Chapter 582 (HB2200) of the 2023 Session directed the Secretary of Health and Human Resources, in collaboration with the Department of Health, to convene a workgroup to analyze and review current reimbursement and operational challenges for medical practices that administer anti-cancer drugs in an in-office setting to patients whose costs for such treatment are paid for by Medicaid, Medicare or TRICARE. The workgroup is required to submit a report of its findings and recommendations to the Chairmen of the House Committee on Finance, the House Committee on Appropriations, the House Committee on Health, Welfare and Institutions, the Senate Committee on Finance and Appropriations, and the Senate Committee on Education and Health by November 15, 2023. This report was prepared by the Department of Health on behalf of the Secretary of Health and Human Resources. Findings and recommendations are listed below.

FINDINGS AND RECOMMENDATIONS

1. Preliminary analysis performed by Virginia Health Information concerning cost and reimbursement of office-administered cancer drugs indicated wide variation in reimbursement rates within established fee schedules. Virginia Health Information should perform further analysis in order to address comments and questions raised by members of the workgroup.

2. There are numerous billing codes used by Medicare for which there is no corresponding reimbursement established by Medicaid. The Department of Medical Assistance Services should continue discussions with the U.S. Oncology Network concerning its coverage and reimbursement of office-administered cancer drugs.

3. The U.S. Oncology Network and Virginia Oncology Associates identified concerns regarding continuity of care following changes during the open enrollment period, and concerns with patient transportation, for Medicaid enrollees receiving treatment at community-based oncology practices. The Department of Medical Assistance Services should continue discussions with these stakeholders to address stated concerns.