NATIONAL POLICY RESOURCES - LOCAL ADVOCACY RESULTS

Advocacy

As cancer care professionals who experience the challenges of providing quality cancer care first-hand, AACP members are well positioned to educate decision-makers on how coverage and reimbursement issues affect community oncology. State and federal legislation can have a significant impact on the financial viability of local cancer programs, which is why it's so important that our members make their voices heard.

We want to hear from you! If there is a specific piece of legislation you want to know more about, an important resource we're missing, or if you want to get more involved, please contact us!

Implementing the New CMS Reimbursement Billing Codes for Patient Navigation Services

As of January 1, 2024, the Centers for Medicare and Medicaid Services introduced new codes so that Medicare could reimburse for patient navigation services. To address challenges of implementation, the Association of Cancer Care Centers, in partnership with WSMOS and 11 other state societies from AZ, CO, IN, IA, NV, NM, NY, NC, SC, WI, and WY, has a 4-part webinar series, Implementing the New CMS Reimbursement Billing Codes for Patient Navigation Services, hosted by Teri Bedard of Revenue Cycle Coding Strategies.

The New CMS Navigation Reimbursement Billing Codes: A 101

The 2024 Physician Fee Schedule included 7 new codes specific to care management. This webinar reviews how these differ from the care management codes available from the American Medical Association, common questions, and challenges for implementing these new codes. Access a PDF of the slides here.

Principal Illness Navigation (PIN) Services Documentation, Coding, and Billing

The 2024 Physician Fee Schedule includes four new codes specific to Principal Illness Navigation–Peer Support. With these new codes, providers will be able to bill for the services of navigators, social workers, and support personnel. This webinar goes into a deep dive, reviewing components of the new codes, answering common questions, and addressing challenges for providers. Access a PDF of the slides here.

AMA CPT® Coding Update for Oncology Navigation Services and The Cancer Moonshot

The American Medical Association (AMA) released a coding update for oncology navigation services in alignment with The Cancer Moonshot program. Featuring discussion on the updates and guidelines from the AMA and review of the components of the AMA’s codes, how these differ from the codes from CMS, and challenges for providers. Access a PDF of the slides here.

CHI & SDOH Risk Assessment Documentation, Coding, and Billing for Oncology Providers and Administrators & Series Wrap-up

The 2024 Physician Fee Schedule includes seven new codes specific to CHI services, SDOH Risk Assessment, and Principal Illness Navigation–Peer Support. With these new codes, providers can bill for the services of navigators, social workers, and support personnel. This final installment reviews the components of these new codes, common questions, and challenges for providers. Access a PDF of the slides here.

STATE ADVOCACY

WIN! PASSED – HB 1626 – Rep. Bronoske (D). Medicaid coverage for colorectal screening exams. Directs the Health Care Authority to require coverage under medical assistance programs for noninvasive preventive colorectal cancer screening tests that have a grade of either A or B from the United States Preventive Services Task Force and to require coverage for colonoscopies performed as a result of a positive test result.

WIN! PASSED – SB 5396 – Sen. L. Wilson (R). Cost-sharing for patients for supplemental breast screening exams. Beginning January 1, 2024, for health plans that include coverage of supplemental breast examinations and diagnostic breast examinations, health carriers may not impose cost sharing for such examinations. “Diagnostic breast examination” means a medically necessary and appropriate examination, including an examination using diagnostic mammography, digital breast tomosynthesis, breast magnetic resonance imaging, or ultrasound, that is used to evaluate an abnormality seen or suspected from a screening examination for breast cancer, or detected by another means of examination. “Supplemental breast examination” means a medically necessary and appropriate examination, including an examination using breast magnetic resonance imaging or ultrasound, that is used to screen for breast cancer based an individual’s personal or family medical history, or additional factors that may increase the individual’s risk of breast cancer.

WIN! HB 1269 – Rep. Riccell (D).We preserved the 2022 passed version of the bill protected clinics in their ability to purchase in-office medications. The Prescription Drug Affordability Board (Board) within the Health Care Authority (HCA) established in 2022 that is directed to review prescription drug affordability data, perform affordability reviews, and establish prescription drug upper payment limits.

OTHER BILLS TO KEEP AN EYE ON:

DIED – HB 1450/SB 5074 – Rep. Stonier (D)/Sen. L. Wilson (R). Would have required a health insurance coverage for biomarker testing for the diagnosis, treatment, appropriate management, or ongoing monitoring of stage 1, 2, 3, or 4 cancer and brain cancer.

DIED – HB 1261 – Rep. Walen (D). Would have prohibited health carriers from imposing cost sharing on diagnostic and supplemental breast examinations. We were pleased to support and see this bill almost make it to the floor for a vote.

DIED – HB 1450/SB 5074 – Rep. Stonier (D)/Sen. L. Wilson (R). This bill in its original version would have required a health insurance coverage for biomarker testing for all biomarker testing. Later versions would have required coverage for biomarker testing for the diagnosis, treatment, appropriate management, or ongoing monitoring of stage 1, 2, 3, or 4 cancer and brain cancer. This bill advanced past where it had in earlier years.