Advocacy Update

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Because of the CAP’s advocacy, the Centers for Medicare & Medicaid Services (CMS) will increase reimbursements for CAR T-cell therapies in 2020. On August 2, the CMS released the 2020 Hospital Inpatient Prospective Payment System (IPPS) final regulation, which included a new technology add-on payment for CAR T-cell therapy. CAR T-cell therapy is a form of immunotherapy that uses specially altered T-cells harvested from a patient to target and destroy cancer cells. The CAP advocated for increasing the add-on payment from 50% to 65% of the estimated costs of the new technology, which brings the maximum add-on payment for CAR T-cell therapies to $242,450, up from $186,500.

The CAP has worked on resolving this issue with key stakeholders for several years. Specifically, the CAP collaborated on advocating for the increase and reviewing Medicare proposals with the American Society of Clinical Oncology, American Society of Hematology, American Association of Blood Bankers, and American Society for Transplantation and Cellular Therapies.

The 50% to 65% add-on payment increase for CAR T-cell therapy will apply to all approved new technologies, except some products which will have a maximum add-on of 75%. The CAP and other stakeholders asked the CMS for the increase because the current payment amount did not provide enough incentive for the use of the new technology.

The CMS will postpone creating a specific payment category, Medicare Severity Diagnosis Related Group, for CAR T-cell services since the costs for these services are evolving. Delaying the creation of this payment category for CAR T-cell services allows for the new technology add-on for 2020.

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The CAP applauded the CMS following a recent decision to allow greater access to innovative cancer treatments for Medicare beneficiaries. The CAP had urged the CMS to expand coverage of CAR T-cell therapy, while recognizing the lifesaving role that pathologists play in evolving cancer therapy technologies. 

In its final regulation published August 7, the CMS announced it will cover CAR T-cell therapies when administered in inpatient or outpatient facilities that are enrolled in the US Food and Drug Administration’s (FDA) Risk Evaluation and Mitigation Strategies (REMS) drug safety program for FDA-approved indications. Additionally, Medicare will cover approved CAR T-cell therapies for off-label uses that are recommended by the CMS-approved compendia.

CAP Successful in Promoting Patient Access to CAR T-Cell Therapies

In response to the CAP’s advocacy, the CMS decided not to proceed with Coverage with Evidence Development (CED), a model that collects additional data and allows for coverage only within the context of a research setting. The CAP urged the CMS not to make CED a condition of coverage for fear it would hinder access to new technologies, and offer treatment only to a limited patient population. Instead, the CMS said it will monitor information obtained from the REMS program and post-approval studies “to the fullest extent possible.”

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Health care is a top concern among Americans, and the CAP fights to protect pathologists' ability to provide high-quality services for patient care in a fair, competitive environment.

Only pathologists can provide an essential perspective on health care legislation and advocate for their specialty. During the 2019 Policy Meeting, pathologists gathered on Hill Day to meet with their senators and representatives in Congress to advocate for the practice of pathology and patient care.

Even if you can't attend Hill day, Pathologists still can easily connect with the CAP’s grassroots advocacy program.

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Are you being paid fairly for the pathology services you provide? Has surprise medical bills affected your reimbursements? Payment for pathology services has a direct impact on the success of your practice. These topics and more will be explored the following advocacy sessions at CAP19.

Advocacy Educational Sessions

  • Timely Topic – Surprise Billing (M1913N)
  • CPT Coding…You Can’t Practice Without It! Why Pathologists Need to Understand CPT Coding (M1962N)
  • Current Payment Policy Challenges in Pathology Practice (M1963N)
  • Thriving in MIPS and Other Value-Based Payment Programs (S1967S)
  • How is My Payment Determined for Pathology Services (MS1971S)
  • Advocacy Town Hall (M1911N)
  • Future of Pathologists in the Workforce (M1912N)

Still need to register for these courses. Check it out.

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Take our Readership Survey and Win an Amazon Gift Card

The CAP invites readers to take a quick survey regarding Advocacy Update, our weekly federal and state advocacy e-newsletter. Advocacy Update strives to keep CAP members updated on the latest regulatory and legislative issues concerning pathologists at the federal and state levels of government. Through news briefs, the advocacy newsletter provides clarity on these issues while also reporting what the CAP is doing to address matters concerning pathologists. Your valuable feedback will allow us to evaluate and improve the e-newsletter to best meet your needs. This survey should take about 3-5 minutes to complete.


The CAP recognizes the value of your time and privacy. Be assured that your individual information will be kept strictly confidential and your email address will not be distributed to anyone. All results are reported in aggregate format. If you need assistance, please email Lori Vernon at LVERNON@CAP.ORG.

As a thank you for your time and feedback, we invite you to enter into a drawing to win one of two $75 Amazon gift cards. If you would like to enter, please enter your information at the end of the study.

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The CMS released of the proposed updates to the 2020 Medicare Physician Fee Schedule and the Quality Payment Program regulations. Therefore, the CAP has rescheduled its webinar to Thursday, August 29, at 3 PM ET/ 2 PM CT. Please review the latest Special Advocacy Update on the proposed 2020 Medicare Payment regulations.

Webinar presenters will be the Chair of the Council on Government and Professional Affairs Donald S. Karcher, MD, FCAP; Vice-Chair of the Council on Government and Professional Affairs and Chair of the Clinical Data Registry Ad-Hoc Committee Emily E. Volk, MD, FCAP; and Chair of the Economic Affairs Committee W. Stephen Black-Schaffer MD, FCAP.

During the 60-minute webinar, attendees will learn about updates to the 2020 Medicare Physician Fee Schedule and the Quality Payment Program regulations and its impact on pathologists. The CAP panel will also answer questions from attendees.

If you are unable to attend the live event, a link to view an archived recording of the presentation will be sent to all registrants following the webinar.

We appreciate your flexibility and look forward to your participation during the webinar on August 29.

Register today for the webinar.

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Join over 120 of your fellow CAP members and test your advocacy knowledge with the new August Advocacy News Quiz. This is the last week to see how you measure up against your fellow pathologists on this month’s quiz and share your results. Good luck!

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