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Lori Gardner, Senior Director
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301.984.9496 ext. 226
For Immediate Release: November 17, 2006
Association of Community Cancer Centers Comments on 2007 Medicare Final Hospital Outpatient Department Rule
ASP +6 Percent, Added Infusion Codes “Positive”, Lack of Payments for Pharmacy Services “Of Concern”
ROCKVILLE, Md.—The Association of Community Cancer Centers (ACCC) supports the decision of the Centers for Medicare and Medicaid Services (CMS) to keep payment for many separately paid oncology drugs at average sales price (ASP) plus 6 percent in 2007, and not to reduce payment to ASP plus 5 percent as CMS had proposed. In its comments to CMS, ACCC indicated that such a reduction would not be adequate to reimburse hospitals for both the costs of acquiring and preparing drugs for administration. ACCC had urged CMS to recalculate its payment rate and set rates at no less than ASP plus 6 percent in its final rule. That rule, Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2007 Payment Rates, was released Nov. 1, 2006.
“ACCC worked very hard with Congress and with CMS to keep 2007 drug reimbursement no lower than the 2006 levels,” said ACCC Executive Director Christian Downs, JD, MHA. “By keeping the payment rate at ASP plus 6 percent, CMS has chosen to protect cancer patients’ access to quality cancer care in the most appropriate setting.”
Still, ACCC is concerned that CMS has chosen not to reimburse hospitals for their pharmacy acquisition and handling costs. In its final rule, CMS stated that pharmacy handling costs are “included in hospitals’ charges for drugs.” ACCC disagrees and urges CMS to continue to work with stakeholders to study these costs.
For 2007, CMS will implement three significant changes to payment policies for drug administration services. First, CMS will make separate payment for second and subsequent hours of drug administration services. Up to now, CMS has packaged payment for additional hours into payment for the first hour. Second, CMS has organized the drug administration codes into new ambulatory payment classifications (APCs) with new payment rates. Although payments for the first hour administration codes have been reduced, payments for administrations lasting two hours or longer will be increased. Third, CMS will use all of the Current Procedural Terminology (CPT) codes for drug administration instead of the current mix of CPT codes and C-codes.
ACCC is undertaking a detailed analysis of these and other recent changes to Medicare payment policies, including payment changes to imaging services, and will report to its membership as to the significance and possible effects on patient access to quality cancer care. ACCC continues to advocate for adequate reimbursement that will help to protect beneficiary access to care by maintaining aggregate Medicare hospital outpatient payments for drugs and biologicals.