Dystonia Association of Kentucky
© Going the DYSTance for all dystonia-affected individuals
LEGISLATION
The Centers for Medicare and Medicaid Services (CMS) are proposing several changes for 2008 that could directly impact dystonia treatment. We are issuing two ALERTS asking for our members to write to CMS encouraging them not to make these changes. Attached is information on these issues and template letter. The more comments CMS receives on this issue the better. The DMRF and other member organizations of the Dystonia Advocacy Coalition will also be formally providing comments but the voice of dystonia-affected persons and their families is very important in this effort.
Please let me know if you have any questions. Thank you for your assistance with this.
The Issue:
The Center for Medicare and Medicaid Services (CMS) has proposed changes to the Hospital
Outpatient Prospective Payment System (“OPPS”) for calendar year 2008. Under OPPS,
Medicare reimburses hospitals for the costs of drugs and biologicals like Botox® that are
provided to program beneficiaries. In some cases, payment for the drug/biological is included
in the payment for the associated administration service; in other cases, Medicare makes a
separate supplemental payment for the drug/biological. In recent years, in cases where Medicare
pays separately for the drug/biological, the payment amount is based on average sales price
(“ASP”) plus 6 percent. CMS uses the same ASP-plus-6 percent methodology to determine
payments to physicians when drugs/biologicals are furnished in the physician office setting.
The Requested Action:
For the sake of all patients, regardless of where they obtain their injections, we’re asking that
you send a letter to CMS Director, Kerry Weems, expressing your concerns. We have drafted
a letter for your convenience but you can make any changes you need to personalize it according
to your medical condition. The important thing is that you write to express your concerns.
If you intend to send it electronically, please read the instructions on using eRulemaking below fully.
Comments must get to CMS on or before September 14th. You can also mail your letter but it
must be received by September 14th. (The mailing address is listed below.)
The Letter:
Dear Mr. Weems:
Regarding: CMS-1392-P, Specified Covered Outpatient Drugs
I would like to commend CMS for seeking to improve patient access to care while simultaneously
keeping down the related costs and trying to eliminate abuse of services. However, as a patient
with (or the form dystonia you have), both types of dystonia (a movement disorder resulting from
sustained involuntary muscle spasms), I have serious concerns about CMS’s proposal to reduce
the payment rate to hospitals for physician-injected drugs. I receive injections of botulinum toxin
to alleviate the debilitating dystonic symptoms. These injections are critically important to my ability
to function normally.
I respectfully request that CMS not change the payment formula for physician-injectable
drugs for 2008, and instead maintain the current payment formula. Any reduction in
reimbursement will lead to fewer injectors in an area where we have too few knowledgeable
injectors in the first place. Anyone can inject botulinum toxin. Not just anyone can inject it
successfully to relieve the spasms. Also, this change in policy would destroy the uniformity
of payments made across settings that ensures there are no economic rewards or penalties
to providers, depending on where the injections are given.
Thank you for allowing me to provide these comments.
Sincerely,
Name and address (not needed is submission is electronic)
Instructions for Using CMS eRulemaking web site:
1. Type the following in your browser’s search field: http://www.cms.hhs.gov/eRulemaking and press Go or search button.
2. At the Centers for Medicare & Medicaid Services eRulemaking web site, click on “Submit electronic comments on CMS Regulations with an open comment period”.
3. On the Dockets Open for Comment page, find the Docket ID CMS-1392-P. You may have to look through other pages at the bottom of the screen to find this docket number.
4. Click on docket ID CMS-1392-P. The Docket Information page will appear showing the comment period end date. Click on Submit Comment.
5. On the Document Management Comment Form, enter your Postal Code, Country, Category (should be Individual), your First and Last Names and in the Organization Name field, type None. Click on Continue.
6. A list of Issue Areas will appear. Choose Specified Covered Outpatient Drugs. Choosing this option will paste it above the comment box. Enter your message into the comment box. Click on Continue.
7. On the Review Comment Submissions screen, read your comment and check for spelling and grammar errors. If you need to make changes, click on Modify and make the changes. At the bottom of the page, click on Save Comments.
8. Your submitted comment will appear on the screen with a Temporary Comment Number. Use the printer icon on your browser to print your comment. Click on Exit. Close your browser (clicking on the back arrow will delete your comment).
9. If you want to copy information from an Action Alert and paste it into the comment box, you must first save what you copy from the Action Alert into Word with an .rtf file extension (instead of a .doc extension). Then you can copy it from the .rtf document and paste it into the comment box.
Comments may also be submitted by mail to:
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS–1392–P
P.O. Box 8011
Baltimore, MD 21244–1850
Or by express/overnight mail service to:
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention:CMS–1392–P
Mail Stop C4–26–05
7500 Security Boulevard
Baltimore, MD 21244–1850
If you submit comments by mail or overnight service, your letter must arrive at CMS by September 14th; additionally, you must submit one original and two copies.
Dystonia Action Alert II
The Issue:
The Center for Medicare and Medicaid Services (CMS) has proposed changes to the Hospital Outpatient Prospective Payment System (“OPPS”) for calendar year 2008. Under OPPS, Medicare reimburses hospitals a fixed, pre-determined amount for each item or service. In the past, with injections of agents like botulinum toxin type A, Medicare would pay the hospital one amount for the injection procedure and a separate amount for any electrodiagnostic guidance service that the physician may use to help place and direct the needle. CMS is proposing to “package” payment for items and services that CMS considers are always or most often conducted together into a single payment of $148.11. This is $26.18 less than if the two procedures were paid separately and represent a loss for hospitals. If approved, CMS would make a single payment for the injection and for the guidance services, regardless of whether or not the guidance service was provided. CMS believes this action will encourage hospitals to use services more judiciously and efficiently. The guidance equipment used in these procedures is somewhat expensive, as well as expensive to operate. The concern with this proposed action is that hospitals may begin questioning physicians who choose to use guidance, and pressuring physicians to limit the use of guidance. The quality of care could be compromised.
The Requested Action:
For the sake of all patients, regardless of whether or not their physicians utilize guidance services for their botulinum toxin injections, we’re asking that you send a letter to CMS Director, Kerry Weems, expressing your concerns. We have drafted a letter for your convenience but you can make any changes you need to personalize it according to your medical condition. The important thing is that you write to express your concerns. If you intend to send it electronically, please read the instructions on using eRulemaking below fully. Comments must get to CMS on or before September 14th. You can also mail your letter but it must be received by September 14th. (The mailing address is listed below.)
The Letter:
Dear Mr. Weems:
Regarding: CMS-1392-P, OPPS: Packaged Services
I would like to commend CMS for seeking to improve patient access to care while simultaneously keeping down the related costs and trying to eliminate abuse of services. However, as a patient with (list the form dystonia you have), (dystonia is a movement disorder resulting from sustained involuntary muscle spasms), I have serious concerns about CMS’s proposal to bundle the payment rate to hospitals for physician-injected drugs. I receive injections of botulinum toxin to alleviate the debilitating dystonic symptoms. Both the guidance service and the botulinum toxin injections I receive are critically important for my ability to function normally and have relief of the pain associated with dystonia.
I respectfully request that CMS not package the payment of these services together but continue to pay for them separately. The proposed change may result in hospitals pressuring doctors not to utilize this equipment and the injections being ineffective because it does not get to the right muscles to have benefit for me. The guidance service is critically important for this treatment to be effective.
Thank you for allowing me to provide these comments.
Sincerely,
Name and address (not needed is submission is electronic)
Instructions for Using CMS eRulemaking web site:
1. Type the following in your browser’s search field: http://www.cms.hhs.gov/eRulemaking and press Go or search button.
2. At the Centers for Medicare & Medicaid Services eRulemaking web site, click on “Submit electronic comments on CMS Regulations with an open comment period”.
3. On the Dockets Open for Comment page, find the Docket ID CMS-1392-P. You may have to look through other pages at the bottom of the screen to find this docket number.
4. Click on docket ID CMS-1392-P. The Docket Information page will appear showing the comment period end date. Click on Submit Comment.
5. On the Document Management Comment Form, enter your Postal Code, Country, Category (should be Individual), your First and Last Names and in the Organization Name field, type None. Click on Continue.
6. A list of Issue Areas will appear. Choose: OPPS: Packaged Services. Choosing this option will paste it above the comment box. Enter your message into the comment box. Click on Continue.
7. On the Review Comment Submissions screen, read your comment and check for spelling and grammar errors. If you need to make changes, click on Modify and make the changes. At the bottom of the page, click on Save Comments.
8. Your submitted comment will appear on the screen with a Temporary Comment Number. Use the printer icon on your browser to print your comment. Click on Exit. Close your browser (clicking on the back arrow will delete your comment).
9. If you want to copy information from an Action Alert and paste it into the comment box, you must first save what you copy from the Action Alert into Word with an .rtf file extension (instead of a .doc extension). Then you can copy it from the .rtf document and paste it into the comment box.
Comments may also be submitted by mail to:
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS–1392–P
P.O. Box 8011
Baltimore, MD 21244–1850
Or by express/overnight mail service to:
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention:CMS–1392–P
Mail Stop C4–26–05
7500 Security Boulevard
Baltimore, MD 21244–1850
ADVOCACY
I suggest that you get familiar with your Senator and Congressmen in your area. Let them know how involved you are concerning these issues. It always helps to be a step ahead when it comes to political issues especially ones that involve legislation that will have a direct affect on you and your family.
There is Strength in Numbers !
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Write to your State Senators
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April 2008 is Dystonia Advocacy Month for Dystonia !
June is Dystonia Awareness Month !
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