In a comment letter to the Centers for Medicare & Medicaid Services (CMS), ASCO urged the agency to ensure that every Medicaid enrollee with cancer can access the high-quality care needed to treat their disease. The comments were submitted in response to a proposed rule on Medicaid and the Children’s Health Insurance Plan (CHIP) Managed Care that aims to streamline the programs’ regulatory requirements, reduce administrative burden, and increase flexibility for state governments.
State Medicaid programs have the authority to contract with private health plans to administer Medicaid benefits on the state’s behalf—this is also known as managed care. ASCO’s comments focus on Medicaid Managed Care (MMC) network adequacy standards, the transition from volume-based to value-based care, and the quality of cancer care enrollees receive. Specific recommendations include:
- CMS should enact network adequacy standards that are appropriate for ensuring that MMC enrollees who are patients or survivors of cancer can access high quality cancer care in a timely fashion. The changes proposed by CMS could eliminate minimum requirements for Medicaid networks, which has the potential to erode access for patients with cancer.
- CMS should continue to allow value-based payment arrangements in MMC contracts. These arrangements facilitate and encourage the transition from a volume to value-based care model.
- CMS should ensure that quality measures for cancer care across focus on the specifics of cancer treatment, are meaningful to patients, and are relevant in all oncology specialties. ASCO also urged CMS to align these measures across all plans, including MMC plans and Medicare.
- CMS should create a quality measures set for cancer care that is focused on clinically relevant measures rather than task-oriented measures.
ASCO’s comments were informed by the society’s policy statement on Medicaid reform, which details its recommendations for ensuring access to high-quality and high-value cancer care for Medicaid enrollees. ASCO’s work on the Patient-Centered Oncology Payment (PCOP) model and the Quality Oncology Practice Initiative (QOPI®) were also highlighted in the comment letter, demonstrating ASCO’s longstanding commitment to providing value-based care and improving the quality of cancer care.
“The proposed rule recognizes the need for continued innovation and reform of health care delivery systems from rewarding volume to rewarding the value of care provided,” writes ASCO President Monica M. Bertagnolli, MD, FACS, FASCO, in the letter. “We would be happy to meet with CMS to discuss our concepts for payment reform for cancer services that can be applied to MMC or other health insurance markets.”
Read the full comment letter.
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