NMDP/Be The Match: Public & Payer Policy Updates 1/2/2019 NMDP/Be The Match: Public & Payer Policy Updates Susan Leppke, MPH & Alicia Silver, MPP September 27, 2017

Current PPP Priorities Appropriations Government Relationships Advocacy/Grassroots Medicare Coverage Medicare Reimbursement Health Economics Sickle Cell Disease Coding & Billing Communication to our Network

COVERAGE

Medicare Coverage Leukemia Aplastic Anemia Severe Combined Immunodeficiency Disease (SCID) Wiskott-Aldrich Syndrome Myelodysplastic Syndromes (MDS) Sickle Cell Disease Myelofibrosis Multiple Myeloma CED CED CED CED

Myelodysplastic Syndromes Current CEDs Opened in 2010 NCT #01166009 Myelodysplastic Syndromes Opened in 2016 aka BMT CTN 1503 (STRIDE2) NCT #02766465 Sickle Cell Disease NCT #02934477 Myelofibrosis NCT #03127761 Multiple Myeloma

Medicare CEDs Increase Patient Access to HCT

Medicare Coverage: Lymphoma

Medicare Coverage: Lymphoma 2015 Financial Barriers to HCT Survey: “Does your program transplant Medicare patients who have a disease indication that is not listed on the National Coverage Determination (NCD) and therefore have unknown reimbursement?” (n=56)

REIMBURSEMENT

Medicare Reimbursement: TC Impact 2017 Inpatient Reimbursement 2017 Outpatient Reimbursement Average NMDP Bone Marrow/PBSC Invoice Average NMDP Cord Blood Invoice $62,693 $27,752 $48,436 $65,117 $14,257 (Marrow/PBSC) -$2,424 (Cord Blood) -$20,684 (Marrow/PBSC) -$37,365

Medicare Reimbursement Overview New C-APC 5244

CODING & Billing

NEW ICD-10 PCS Crosswalk!

NEW Donation Process Coding & Billing Guide

Policy

Congressional Caucus to Cure Blood Cancers and Other Blood Disorders 1/2/2019 Congressional Caucus to Cure Blood Cancers and Other Blood Disorders Representative Gus Bilirakis (R-FL) Representative Doris Matsui (D-CA) Currently, Dear Colleague letter circulating throughout House of Representatives to solicit members

Medicare Reimbursement: FY17 Strategy Current Payment (FY17) MS-DRG 014: $69,844 Average Outlier*: $16,553 Total: $86,397 *Weighted average includes related and unrelated transplants Future Payment Modeled MS-DRG 014: $58,264 Projected Standard Acquisition Charges Related: $21,620 Marrow/PBSC: $48,436 Cord Blood: $65,117 Total: $79,884-$123,381* *Total could include an outlier payment but the calculation would not include the SAC, only charges for other charges and services.

Advocacy & grassroots

Advocacy Action Network 20,182 Advocates

Key Advocacy Successes OPPS CY 2017 Comment Letters to CMS 20 Health Professionals 7 Transplant Centers 29 Patients 347 Advocates IPPS FY 2018 Comment Letters to CMS 68 Health Professionals 141 Transplant Centers 51 Patients 1,202 Advocates 2017 Appropriations Letters to MoC 4,114 Advocates

Nmdp grants

Patient Services Grants Family Typing Grant Search Assistance Fund Transplant Support Assistance Funds John & Caryn Camiolo Survivorship Grant patientgrants@nmdp.org

Jason Carter Clinical Trials Program The Jason Carter Clinical Trials Program was created for patients and their families, to make it easier to find and join clinical trials. Funding was provided by the Carter family, in memory of their son and brother, Jason Carter who passed away May 2016 at age 28 from leukemia. This program provides: Easy-to-use web-based search tool to find relevant clinical trials. www.jasoncarterclinicaltrialsprogram.com. The trial descriptions are taken directly from clinicaltrials.gov and written in plain language for better patient comprehension Clinical Trials Patient Education Specialist available by phone and email to provide one-on-one support for patients and families by answering questions and helping navigate their specific clinical trials search. Educational resources for patients and families to help them learn about clinical trials

Take Action Stay up-to-date by joining the Advocacy Action Network. BeTheMatch.org/Advocacy Contact Us: Legislation@nmdp.org Can’t get enough HCT policy information? Subscribe to our monthly Reimbursement eNews Contact Us: payerpolicy@nmdp.org

Questions?

Thank you. Susan Leppke sleppke@nmdp. org Alicia Silver alicia Thank you! Susan Leppke sleppke@nmdp.org Alicia Silver alicia.silver@nmdp.org