Last year, after direct advocacy from the Association for Clinical Oncology (ASCO) and its members, Congress passed the CLINICAL TREATMENT Act, which requires all states and territories to cover and reimburse for the routine costs of care for services associated with Medicaid enrollee participation in a qualifying clinical trial. This requirement begins on January 1, 2022.
To help states prepare to implement the legislation, the Center for Medicaid and CHIP Services (CMCS) issued a State Medicaid Director Letter outlining new Medicaid state plan requirements, including what is/is not a covered service, definition of a qualifying clinical trial, coverage determinations, and state exceptions for compliance.
CMCS is instructing states to submit a state plan amendment (SPA) outlining individual state’s coverage and benefit policies and another to describe payment methodologies that will be used to pay service providers. SPAs must be issued at least one day prior to the effective date. Because some states may need to act legislatively to implement the new requirements, the guidance also includes language describing the timing of state legislative sessions and applications for delay.
ASCO is working closely with its State Affiliates to ensure consistent, transparent, and equitable access to routine care across all states and territories.
ASCO will continue to monitor and advocate for robust CLNICAL TREATMENT Act implementation policies, as well as additional activities that will increase access to clinical trials for all people with cancer.
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