Legislative and Economic Update. Arash Naeim, MD PhD Director, UCLA Geriatric-Oncology Member, ASCO Clinical Practice Steering Subcommittee. Special Thanks. Joseph S. Bailes, MD Chair, ASCO Government Relations Council Shelagh Foster, Esq ASCO Leglislative Affairs Georgia Nixon
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Arash Naeim, MD PhD
Director, UCLA Geriatric-Oncology
Member, ASCO Clinical Practice Steering Subcommittee
Payments for chemotherapy and supportive care drugs
Medicare statute authorizes carriers to cover off-label uses of cancer drugs not in the compendia based on studies in peer-reviewed publications specified by CMS
CMS’s current list of 15 journals had not been updated since legislation was passed in 1993
ASCO recommended that additional journals be added to the CMS list.
CMS announced that an additional 11 journals would be recognized effective October 22, 2007.
Annals of Oncology
Biology of Blood and Marrow Transplantation
Bone Marrow Transplantation
Clinical Cancer Research
Int’l Journal of Radiation, Oncology, Biology, and Physics
Payments for technical component of imaging services provided in the office capped at HOPPS level (includes CT, PET, MRI, etc. but not mammography)
Reduction of 25% for multiple imaging services in same “family” continuing. Savings will not be transferred to other services as CMS had planned
For services affected by both provisions, CMS will first apply the multiple imaging adjustment and then apply the HOPPS cap
The CMS NCD still stands
FDA mandated changes to ESA labels (July 2008)
Two new reports of negative outcomes in ESA studies (November/December 2007)
ODAC met March 13 to review ESA safety data and make recommendations to FDA.
CMS Recovery Audit Contractors (RACs) have identified overpayments (and underpayments to a lesser extent) in New York, Florida, and California as part of a demonstration project.
Drugs and services are subject to review.
In response to complaints that audits are excessively burdensome, ASCO has recommended measures to CMS to make program less onerous on practices.
Recent legislation authorizes expansion of RAC program to all 50 states by 2010.