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September 23, 2015

NPAF Urges CMS to Reimburse for Lung Cancer Screening, Eliminate 2-Midnight Rule

2015-09-23 | August 31, 2015

(Washington, DC) Citing cost and parity concerns, National Patient Advocate Foundation (NPAF) today urged the Centers for Medicare and Medicaid Services to reconsider the “two-midnight” rule for hospital admissions and to reimburse for lung cancer screenings.

The comments, among others, were made in response to proposed rule “Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals Under the Hospital Inpatient Prospective Payment System.”

In its comments, NPAF supported CMS’ proposal to reimburse for cancer screening beginning in CY 2016, and urged that such coverage should include a lung cancer screening counseling and shared decision-making visit.  For appropriate beneficiaries, NPAF also supported annual screening for lung cancer with low dose computed tomography(LDCT) as an additional preventive service under Medicare.

In the comments, NPAF noted that lung cancer currently accounts for about 27 percent of all cancer deaths nationwide and is by far the leading cause of cancer death among both men and women.  The use of LDCT technology, NPAF concludes, will ensure that lung cancer can be identified at an early stage so that it can be successfully treated.

In the same comment letter, NPAF also urged CMS to rescind the 2-midnight rule, which currently limits Medicare Part A reimbursement to cases in which the physician expects the patient to require at least a two-night stay in the hospital.  If patients do not meet this often arbitrary criteria, they not only face higher costs, but may not later qualify for reimbursement for other services.

“We believe that this rule has created a scenario in which two patients with the same condition and receiving similar care could have significantly different cost-sharing obligations, solely based on time,” commented George Dahlman, NPAF Executive Vice President.

Also within the same comment letter, NPAF highlighted the the importance of reimbursement parity particularly in regards to oncology patients; requirements related to payment for chronic care management and the importance of meaningful value-based quality measures.

The full text of the NPAF comment letter can be found on its website.