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Transplant Community Voices Support to Improve Outpatient Reimbursement

By the time the comment period on the Hospital Outpatient Prospective Payment System (HOPPS) proposed rule closed, the Centers for Medicare & Medicaid Services (CMS) had received nearly 3,000 comments. While only a small portion of these comments included discussions about the proposed improvements to the way bone marrow, cord blood and peripheral blood stems cells are reimbursed, these commenters represent all parts of the transplant community. In addition to the National Marrow Donor Program (NMDP) / Be The Match, the following organizations, among others, submitted favorable comments:

American Society of Blood and Marrow Transplantation (ASBMT - representing transplant physicians throughout the country)
American Hospital Association (AHA - representing the nation's hospitals)
American Society of Hematology (ASH - representing clinicians and scientists around the world who are working to conquer blood diseases)
American Association of Blood Banks (AABB - representing individuals and facilities that seek to advance the practice and standards of transfusion medicine and cellular therapies to optimize patient and donor care and safety)
Alliance of Dedicated Cancer Centers (representing hospitals known as dedicated cancer centers
Provider Roundtable (an organization of hospital professionals who focus on Medicare policies)

We are also particularly grateful to all of the individual physicians, nurses, professionals, family members, caregivers and patients who took the time to tell CMS how important it is to eliminate reimbursement as a barrier to accessing life-saving transplants.

CMS is now considering these comments and will issue a final rule in early November.



Continuing work on Medicare Coverage

We are continuing our efforts to work with transplant centers, physicians and researchers as they begin implementing the requirements to open access for the three new areas of Medicare coverage: Sickle Cell Disease, Multiple Myeloma and Myelofibrosis. Yet, more work needs to be done to ensure that patients 65 years and older who are fighting a blood cancer or other blood disorder have access to a bone marrow, cord blood or peripheral blood stem cell transplant.

During the month of October, we will be meeting with Members of Congress to help them better understand the coverage challenges facing Medicare patients in need of a transplant. We will also continue our efforts with CMS to find a more efficient way to review and, ideally, improve access to transplant.

In the coming months, we may need your help to make sure this important issue becomes a top priority for the Administration and the Congress.

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Congressional Budget Controversy and What it Means for the Program

As we go to press, the Congress is still trying to find a way to reach agreement on a short-term spending package that will allow the federal government to remain open past October 1st. Leaders in both the House and the Senate believe they will reach agreement on a "continuing resolution" (also known as a "CR") to hold spending steady for the vast majority of federal programs through early December. The controversy stems from how to provide relief to the people of Flint, Michigan and Louisiana, as well as requests for additional funds to combat the Zika outbreak.

Assuming the Congress passes a CR, it will have to take up the spending bills either individually or together (known as an "omnibus"). Funding for the C.W. Bill Young Cell Transplantation Program, operated by the NMDP, will likely be held at current levels in the continuing resolution, as well as in the end of year appropriations bill(s). There is a chance that our efforts to increase funding for the National Cord Blood Inventory (NCBI) will result in an increase of $5 million. For that to happen, Members of the Senate will have to agree to the higher level that House appropriators allocated to the NCBI.

During October, Members of Congress will be at home, many campaigning before the November election. If you have the opportunity to see your Members, remind them how important it is to you that the Congress fully fund the CW Bill Young Cell Transplantation Program (Program) and NCBI. Current funding levels are about $8 million lower than full funding for the Program and about $7 million below full funding for the NCBI.

Don't know who your Members of Congress are? No judgment -- find out HERE!

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Advocate Profile: Jeff Haertling

"Save this girl's life and I'll be an advocate to the cause for the rest of mine." This was the short prayer Jeff whispered just before he was anesthetized to harvest his bone marrow for a sixteen-year-old girl fighting leukemia. Eight years later, his recipient, Kim, is living life to the fullest and is cancer free. Learn all the ways Jeff is holding up his end of the bargain.

Read More

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