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CMS Announces Hospital Outpatient Reimbursement Rates for 2004 Alpha-1 Medicare Recipients Guaranteed Access to Care WASHINGTON, DC – November 4, 2002 – On October 31, 2003 the Centers for Medicare and Medicaid Services (CMS) announced the 2004 hospital outpatient reimbursement rates for the plasma derived augmentation therapy used to treat the degenerative lung disease Alpha-1 Antitrypsin Deficiency (Alpha-1). The 2004 rate sustains patient access and may extend benefits to all augmentation therapies currently available for the treatment of Alpha-1. In August CMS proposed a significant change in Alpha-1 reimbursement based on averaged hospital claims data. The Foundation and Association became alarmed due to errors in the claims data that resulted in proposed rates far below the hospital acquisition cost. According to Alpha-1 Foundation President and CEO John W. Walsh, “Claims data isn’t representative of small widely dispersed populations such as Alpha-1 and would have required hospitals to administer the drug at an annual loss of $25,000 or more per patient. We had to convince CMS to change their approach.” CMS’s final rule indicates the power of the Community, comments from Alpha-1 organizations and individuals were taken into consideration. The final decision allows hospitals to bill 88% of the Average Wholesale Price - a significant increase over the August proposal. Alpha-1 Association Board Chair John P. Morton stated, “We knew that patients would be turned away from treatment if CMS didn’t handle Alpha-1 payments differently. We are grateful for the way the Community responded when we issued an Action Alert. Hundreds of Alphas wrote to CMS and their members of Congress we have tangible proof that this effort made a difference.” More remains to be done. “The Foundation has petitioned CMS for a new Alpha-1 diagnostic code to improve data collection and we are currently planning an educate program for hospital billing departments so that Alpha-1 therapies are appropriately reimbursed and accurately represented in the system. The goal is to be removed from annual rate review, have accurate data collected in the hospitals and permanently secure access to care,” stated Walsh. The Foundation and Association continue to partner with other like minded organizations in an effort to promote a legislative solution. Both organizations continue to encourage members of Congress to co-sponsor H.R. 2700 which will amend the Social Security Act improving reimbursement for all orphan therapies. Source: |