1. 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

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

3. COVERAGE

4. 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

5. Myelodysplastic Syndromes
Current CEDs
Opened in 2010
NCT #
Myelodysplastic Syndromes
Opened in 2016
aka BMT CTN 1503 (STRIDE2)
NCT #
Sickle Cell Disease
NCT #
Myelofibrosis
NCT #
Multiple Myeloma

6. Medicare CEDs Increase Patient Access to HCT

7. Medicare Coverage: Lymphoma

8. 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)

9. REIMBURSEMENT

10. 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

11. Medicare Reimbursement Overview
New C-APC 5244

12. CODING & Billing

13. NEW ICD-10 PCS Crosswalk!

14. NEW Donation Process Coding & Billing Guide

15. Policy

16. 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

17. 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.

18. Advocacy & grassroots

19. Advocacy Action Network
20,182 Advocates

20. 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

21. Nmdp grants

22. Patient Services Grants
Family Typing Grant
Search Assistance Fund
Transplant Support Assistance Funds
John & Caryn Camiolo Survivorship Grant

23. 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. 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 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

24. Take Action
Stay up-to-date by joining the Advocacy Action Network. BeTheMatch.org/Advocacy Contact Us:
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25. Questions?

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