puerto Rico
  • Tennessee
  • Texas
  • Virginia
  • West Virginia

Please email me – StephanieFarnia@asbmt.org – if you are interested. Administrators: please share with your MD team, as well. (If your state is not currently on this list as open, email me anyway – I will share with ASH & ASCO that you are interested if the slot opens up)

HCT:

  • We had a great session at Tandem regarding all things transplant and Medicare. If you missed it, we have our extensive slide deck posted as part of the Administrative Directors’ SIG page: http://asbmt.org/page/administrative-directors-sig-2017-meeting-presentations Share with colleagues!
  • There are several projects underway to create and update position papers on indications for transplantation that are meant to be shared with payers. Keep an eye out for information on AutoHCT and scleroderma this Spring and a broader update to the Standard Indications paper in the Fall.
  • The ASBMT Request for Information (RFI) used by payers and transplant programs will be available in early April. Please note that the CIBMTR electronic data pull option does not match exactly for the 2018 RFI process – more information can be found on the RFI page. For those pulling the data internally, the RFI categories have not changed from other years.

CAR-T:

  • ASBMT is leading a meeting with CMS on March 6 that includes ASH, ASCO and CAP to discuss the CAR-T coding situation, in the hope of securing HCPCS Level II G codes while we wait for new CPT codes to come online in 2020. G codes track the physician and facility services and are separate from the coding of the drug – they are accepted by CMS and most other payers and can provide data on the service utilization before the CPT codes are available. I am hoping to know more on this request by the June or July newsletter.
  • There has been an overwhelming number of questions for personalized support at the center level as your programs begin administering commercially approved CAR-T products. We will try to build out more resources for you to utilize and share with your teams including another Town Hall session on CAR-T coding and reimbursement in early April. Watch for more information and how to sign up via email and the Administrative Directors SIG listserv – please sign up for the listserv if you are not currently taking part.
  • By the time you read this, the ICER process will have wrapped up with a day-long meeting with the California Technology Assessment Forum. Dr. Komanduri presented a view from the ASBMT perspective and we anticipate a recording of the session to be available on the website: https://icer-review.org/topic/car-t/
  • At Tandem, I presented an overview of current coding and reimbursement ‘quirks’ to be aware of for CAR-T. The presentation is available on the Administrative Directors’ SIG page.

CMS Inpatient Prospective Payment System: The annual proposed rule will be issued in late March/early April and will likely contain some unexpected issues to sort through. We have asked for new CAR-T MS-DRGs and for CMS to address the acquisition reimbursement issue for HCT. Please keep an eye out for a brief analysis and call to action in mid-April.

Value and Health Economics SIG: There were several standing-room-only presentations in the Value and Health Economics SIG track (within the Administrative Directors track) at Tandem. We are hoping to repeat a few of these via webinar later this year, along with launching other initiatives. Stay tuned!

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