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Proposed Changes in Outpatient Payment will Improve Patient Access to Care

In this year's Proposed Rule for the Fiscal Year (FY) 2017 Hospital Outpatient Prospective Payment System (HOPPS), CMS has proposed to adopt the recommendations the National Marrow Donor Program / Be The Match (NMDP) has previously made to improve the reimbursement for bone marrow and cord blood transplants that are performed in the outpatient setting. Specifically, CMS proposes to modify its coding and cost reporting requirements in a manner that should more accurately compensate hospitals for the cost of aquiring the cells that are used in transplants. Today, while the cells on average can cost more than $46,653 per transplant, Medicare only reimburses hospitals for $3,045.

While an important step forward, the details matter. There are some important modifications the NMDP and others in the transplant community will be requesting to make sure that the new rate is set using the best data possible and can be updated over time as costs naturally fluctuate.

The NMDP applauds CMS for taking this important first step forward. 

Please join us in our efforts to protect patient access to transplants in the outpatient setting by writing to CMS during the comment period on the HOPPS Proposed Rule. 

Act Now

House Increases Funding for Cord Blood Inventory, Maintains Registry Funding

Each year, the Congress provides funding to support the C.W. Bill Young Cell Transplantation Program (Program), which the National Marrow Donor Program operates as Be The Match through a contract with the federal government. It also provides funds to support the collection and maintenance of cord blood units through the National Cord Blood Inventory (NCBI). These dollars help increase the number of marrow donors and cord blood units on the Be The Match Registry. 

Each chamber of Congress drafts its own funding legislation. Then Members of Congress from the House and Senate meet to agree upon a single bill. Last month, we reported that the Senate legislation would keep funding at last year's levels: $22,109 million for the Program and $11,266 million for the NCBI. The House committee released its report earlier this month. It would maintain the same funding amount for the Program, but would increase the funding for the NCBI by $5 million.

The Congress must next reconcile, or reach agreement on, the differences between the two bills. This will occur in the coming months. Once they agree upon final numbers, the hope is that both the House and Senate will pass the bill before the end of the calendar year.

Thank you for your help and support in reaching out to the Congress to protect funding for the Program and NCBI.


Advocate Profile: Ed Plass

For Ed Plass, battling cancer wasn't just the fight of his life, it was a terrifying daily game of 'what ifs.' His outcome depended on two factors: whether he could find treatment that would save his life and, if he did, whether insurance would pay for it.

After three courses of chemotherapy for Acute Myeloid Leukemia (AML), doctors knew he was running out of options. A matching marrow donor or cord blood unit was his only hope for a cure. For Ed, finding that match wasn't as easy as he expected. Doctors at the Mayo Clinic in Rochester, MN were surprised to find that he was one of only three percent of Caucasian males who do not immediately find a marrow donor match. Despite some initial disappointment in not finding a match, doctors successfully located a cord blood unit.

Finding a match was just the first step. Then, the question was whether insurance would cover the transplant.

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