New Healthcare Laws
AB 1823 establishes the California Cancer Clinical Trials Program to increase access to cancer clinical trials for patients, especially women and under-represented communities. This makes the state the first in the country to legally recognize the financial burdens afflicting cancer patients seeking treatment in clinical trials. The new law distinguishes between inducement and reimbursement. It recognizes ancillary costs as a barrier to clinical trial participation, encourages industry support of these costs, and identifies the allowable expenses that can be reimbursed to patients. The California Cancer Clinical Trials Program will be administered by the University of California, which will raise funds and distribute privately funded grants aimed at reducing barriers to trial participation. The funds will be used to help connect patients with appropriate clinical trials and to cover expenses stemming from participation in those trials. It will authorize industry, public and private foundations, individuals and other stakeholders to donate to the program directed by UC, as well as to other nonprofit corporations and public charities that specialize in the enrollment, retention and increased participation of patients in cancer clinical trials.
“The California Cancer Clinical Trials Program will transform how we connect patients with cancer trials in California and engage with industry and businesses in the oncology field,” said Assemblywoman Susan Bonilla (D-Concord), the author of the bill. “Research and clinical trials are keys to treatment success, but just as important is the access and participation to those trials by a diverse population.”
8 Key Changes to the 2017 Medicare Fee Schedule In November, CMS released its final 2017 Medicare physician fee schedule aimed to improve Medicare payments for services provided by primary care doctors with a focus on chronic care management and behavioral health. Bakers Hospital Review published eight key changes that doctors need to be aware of.
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1. Data on post-operative visits: Starting July 1, 2017, doctors in practices with 10 or more physicians must report data on post-operative visits for high-volume/high-cost procedures. 2. Screening: Providers and suppliers must be screened and enrolled in Medicare to contract with a Medicare Advantage organization to provide items and services to those enrolled in Medicare Advantage health plans. This provision will start two years after publication of the final rule and will be effective on the first day of the plan year. 3. Telehealth services: Additional codes include those for end-stage renal disease-related dialysis, advanced care planning and critical care consultations. The critical care consultations provided via telehealth will use the new Medicare G-codes. 4. Improve data transparency: Medicare Advantage organizations use a bidding process to apply to participate in the Medicare Advantage program. The bids reflect the organization’s estimated costs to provide benefits to enrollees. Under the final rule, Medicare Advantage organizations are required to release data associated with these bids every year. CMS also requires Medicare Advantage organizations and Part D sponsors to release medical loss ratio data on a yearly basis to help beneficiaries make enrollment decisions. 5. Geographic practice cost indices: CMS adjusts payments under the physician fee schedule to reflect local differences in practice costs using geographic practice cost indices, which will also overhaul California’s outdated geographic payment localities. This reform will raise payment levels for 14 urban California counties classified as rural while holding the remaining rural counties permanently harmless from cuts (the hold harmless provisions will take place in 2018). 6. Expansion of Medicare Diabetes Prevention Program (MDPP): The MDPP expanded model seeks to help prevent onset of type 2 diabetes among Medicare beneficiaries diagnosed with pre-diabetes, CMS said. Payment for MDPP services will begin in 2018. 7. Billing codes: Among the changes are new codes to pay primary care practices that use interprofessional care management resources to treat patients with behavioral health conditions. 8. Pay increase: Physician payment rates will increase by 0.24% in 2017 compared to 2016, accounting for a 0.5% increase required by the Medicare Access and CHIP Reauthorization Act and mandated budget neutrality cuts, according to the American Hospital Association. For more information, visit the CMS.gov page at: https://goo.gl/D2xu7l