Access to Health Care

ACS CAN advocates for policies that provide access to treatments and services people with cancer need for their care - including those who may be newly diagnosed, in active treatment and cancer survivors.

Access to Health Care Resources:

ACS CAN, the American Heart Association, the American Diabetes Association released a joint statement providing principles for any entitlement reform proposal.

ACS CAN filed extensive comments expressing deep concern with the proposed Medicare Part B Drug Payment Model and noting that in its proposed form the Part B Drug Model Model failed to protect cancer patients' access to life-saving medications.

On November 10, 2015, ACS CAN hosted the first National Summit on Health Equity in St. Louis, Missouri. The summit brought together over 150 innovative thinkers in public policy, business, technology, academia, patient care, community health, and patient advocacy to examine public policy solutions for assuring greater health equity for cancer patients in the evolving health care system.

These comments were submitted by ACS CAN to the U.S. Department of Health and Human Services regarding changes to the template Summary Plan Document that health insurance plans must provide to consumers.

In a letter to the National Association of Insurance Commissioners (NAIC), ACS CAN and other organziations provided specific comments to provide greater consumer protections and improvements to  the NAIC's Health Carrier Prescription Drug Benefit Model Act (Formulary Model Act). 

ACS CAN filed comments on the 2017 Notice of Benefit and Payment Parameters, including issues related to Medicare notices, standardized plan option designs, and network adequacy.

ACS CAN filed comments supporting the Internal Revenue Services' proposed clarification requiring plans to provide coverage for physician services and inpatient hospitalization in order to qualify as minimum value coverage. 

ACS CAN filed comments on the Medicare CY2016 Physician Fee Schedule, supporting CMS' proposals to establish a separate payment for collaborative care services and provide reimbursement for advanced care planning services.

This paper explores from a cancer patient’s perspective the adequacy of provider networks, the transparency of provider network information for the new qualified health plans (QHPs) offered in the Marketplace and the availability of out-of-network coverage.

Workforce Resources:

These comments submitted to the Institute of Medicine’s Committee on the Governance and Financing of Graduate Medical Education address ways to ensure an adequate and appropriate cancer care workforce to treat cancer patients. These comments address workforce issues in cancer care and also palliative care.

Private Health Insurance Resources:

ACS CAN Examination of Cancer Drug Coverage and Transparency in the Health Insurance Marketplaces

ACS CAN filed comments supporting the Internal Revenue Services' proposed clarification requiring plans to provide coverage for physician services and inpatient hospitalization in order to qualify as minimum value coverage. 

ACS CAN filed comments on the Medicare CY2016 Physician Fee Schedule, supporting CMS' proposals to establish a separate payment for collaborative care services and provide reimbursement for advanced care planning services.

ACS CAN provided comments on the proposed rule implementing changes to the Summary of Benefits and Coverage (SBC) and the Uniform Glossary in which we urged the Tri-Agencies to include a high-cost coverage example (specifically a breast cancer example) in the SBC, to require the inclusion of premium information on the first page of the SBC, and to eliminate the current coverage calculator and require plans to use actual plan data when providing coverage examples.

ACS CAN provided comments on CMS' Draft 2016 Letter to Issuers in the Federally-facilitated Marketplaces, including comments related to network adequacy, provider directories, nondiscrimination provisions, and other issues.

ACS CAN filed comments on the 2016 Notice of Benefit and Payment Parameters proposed rule, including comments related to Special Enrollment Periods, prescription drug benefits, nondiscrimination, cost-sharing requirements, network adequacy standards, and other issues.

As the National Association of Insurance Commissioners (NAIC) updated its Managed care Plan Network Adequacy Model Act (Network Adequacy Model Act), ACS CAN filed comments urging the NAIC to adopt policies that would ensure that health plan networks are sufficient to provide enrollees with access to a sufficient number and type of providers (including oncology services) to meet the needs of the enrollees.

For persons living with cancer, access to specialty practitioners is paramount. Millions of Americans are now choosing health coverage through the new insurance Marketplaces and these enrollees need to be able to easily determine whether specific physicians are in a plan’s network.

The Affordable Care Act (ACA) expanded access to health insurance through reforms of the private health insurance market, including income-related premium support and cost-sharing subsidies and establishment of Health Insurance Marketplaces.

Medicare Resources:

ACS CAN commented on the Medicare CY2015 Physician Fee Schedule, in which we urged, among other things for CMS to designate screeming colonoscopioes that resule in polyp removal or biopsy as a preventive service.  We also commented on the proposed provisions related to the Chronic Care Management code.

ACS CAN commented in the FY2015 Medicare Hospice payment rule.

ACS CAN commented in the FY2015 Medicare Hospice payment rule, in which we urged, among other things, for Medicare to develop a workable solution to better clarify when a prescription drug is covered under the Hospice or Part D benefit.

ACS CAN filed comments in response to the Center for Medicare & Medicaid Innovation's (CMMI's) request for information on specialty practitioner payment model opportunities.  ACS CAN's comments urged CMMI to pay particular attention to the impact various payment policies would have on a beneficiary's access to care.

In a letter to CMS Administrator Tavenner, ACS CAN joined other organizations urging CMS to reqire Medicare Advantage plans to provide coverage for clinical trials.

ACS CAN filed extensive comments in response to CMS' proposed rule implementing changes to the Medicare Part C and D programs, including opposing proposed changes to the Part D six protected classes.

This analysis examines two issues of particular interest to the American Cancer Society Cancer Action Network (ACS CAN) and its members: the extent of coverage and cost-sharing for cancer drugs, and whether information on the coverage of cancer drugs can be readily obtained, compared, and understood by patients.

ACS CAN commented on CMS' Accountable Care Organizations (ACOs) proposed rule. Our comments offered specific recommendations to improve the ACO program to better serve the needs of cancer patients and survivors.

Cancer patients and others who may suffer from multiple chronic conditions or long-term side effects from treatment would benefit from payment reform in Medicare.

Disparities Resources:

Despite the fact that US cancer death rates have decreased by 26 percent from 1991 to 2015, not all Americans have benefited equally from the advances in prevention, early detection, and treatments that have helped achieve these lower rates.

On November 10, 2015, ACS CAN hosted the first National Summit on Health Equity in St. Louis, Missouri. The summit brought together over 150 innovative thinkers in public policy, business, technology, academia, patient care, community health, and patient advocacy to examine public policy solutions for assuring greater health equity for cancer patients in the evolving health care system.

The National Institutes of Health (NIH) and the National Cancer Institute (NCI) are the foundation of our national cancer research program and support research in every state. Today, that program is making remarkable progress in every area of discovery to improve cancer prevention, early detection, treatment, and care.

Health Care Delivery Resources:

Adequate and sustained investments and improvements in the prevention and early detection of disease are essential to refocusing the health care system on wellness.

Adequate and sustained investments and improvements in prevention and early detection are essential to meaningful health care reform. The Affordable Care Act took an important step in addressing these issues by creating a mandatory fund, known as the Prevention and Public Health Fund, to provide an expanded and sustained national investment in evidence-based programs that will help improve health and reduce chronic disease in our nation. 

Medicaid coverage of preventive services is essential to improving the long-term health and well-being of our nation’s most vulnerable populations. 

Ensuring access to evidenced-based cancer screenings and quality treatment is critical to the fight against colorectal cancer. 

Policymakers, providers and patients agree that the United States’ health care delivery system fails on a number of key measures – including safety, effectiveness, efficiency and patientcenteredness, among others.

Our nation’s health care system is one of the most expensive in the world. Yet the quality of care we deliver to our citizens continues to lag behind that of other industrialized nations. 

Currently, Medicare beneficiaries with a chronic disease such as cancer often receive health care services from multiple physicians and specialists who rarely coordinate care. This is not only frustrating for patients, who essentially have to understand how to access and navigate our complex health care system on their own, but it is also costly for the Medicare program.

Approximately 160 provisions in the final health care legislation will directly impact the millions of Americans who have or will face cancer. The following is a list of the most important provisions for the cancer community:

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Medicaid Resources:

ACS CAN CMS Comments on Michigan's 1115 Demonstration Waiver

ACS CAN CMS Comments on Alabama's 1115 Demonstration Waiver

ACS CAN CMS Comments on Kansas 1115 Demonstration Waiver

ACS CAN CMS Comments on North Carolina 1115 Demonstration Waiver

ACS CAN CMS Comments on New Hampshire 1115 Demonstration Waiver

ACS CAN CMS Comments on Massachusetts 1115 Demonstration Waiver

The Children's Health Insurance Program (CHIP) is an integral part of the safety-net for lower-income children and their families. CHIP provides access to quality, affordable, and comprehensive health care coverage to nearly nine million lower income children up to age 19 in the U.S. – many of whom have been affected by cancer.

ACS CAN CMS Comments on Maine 1115 Demonstration Waiver

ACS CAN CMS First Comments on Massachusetts 1115 Demonstration Waiver