Affordable Care Act

ASCO, patient advocacy groups, and other provider organizations recently sent a letter to Centers for Medicare & Medicaid Services Acting Administrator Marilyn Tavenner urging the agency to correct a longstanding inequity in Medicare coverage for cancer patients wishing to participate in clinical trials.

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The Final Rule to implement the Physician Payment Sunshine Act—Section 6002 of the Patient Protection and Affordable Care Act (released on February 1)—will make information publicly available about payments or transfers of value to physicians and teaching hospitals (“covered recipients”) from applicable manufacturers and group purchasing organizations (GPOs). The Centers for Medicare & Medicaid Services (CMS) will publish the information on a public website.

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On February 1, CMS announced a final rule implementing Section 6002 of the Affordable Care Act (the “National Physician Payment Transparency Program: Open Payments”). The final rule, commonly called the “Sunshine” rule, will make information publicly available about payments or other transfers of value from applicable manufacturers to physicians and teaching hospitals (“covered recipients”), and about physician (or immediate family members of a physician) ownership or investment interests in applicable manufacturers and group purchasing organizations (GPOs).

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A provision included in the Affordable Care Act requiring state Medicaid programs to begin paying for primary care services and vaccine administration at rates no lower than Medicare is now in effect as of January 1.

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In follow-up to a meeting with regulators from the Centers for Medicare & Medicaid, 19 leading cancer organizations submitted comments addressing inquiries regarding implementation of the Affordable Care Act requirement that mandates private insurers to provide coverage for routine patient costs associated with participation in approved clinical trials, effective in January 2014.

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The American Society of Clinical Oncology released the following statement by ASCO President Sandra M. Swain, MD, medical director of the Washington Cancer Institute at MedStar Washington Hospital Center:

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ASCO and several other cancer organizations met with regulators from the Centers for Medicare & Medicaid Services on April 16 to discuss recommendations for implementing the Affordable Care Act requirement that mandates private insurers to provide coverage for routine patient costs associated with participation in approved clinical trials. This requirement goes into effect 2014.

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The U.S. House of Representatives voted Thursday to repeal the Independent Payment Advisory Board, a central provision of President Obama’s health care reform efforts.

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