Washington Update, August 2019

Washington Update

Washington Update
By Johanna Gray

I’m writing today with two updates on issues that we’ve discussed in prior Newsletters and emails:

Skilled Nursing Facilities Update: In August, the Centers for Medicare and Medicaid Services released the final Skilled Nursing Facility (SNF) payment rule for 2020. In the final rule (available here), the Agency responded to the request made by the Hemophilia Alliance and NHF for hemophilia treatments to be able to be billed separately by saying that it does not have discretion to add new categories of treatments to the excluded categories. Here is the relevant section:

Comment: Commenters urged CMS to create an exclusion from consolidated billing for clotting factor and non-factor medication therapies for patients with hemophilia, similar to the existing exclusions for chemotherapy and its administration, radioisotope services, and certain customized prosthetic devices.

Response: We note that the item/ service categories cited by the commenters (chemotherapy and its administration, radioisotope services, and certain customized prosthetic devices) are in statute at section 1888(e)(2)(A)(iii) of the Act (as enacted through section 103 of the BBRA). As we indicated previously in the FY 2012 SNF PPS final rule (76 FR 48531), hemophilia treatments are outside the particular service categories that the statute authorizes for exclusion, and establishing an exclusion category for hemophilia treatment services, or any other service categories that are not specified in the statute, would require legislation by Congress to amend this statutory provision. Thus, we decline to adopt the commenter’s suggestion.

This was the expected response, which is why we continue our advocacy with Congress and hope to have legislation to address this issue introduced this fall. We’ll provide an update to the membership at the meeting in Portland in September.

Essential Community Providers Database: As Joe emailed to the membership a few weeks ago, it is time once again for HTCs to verify their listings in the HHS Essential Community Providers (ECPs) database. The Affordable Care Act (ACA) designates HTCs, along with all 340B covered entities, as essential community providers (ECPs) and requires that marketplace plans include a certain number in their networks. To implement this policy, several years ago, HHS created a database to facilitate plans’ ability to identify and contract with ECPs in their service areas. Contracting with a provider in the ECP database allows insurance plans to get “credit” for including the ECP in its network.

Due to technical issues with the ECP website, HHS has extended the deadline for covered entities to update their listings to August 31, 2019. If you haven’t already, please check to make sure that your center’s information is correct (for those already listed) or complete the form to be added to the database. There are more than 120 HTCs (and/or their parent institutions) who are listed in the database already, but it is important to make sure that the information is correct. We have heard from a few HTCs that they have been contacted by plans and ultimately got contracts because of the database. While changes can be made on a rolling basis, we encourage you to review your listing before August 31, 2019 so that any changes will take effect for the 2021 plan year.

You can complete the form here: https://data.healthcare.gov/cciio/ecp_petition. More information is available there and feel free to contact me (jgray@dc-crd.com) with any questions, as well.

Also in this Issue…

Notes from Joe
· The More Things Change…

Alliance Update
· We are Growing!
· Save the Date for an Alliance Session at the ASH Meeting on Making the Running of an HTC Tolerable

Legal Update
· Factor Loans During Emergencies: Truth and Fiction

Operations Update
· Reminder: Sharing HTC Information: Caution is the Best Policy
· Save the Date for an Alliance Session at the ASH Meeting on Making the Running of an HTC Tolerable

Payer Update
· Payer Relations Update


Team Alliance Contact Information

We work for you! Please don’t hesitate to contact any of us with any questions or concerns:

Name Email Phone
Joe Pugliese joe@hemoalliance.org 215-439-7173
Sean Singh sean@hemoalliance.org 727-388-7326
Jeff Blake jeff@hemoalliance.org 317-657-5913
Jeff Amond amond@hemoalliance.org 608-206-3132
Johanna Gray, MPA jgray@dc-crd.com 202-484-1100
Elizabeth Karan ekaran@feldsmantucker.com 202-466-8960
Roland P. Lamy, Jr. roland@hemoalliance.org 603-491-0853
Dr. George L. Oestrich, Pharm.D., MPA george@gloetal.com 573-230-7075
Ellen Riker eriker@dc-crd.com 202-484-1100
Mark Plencner mark@hemoalliance.org 701-318-2910
Michael B. Glomb MGlomb@ftlf.com 202-466-8960
Theresa Parker theresa@hemoalliance.org
Karen Bowe
Joel Bellucci webmaster@hemoalliance.org 727-504-0491