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REIMBURSEMENT UPDATE

OPPS CY2017 Update

Thank you to everyone who submitted comments during the Outpatient Prospective Payment System CY2016 comment period! Read NMDP/ASBMT’s joint comment letter to CMS. We will share analysis of the final rule when it is published in November.

Work with Utah Medicaid Successful in Preserving HCT Coverage

In July, Utah’s Department of Health issued a proposed rule that would limit Medicaid coverage of HCT−both in covered indications for HCT and donor search coverage. We worked with the University of Utah and Intermountain LDS Hospital to inform the Department of Health about the severity of the proposed rule’s impact on patient access to care. Thankfully, the Department of Health understood that the changes would be detrimental for the Utah Medicaid population and is in the process of correcting the final rule to align with our recommendations. We thank the University of Utah and Intermountain LDS Hospital for their help in ensuring Medicaid patient access to HCT.

Attend NMDP/Be The Match Council Meeting 2016

Join us in Minneapolis for our annual Council Meeting. Highlights include educational sessions on clinical and scientific research, patient and donor advocacy as well as a presentation titled Financial Barriers to HCT: Network Survey Review and Resources, from Kristen Edsall and Alicia Silver from our Payer Policy team.

Noteworthy Publication Roundup

Improve Medicare Policy to Remove Barriers to Bone Marrow and Cord Blood Transplants

Dr. Jeffery Chell, NMDP/Be The Match CEO, authored an article for the American Journal of Managed Care in August discussing the challenges of Medicare reimbursement for HCT and proposed policy solutions. In this article, he notes that “The most direct way to eliminate this barrier is to reimburse these cellular transplants in the same manner as solid organs.”

Allogeneic Hematopoietic Cell Transplantation as Curative Therapy for Patients with Non-Hodgkin Lymphoma: Increasingly Successful Application to Older Patients

Read about the efficacy of allogeneic HCT as standard of care for older patients with non-Hodgkin lymphoma. Fenske TS, et al. Published in Biology of Blood and Marrow Transplantation, September 2016.

Administrative Claims Data for Economic Analyses in Hematopoietic Cell Transplantation: Challenges and Opportunities

This article reviews the opportunities and challenges of administrative claims data to examine the cost and service utilization of allogeneic HCT and chemotherapy alone for patients with acute myeloid leukemia. Preussler JM, et al. Published in Biology of Blood and Marrow Transplantation, October 2016

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If you have any questions or need additional information, please contact the Payer Policy Team at PayerPolicy@nmdp.org. All of our resources are available on our website: Network.BeTheMatchClinical.org/Reimbursement.

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