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Public Policy Newsletter Article

Biocom Submits Comments on CMS 2021 IPPS Proposed Rule

  • 2020-07-30T15:00:00.000+0000
  • Washington DC
  • Author: Brittany Blocker

On July 10, Biocom submitted comments in response to CMS’s 2021 IPPS Proposed Rule. The proposed rule was released on May 11 and includes the creation of a new Medicare-Severity Diagnosis-Related Group (MS-DRG) for chimeric antigen receptor T-cell (CAR-T) therapy. The new MS-DRG 18 would help to predictably compensate hospitals for their costs in delivering necessary care to Medicare beneficiaries and provide payment flexibility for the future as new CAR-T therapies become available.

Biocom has long advocated for the creation of a CAR-T specific MS-DRG as the NTAP for CAR-T expires in September 2020 and cannot be extended because it has been three years since the Food and Drug Administration (FDA) approved the CAR-T therapies. Without the NTAP or a new MS-DRG 18, hospitals would face drastic reductions in reimbursements for these cases.

Biocom’s letter supports CMS’s proposal to create a new MS-DRG 018 for CAR-T therapies and exclude clinical trial cases from the calculation of the relative weight for DRG 018 to ensure accurate reimbursement. We urged the Agency to finalize the proposal as written and ensure that new CAR-T therapies map to MS-DRG 018 immediately upon FDA approval to ensure appropriate patient access at launch.