Policy Perspectives, October 2017
By Stephanie Farnia, ASBMT Director of Health Policy and Strategic Relations
September was an enormously busy month for ASBMT policy activities. Comment letters were submitted to CMS, we hosted our first Hill Day, spoke with our industry partners at the Corporate Council event and continued to work our way through the wacky world of reimbursement coding.
New CAR-T Code Alert
Two new ICD-10-PCS codes for CAR T go into effect as of October 1, 2017. The new ICD-10 codes are payer and product agnostic, meaning the new CAR T code can be used with all payers and for all CAR T products. Caveat: check with your commercial payers in terms of their use and acceptance of this code, as always. We are encouraging providers to use this code with any inpatient CAR-T treatment episode, regardless of whether it is part of a trial or with an approved product.
XW033C3: New Technology, Introduction via Peripheral Vein; Engineered Autologous Chimeric Antigen Receptor T-cell Immunotherapy
XW043C3: New Technology, Introduction via Central Vein; Engineered Autologous Chimeric Antigen Receptor T-cell Immunotherapy
More codes to come: In the month of October, ASBMT will be releasing a document that outlines the analysis we have performed, with the help of Nimitt Consulting, to identify the CPT and revenue codes that can be used to bill outpatient services, physician service and/or used for internal cost accounting practices in relation to the provision of CAR-T. Keep an eye out for an email blast noting that the document is available. We are also hard at work on the coding applications we will need to secure new codes for those areas where gaps have been identified.
Comment letters to CMS
A number of comment letters were submitted to CMS in the last few weeks. All of the letters are available in their entirety on the ASBMT website; quick highlights are below.
Outpatient Prospective Payment System: CMS made a proposal to adjust a status indicator for the 38205, PBSC harvesting for allogeneic transplant, simply as part of a routine house-keeping effort. There are unintended billing implications for this, which we outline in the letter. Additionally, we asked CMS to consider creating Comprehensive Ambulatory Payment Classifications (C-APCs) for Autologous HCT, Donor Lymphocyte Infusion and HPC Boost. As these C-APC request changes were not proposed by CMS, they have a slim chance of being finalized in the rule but may be taken up as off-cycle work by CMS for next year. Finally, we repeated our request that CMS find a way to pay separately for donor cell acquisition costs
Physician Fee Schedule: The PFS rule is considered one of the most important policy pieces of the year for physician groups that practice primarily in the clinic setting, as it governs which codes will be paid, at what rate and in which combination. While it is less immediately important for most of you in tertiary health systems, the ASBMT works with ASH, ASCO, and other societies to monitor downstream impact to your ability to bill the appropriate RVUs for your patient care encounters and demonstrate the required productivity levels to your financial team. Our comment letter this year included our concerns with proposed changes to the series of bone marrow aspiration codes, as well as apheresis and chemotherapy codes, and also encouraged CMS to continue their efforts to pay for more telehealth services. Dr. James Gajewski performed the lion’s share of the work in analyzing the proposed rule and sharing his perspective on the proposed changes with the other partner societies.
CAR-T: There was not a proposed rule issued by CMS in relation to payment policy for CAR-T, but we felt it was crucially important to create a problem statement letter, outlining the concerns we anticipate in the first year of using FDA-approved commercial products in the Medicare population. This is the longest of the letters by far – grab a cup of coffee first – but is important in understanding potential impact to your facilities. This is a public document and can be shared with financial staff at your facilities.
Legislative Advocacy in Washington
Partnering with the NMDP/Be the Match Payer and Public Policy team, the ASBMT hosted its first true Hill Day on September 7. As mentioned elsewhere in this newsletter, we were lucky enough to have 11 representatives from across the country join us to meet with Congressional members and staffers to talk about the need for improved research funding and appropriate reimbursement for HCT in the Medicare population. Throughout the day, we put a special focus on discussion of draft legislation being circulated by the NMDP that would require CMS to pay donor acquisition costs separately from reimbursing the cost of the patient’s hospital stay. So far, the bill has bipartisan support and the NMDP team is seeking a legislative vehicle to attach it to for passage this Fall. We will keep you informed as that develops and may ask for outreach to your government affairs teams or elected representatives. A tremendous thank you goes to the advocates who found time in their schedules to join us on the Hill, the NMDP team for their partnership and to Kathleen Lester, of Lester Health Law, who performed the intensive planning and coordination of our time in Washington.
ACA Repeal Efforts
As all of you well know, the efforts to try to repeal the Affordable Care Act continued in September with the Graham-Cassidy bill. The ASBMT continues to oppose any legislation that greatly reduces access to insurance coverage and care, threatens Medicaid funding and/or creates systems in which individuals face steep insurance penalties for pre-existing conditions. It is unlikely these efforts to undermine the ACA will cease, though they may shift into more regulatory efforts that impact the way the law is moved through the annual appropriations and rule-making cycles. We will continue to monitor these efforts and speak up when needed. I greatly appreciate the on-going willingness of many of you to speak up and advocate on behalf of the patients and families you treat.
Here’s hoping October brings more time for thoughtful work on all of our respective projects, as well as a bit of time for caramel apples, Halloween costumes and walks in the park before the snow flies.
Read the entire October 2017 ASBMT eNews here.