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California Oncology Weekly
"Where California Oncologists Go For Answers!"
A collaborative publication of the
Medical Oncology Association of Southern California, Inc.
and the
Association of Northern California Oncologists, Inc.
August 15, 2017
National Health Center Week, August 13-19
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- CMA Board of Trustee Meeting summary (California News)
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California News
- Californians Allied for Patient Protection (CAPP) the Coalition to Protect MICRA, is opposing AB 859
(Eggman), a bill that would make it easier for trial lawyers to circumvent MICRA's protections. The bill will be back up for discussion once the legislature reconvenes in late August. In the meantime, CAPP is using this time to reconnect with state legislators about the importance of protecting MICRA.
- The Institute for Clinical and Economic Review (ICER) has posted a Draft Scoping Document on chimeric antigen receptor t-cell (CAR-T) therapies for treatment of B-cell malignancies. The document will be open to public comment for three weeks until August 29, 2017 at 2pm PT. It will inform a report assessing the comparative clinical effectiveness and value of CAR-T therapies, which will serve as the basis of discussion during a March 2018 public meeting of the California Technology Assessment Forum (CTAF).
- Attached, please find a note from CMA Board Trustee, Dr. Barbara Yates Weissman of the last CMA Board of Trustee meeting, as well as a CMA summary of the meeting.
- Forthcoming CMA webinars include:
* Assembly Bill 72: How to Challenge the Interim Payment for Out-of-Network Services at In-Network Facilities (September 27).
Learn more and register at
www.cmanet.org/events
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* MLN Connects
Announcements--New Medicare Card: Webpage Updates; Hospice Quality Reporting Program: Reconsideration Period Ends August 17; EHR Incentive Program Hardship Exception Application Due by October 1; Chronic Care Management: New Connected Care Videos; Quality Payment Program Hardship Exception Application for 2017 Transition Year Open; Quality Payment Program: Explanation of Special Status Calculation-Correction
Claims, Pricers, & Codes
--July 2017 OPPS Pricer File; Part B Billing for Certain New Biosimilars Biological Products before the Modifier is Implemented
Publications--
Quality Payment Program 2017: MIPS Quality Performance Category Web-Based Training Course-New; Medicare Secondary Payer Web-based Training Course-Revised; Medicare Secondary Payer Booklet-Revised
* CMS National Provider Enrollment Conference-September 6 and 7, 2017
* MolDX: Polaris Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease Final LCD-Effective September 25, 2017
* MolDX: Xpresys Lung Final LCD-Effective September 29, 2017.
- Forthcoming Noridian/JEMAC webinars include:
* Duplicate Claims (September 13)
- Noridian has published the ICD-10 Coding Revision to NCDs CR10184.
Change Request (CR) 10184 outlines edits to International Classification of Diseases, 10th Revision (ICD-10) and other coding updates specific to National Coverage Determinations (NCDs) that will be included in subsequent, quarterly releases as needed. No policy-related changes are included with these updates. Read the complete update
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- The Department of Managed Health Care (DMHC) invites you to a public meeting on the development of the standard formulary template as required by Senate Bill 1052 (2015). The meeting will be held at 980 9th Street, 5th Floor, Sacramento, 95814, on August 25, 2017, beginning at 10:00 a.m. and ending after the last public comment is received. Seating is limited for in-person attendance and will be on a first-come, first-served basis. Participants may also join via conference line at the phone number listed in the agenda. The purpose of the meeting is to solicit public input on the draft standard formulary template in advance of the DMHC beginning the formal rulemaking process.
Click here to view the agenda for the public meeting. Click here to view the draft standard formulary template. For additional information, please contact stakeholder@dmhc.ca.gov.
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SAVE THE DATE! Join us for the 2017 Clinical Staff, Oncology Billing & Administrator Programs8:30am to 12:30am, November 8, 2017- Clinical Staff Program (Nurses, pharmacists, NPP's) and November 9, 2017- Administrators Program and Billers Program, at the DoubleTree Suites by Hilton Anaheim Resort. Topics to be presented and discussed are: Pharmacy Standards/USP Regulations; Immunotherapy and Targeted Therapy; Nibs & Mabs; MACRA/MIPS; Pain Management; A/R Billing Updates, and more. For more
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- The Conquer Cancer Foundation of the American Society of Clinical Oncology is now accepting applications for the 2018 Young Investigator Award (YIA). The Association of Northern California Oncologists (ANCO) is funding one 2018 YIA for a qualified northern California applicant, and urges all eligible northern California physicians to apply. The YIA is a one-year, $50,000 grant that provides research funding to promising physicians to support their transition from final years of training to faculty appointment and to encourage and promote quality research in clinical oncology. Applications in all areas of cancer research are accepted from U.S. and international applicants. For 2018, CCF has dedicated funding for the following areas: breast cancer, northern California researchers, global oncology, kidney cancer, lung cancer, pediatric cancer, sarcoma, and supportive care. Other areas of interest include cholangiocarcinoma, chronic lymphocytic leukemia, gynecological caners, and melanoma. YIA applications opened on July 1 and are due by 11:50PM ET on September 21. Eligibility criteria, award details, and the request for proposals are available on the CCF website (www.conquer.org/YIA). For questions about the YIA or assistance with your application, please e-mail grants@concquer.org.
- ANCO's 2017 Professional Education Meeting will take place on September 6 at the San Jose Fairmont and feature talks on QPP/MACRA, ASCO's COME HOME Project, USP 797/800, and California Legislative/Regulatory Updates. Download the meeting announcement and registration form at www.anco-online.org/ProfEduc2017.pdf.
- ANCO's 3Q2017 Hematologic Malignancies Update will take place on September 9 at the Stanford Park Hotel in Menlo Park. Watch for a meeting announcement in late July. Bruno Medeiros, M.D., Stanford University, Charalambos Andreadis, M.D., University of California, San Francisco, and Brian Sworder, M.D., Ph.D., Stanford University, will review the latest research on novel treatment modalities for leukemia and lymphoma, along with case studies for these diagnoses. These Updates are supported by Janssen Biotech, Merck, Pfizer Oncology, and Pharmacyclics. Download the meeting announcement and registration form at www.anco-online.org/3Q2017HemeMalig.pdf.
- The 18th Multidisciplinary Management of Cancers: A Case-based Approach returns to the Silverado Resort and Spa in Napa on March 16-18. The meeting is sponsored by the Association of Northern California Oncologists, Stanford Cancer Institute, UC Davis Comprehensive Cancer Center, and UCSF Helen Diller Family Comprehensive Cancer Center. Go to www.multicancers.org to register your interest in receiving registration and housing information when it becomes available in the Fall.
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- President Donald Trump appointed Tomas Philipson, an economist who specializes in health care policy, to the three-member Council of Economic Advisers. Philipson, who briefly advised the Trump transition team on health care matters, was a senior economic advisor at the Food and Drug Administration and Centers for Medicare and Medicaid Services during the George W. Bush administration.
- A Senate-passed bill to make it easier for terminally-ill patients to access experimental drugs that have not won federal approval will likely face lengthier deliberations in the House. The Senate fast-tracked the legislation on Aug. 3, but the House will likely have the bill move through the committee process before considering it on the floor.
- The Anthem Network Update (August 2017) is now available online at
www11.anthem.com/ca/provider/f5/s3/t3/pw_g314735.pdf
and features articles entitled Specialty pharmacy program includes utilization review of clinically equivalent agents as of June 1, 2017; Specialty pharmacy program expands to include utilization review of drug dosage and frequency; and, Reminder: Prior authorization for genetic testing.
- The UnitedHealthcare Network Bulletin (August 2017) is now available online at www.unitedhealthcareonline.com > Tools & Resources > News & Network Bulletin and features articles about the new care provider website, enhancements to Link, revamped prior authorization and notification app, and much more.
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- TOMORROW, Wednesday, August 16, CMS will host an "office hours" session from 9AM to 10AM PT on the draft provisions included in the QPP Year 2 proposed rule. During the webinar CMS will provide a brief overview of the QPP and respond to questions on the Year 2 notice of proposed rule-making. Register at
- Subscribers of the PQRS listserv are encouraged to sign up for the new CMS Quality Payment Program (QPP) listserv.
The Quality Payment Program is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and includes two tracks - Advanced Alternative Payment Models (APMs) and the Merit-based Incentive Payment System (MIPS).
MIPS will replace three Medicare reporting programs:
EHR Incentive Program (Meaningful Use); Physician Quality Reporting System and the Value-Based Payment Modifier.
The Quality Payment Program listserv will provide news and updates on: New resources and website updates; Upcoming milestones and deadlines and CMS trainings and webinars.
The Quality Payment Program's first performance period began on January 1, 2017 and ends on December 31, 2017. Participation in MIPS can start as early as January 1, 2017 or as late as October 2, 2017. The first payment adjustments based on performance go into effect on January 1, 2019. Subscribe to the Quality Payment Program listserv to receive reminders for all of these important deadlines. To subscribe, visit the Quality Payment Program website and select "Subscribe to Updates" at the bottom of the page or in the footer. The Resource Library includes program resources to help you learn more about the Quality Payment Program and how to participate.
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Affiliate Association News
- As we have discussed in our Weekly, COA has been in discussion since last year regarding Express Scripts and other commercial plans excluding oncology practice pharmacies from network. Last April 1, 2016 ESI gave notice that the 25 drugs they listed would be filled outside of the oncology-practice pharmacies. There are others, like Argus, not allowing oncology-practice pharmacies to be in network. Many of you may have received denials when trying to fill drugs for patients in your network. The law firm Frier Levitt has been working on this issue for some time now. They do not believe that these plans can exclude oncology-practice pharmacies from network and now have a plan to fight on our behalf. Frier Levitt will need very specific information on these plans' rejections showing your inability to dispense to patients with these specific plans. The letter they would write on your behalf would be specific to that plan as the wording would change based on such things as whether it is an ERISA or non-ERISA plan. Frier Levitt would research state laws pertinent to where your pharmacy is located. Frier Levitt hopes that by representing your pharmacy they will get the commercial plan networks to open up on your behalf, using the denials you receive as their starting point in this fight. Unfortunately, if they are successful on your behalf, this would only open up the network for your one pharmacy, and not for everyone in the country. The hope would be that if ESI or another PBM received a large quantity of letters stating that legally they could not deny you the ability to dispense to your patients that at some point they would open their networks to everyone. That is our ultimate hope. For those that submit letters with Frier Levitt fighting on your behalf, at least your pharmacy would receive any benefits from them representing you.
COA has negotiated a very reasonable flat fee from Frier Levitt for which you would have to pay directly to them if you proceed. The fee will be $500 for your pharmacy. It is worth the investment to try to end the denials to oncology-practice pharmacies on many commercial plans. Frier Levitt feels we have a strong case against the PBM's. For more information, please feel free to contact Ricky Newton at rnewton@COAcancer.org .
- ACCC and the Advisory Board Oncology Roundtable are collaborating on a comprehensive survey to capture the challenges and successes of cancer programs across the country. The Trending Now in Cancer Care survey examines the hottest topics in oncology today, including hospital and physician alignment strategies, value-based care models, EHR use and interoperability, clinical staffing challenges, and more! The survey is now open but will close NEXT MONDAY, August 21. Take the survey at
- The nonprofit Reagan-Udall Foundation for the FDA has released a new, online resource called the Expanded Access Navigator. The website, which focuses on oncology with plans to expand to other disease areas, features the first pharmaceutical company directory of expanded access policies and criteria, educational resources, guides and downloadable forms. ASCO was one of several organizations to help develop the Navigator. The Navigator guides patients and physicians through the complicated process often called compassionate use, beginning with assessing whether all approved therapeutic options for patients with serious or life-threatening conditions are exhausted. If no clinical trials or expanded access programs are available, the Navigator acts as a clearinghouse for the single-patient expanded access policies of dozens of leading biopharmaceutical companies. ASCO, the American Cancer Society, the Biotechnology Industry Association, FDA, Foundation Medicine, PhRMA and Susan G. Komen helped develop the Navigator along with the support of Bristol-Meyers Squibb, Genentech, Janssen, Lilly, Merck and Pfizer. To access the Navigator, go to http://navigator.reaganudall.org.
- An update of the ASCO clinical practice guideline covers new medicines for nausea and vomiting related to cancer treatment. The update provides new evidence-based information on the appropriate use of olanzapine, NK1 receptor antagonists and dexamethasone. Read the updated guideline at
www.asco.org/supportive-care-guidelines
.
- ASH members can now sign up to report data for the Medicare MIPS through Healthmonix's MIPSPRO, a 2017 Qualified MIPS Registry. Learn more at
http://www.healthmonix.com/mips-pro/
.
- ASH's Meeting on Hematologic Malignancies will be held in Chicago, IL, September 8-9, 2017. The program's "How I Treat" presentations showcase speakers' evidence-based treatment approaches, identify cutting-edge scientific data that can be translated into new strategies for diagnosis and treatment, and address what to do in cases where there is no data. This meeting is a unique opportunity to join colleagues and top experts in treatment of hematologic malignancies in an intimate, smaller-meeting setting and discuss the latest drug developments and most relevant research findings advancing patient care today. Visit
www.hematology.org/malignancies
for information related to next year's meeting!
- NCCN has published and/or updated their Chemotherapy Order Templates; Clinical Practice Guidelines in Oncology, Drugs & Biologics Compendium; Evidence Blocks; Guidelines for Patients; Imaging Appropriate Use Criteria; and/or, Radiation Therapy Compendium for acute lymphoblastic leukemia (V1.2017), adolescent/young adult oncology (V1.2018), esophageal and esophagogastric cancer(V2.2017), genetic/familial high-risk assessment: colorectal (V2.2017), kidney cancer (Spanish, V1.2017), lung cancer screening (V2.2018). Go to www.nccn.org for more information.
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Celgene announces that the US Food and Drug Administration's recent approval of IDHIFA® (enasidenib)
100 mg/50 mg, for the treatment of adult patients with relapsed or refractory acute myeloid leukemia with an isocitrate dehydrogenase-2 mutation as detected by an FDA-approved test. Attached please find an announcement of this important approval. Please see information on
how to access IDHIFA
.
- The legal team at Johnson & Johnson created "2018 MACRA QPP Proposed Rule Update" highlights and Q&A documents. These provide a concise summary of the 2018 MACRA QPP Proposed Rule. CMS is accepting comments until September 11, 2017.
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MOASC CALENDAR
Professional Educational Series
November 8-9
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The
Medical Oncology Association of Southern California
(MOASC) is a leading oncology society that advances and protects the ability of cancer patients to obtain, and the ability of the oncology physicians to provide, optimal cancer care. The
Association of Northern California Oncologists
(ANCO) is an association of hematologists/oncologists dedicated to promoting high professional standards of cancer care by providing a forum for the exchange of ideas, data, and knowledge.
The material contained in the
California Oncology Weekly
is intended as general information for ANCO and MOASC members. Because diagnostic, treatment, contracting, coding, and billing decisions should be made on a case-by-case basis, any such information contained in the
California Oncology Weekly
may not apply in any given situation. Members are encouraged to contact their own consultants or advisors to obtain specific advice on matters relating to contracting, coding, and billing. The information contained in
California Oncology Weekly
should not be used as a substitute for such advice.
This publication provides a summary of regulations affecting oncology and its business practices. Reading this newsletter does not substitute for understanding regulations and verifying the validity of every claim. This information is time-sensitive and is subject to change. MOASC or ANCO accepts no liability for any statements or articles herein.
CPT codes are owned and trademarked by the American Medical Association. All Rights Reserved.
MOASC: P.O. Box 161, Upland, CA 91785 | P (909) 985-9061 | F (909) 804-5006| www.moasc.org
ANCO: P.O. Box 151109, San Rafael, CA 94915 | P (415) 472-3960 | F (415) 472-3961 | www.anco-online.org
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