California   Oncology  Weekly
"Where California Oncologists Go For Answers!"
A collaborative publication of the
Medical Oncology Association of Southern California, Inc.
and the
Association of Northern California Oncologists, Inc .
May 21, 2019
This Weekly's Hot Topics  

  • California Cancer PAC 2019 Legislative UpdateCalifornia News
  • Contact your Congressional Representatives to co-sponsor the Clinical Treatment Act (HR913)National News
  • CMS will not be issuing final NCD on CAR T-cell therapy for cancer CMS News

California News

Following is the MOASC & ANCO California Cancer PAC 2019 Legislative Update:
Both houses held their Appropriations Suspense hearings last week. We are pleased to report that the bill that will require the Board of Pharmacy to create the Cancer Medication Advisory Task Force passed out of Committee on a unanimous vote.  As you will see, some of the bills were passed but contingent upon Appropriations.  These issues will move/continue to be fought out in the budget process.  Several of the bills were also amended in committee, and we will review them once they are in print in the next few days.
SB 38 (Hill) Flavored tobacco product ban - Passed as amended
SB 600 (Portantino), health care coverage fertility preservation, bill we supported along with ASCO - Passed
SB 650 (Rubio) Cancer Medication Advisory Task Force - Passed
Other key healthcare bills: 
AB 4 (Bonta), Medi-Cal eligibility, providing coverage to undocumented adults - Passed contingent upon funding in the budget
AB 174 (Wood). Healthcare coverage, financial assistance - Passed contingent upon funding in the budget
AB 414 (Bonta), Healthcare coverage, minimum essential coverage, regarding the insurance mandate - Passed as amended to be phased out if the mandate is reinstated at the federal level
SB 29 (Durazo), Medi-Cal eligibility, providing Medi-Cal coverage regardless of immigration status - Passed with amendment to make it contingent of funding in the budget
SB 65 (Pan), Healthcare coverage financial assistance - Passed
SB 175 (Pan),Healthcare coverage, minimum essential coverage regarding the insurance mandate - Passed
SB 612 (Pan), Healthcare Data Reporting regarding Kaiser Permanente  - Held in Committee
- The American Medical Association (AMA) and other state and specialty societies have now joined the California Medical Association (CMA) to push back on a new Anthem Blue Cross policy that will deny certain evaluation and management (E/M services submitted with modifier 25. Learn more at 
Despite skyrocketing teen use of e-cigarettes, a proposal to make California the nation's first state to ban flavored tobacco is struggling in the Legislature-and health advocates blame the political potency of the tobacco industry.
An analysis of data from California hospitals found private health insurance providers paid hospitals an average of 209% more than Medicare rates for similar services in 2015 and 2016. Researchers from the West Health Policy Center said the difference could be attributed to efforts to offset payment shortfalls from Medicare and Medicaid. Other contributors may also be from market failures stemming from consolidation in the hospital industry, the position of 'must-have' hospitals even in markets where there may appear to be competitors, and the pressure that private insurers face from employers and employees to offer broad networks. HealthLeaders Media.
- In a push to encourage Californians to prepare for natural disasters, the state is spending $90 million on its effort to promote the census, targeting the communities that stand to lose the most in an undercount. With millions of dollars in federal funding at stake, California is trying some unusual strategies to encourage hard-to-count populations to participate in the census. Because the factors that contribute to a population being hard-to-count also often lead to high insurance rates within those vulnerable communities, advocates believe the efforts can be tied together. The state already is working to coordinate its census-outreach efforts in those communities with other public information campaigns. Gov. Gavin Newsom wants to add another $50 million. The state would likely lose millions of dollars for child care, combating substance abuse and other social services. Read more from the Sacramento Bee.
Gov. Gavin Newsom's administration reversed course on his plan to divert public health dollars from several counties to help provide health coverage to young adults who are in the country illegally. The administration considered the concerns of Sacramento, Placer, Santa Barbara and Stanislaus counties, which had warned that the governor's plan would compromise their ability to cope with surging rates of sexually transmitted diseases and, in some cases, measles outbreaks. Newsom still plans to divert state money from 35 mostly small and rural counties, funds that currently pay for health services for uninsured residents, including undocumented immigrants. Legislators are working on their own budget proposals and have held dozens of hearings examining Newsom's plan. The governor and lawmakers have until June 15 to negotiate a final budget, so it is not yet clear which proposals will be included.
CMA has sent out a call for applications/nominations for interested physician members to serve on CMA's standing councils and subcommittees. All current appointments expire at the conclusion of the CMA House of Delegates in October 2019. New appointments will begin their terms at that time, with the new terms expiring at the conclusion of the 2020 House of Delegates.
Current members who are eligible for reappointment must submit an application for the 2019-2020 term. Even if you submitted an application last year and there are no changes, you must complete the new online form.
Please join Californians Allied for Patient Protection (defenders of MICRA) for an evening reception in honor of Assembly Member Sabrina Cervantes on Thursday, June 6th from 5:30 PM to 6:30 PM. The reception will be held at PrimeCare, part of OptumCare (2275 Sampson Ave. Ste. 111, Corona, CA 92879). Please click here to view the invitation.
Please share this invitation with your colleagues and encourage them to attend. Please RSVP to Kristina Gelabert Thank you for your continued support of CAPP.

Noridian News  
- Noridian/JEMAC has the following updates on their website
Proposed Rules on Interoperability: Comment Period Extended to June 3; Quality Payment Program: MIPS 2019 Call for Measures/Activities Ends July 1; Medicare Promoting Interoperability Program: Submit a Measure Proposal by May 28; SNF Provider Preview Reports: Review Your Data by May 30; Medicare Shared Savings Program: Submit Notice of Intent to Apply Beginning June 11; Promoting Interoperability Programs: Submit Comments on Proposed Changes by June 24; New Medicare Card: Need an MBI for a Patient?; Promoting Interoperability Program: Hardship Exception Application; Improper Payment for Intensity-Modulated Radiation Therapy Planning Services
MIPS Improvement Activities Performance Category in 2019 Webinar-Mary 23 
International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) 
* IVR Enhancements Coming Soon
* MolDX Draft LCDs Published for Review and Comment
* Modifier Education on Demand
* Invalid Data Billed on Clinical Trial Claims to Deny as Unprocessable
Forthcoming Noridian JEMAC meetings/webinars/workshops :
* Duplicate Claims Webinar (May 22)
 * Modifier 59, NCCI and MUEs Webinar (May 28)
* Submitting Your Enrollment Online-Part 1 Webinar (I&A; May 29)
* Recoupment Webinar (May 30)
* Eligibility Claim Denials & Rejections Webinar (June 4)
* Using the Medicare Beneficiary Identifier (MBI) Webinar (June 13)
* Completing Appeals through the Noridian Medicare Portal (NMP) Webinar (June 19)
* Advanced Beneficiary Notice of Non-coverage (ABM) Webinar (June 21)
* Modifier 59, NCCI, and MUEs Webinar (June 26)
* Submitting Your Enrollment Online-Part 2 Webinar (PECOS; June 26)
* Telehealth/Telemedicine Enrollment Only Webinar (July 10)
* Medicare Part A/B Revalidation Webinar (July 24)
* Revocation, Caps and Appeals Webinar (August 7)
* Submitting Your Enrollment Online-Part 1 (I&A) Webinar (August 21)
Recent Announcements Published to "Latest Updates:"
MolDX Draft LCD (DL38131) - Published for Review and Comments
The following draft JEB MolDX Local Coverage Determination (LCD) has been published for review and comments for contract numbers: 01112 (NCA), 01182 (SCA), 01212 (HI, and Territories) and 01312 (NV). Read the complete update
MolDX Draft LCDs (DL38151, DL38135) - Published for Review and Comments
The following two draft JEB MolDX Local Coverage Determinations (LCDs) have been published for review and comments for contract numbers: 01112 (NCA), 01182 (SCA), 01212 (HI, and Territories) and 01312 (NV). Read the complete update
Collaborative A/B/DME MAC Lower Limb Orthoses Webinar - June 20, 2019
The Noridian Provider Outreach and Education (POE) staff is hosting the Collaborative A/B/DME MAC Lower Limb Orthoses webinar on June 20, 2019 at 11 a.m. PT. Read the complete update
Reporting the HCPCS Level II Modifiers of the PRC CR11259
CR 11259 advises and provides educational information regarding reporting of the HCPCS Level II code modifiers for the Patient Relationship Categories and Codes (PRC). CR 11259 contains advice and educational information for MACs and clinicians reporting the PRC. Read the complete update
For more information and to register, visit: http://med.noridianmedicarecom/web/jeb/education/training-events.

MOASC News  
- SAVE-THE-DATE for MOASC's Spotlight On Oncology, August 17, 2019 in Huntington Beach. Through a restricted grant from MOASC, selected oncology fellows and faculty from the University of California, Irvine (UCI), present the premier topics from their attendance at the 2019 Annual ASCO meeting. The presentations promote collegial discourse among colleagues along with networking in an informal setting.  Contact the MOASC Office for more information at .
- MOASC Member, City of Hope CME presents: Multidisciplinary Approaches to Cancer Symposium on October 10-13, 2019 @ Waldorf Astoria, Las Vegas, Nevada. This intensive program will provide participants with an enhanced ability to interpret and apply best treatment options into their individual cancer practices. For more information click HERE. To register go to:

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ANCO News  
- Congratulations to ANCO member Richard Bold, MD, who has been named Physician-in-Chief of the UC Davis Comprehensive Cancer Center.

- ANCO members may register with a discounted rate using code ILC19ANCO for the 20th Annual International Lung Cancer Congress taking place on July 25-27 at the Hyatt Regency Huntington Beach. Visit for more information.

- SAVE THE DATE: ANCO's ASCO Highlights 2019 will take place on Saturday, August 17 at The Claremont Resort in Berkeley. Watch for an official announcement in June!

- Several new employment opportunities are now announced on the new ANCO website at

- The new ANCO website ( is now live!  ANCO physician members, their practice staff, and representatives from ANCO's corporate members must register to access password protected content at .
ANCO is now on Twitter ; follow  @ANCO News .

National News 
- ANCO, MOASC, and ASCO call on all members to contact their Congressional Representatives to as ask them to become co-sponsors of the Clinical Treatment Act (HR913) that would guarantee overage of routine care costs of clinical trial participation for Medicaid enrollees with life-threatening conditions. Learn more and contact your Representatives by visit the ASCO Action Network at .
Legislation that would raise the minimum age for purchasing tobacco products, including e-cigarettes, from 18 to 21 has been introduced by Senate Majority Leader Mitch McConnell, R-Ky., and Sen. Tim Kaine, D-Va. "By making it more difficult for tobacco products to end up in the hands of middle school and high school students, we can protect our children and give them the opportunity to grow and develop into healthy adults," McConnell said. The Washington Post 
- A new investigation into the dark side of the generic-drug boom suggests widespread fraud at plants in India and China. Quality of Generic Drugs Manufactured Overseas Comes into Question
At this week's Annual Meeting of the International Society for Pharmacoeconomics and Outcomes (ISPOR), the Institute for Clinical and Economic Review (ICER) announced it will be developing two new tools to enhance the ability of payers, pharmaceutical companies, patient groups, and other stakeholders to quickly examine ICER's entire body of work and generate actionable summaries, allowing them to more readily use this work in a variety of strategic decisions. The entirety of each individual ICER assessment will remain in the public domain and free for anyone to access through the ICER Evidence Reports. These new decision-support tools -- the ICER Evidence Compendium and the ICER Interactive Modeler -- will be subscription-based products intended to make the entire body of past and present ICER work easier to search, to analyze, and to apply to a wide variety of policy and decision-making platforms. 
ICER will welcome comments through Monday, June 10th. The Institute for Clinical and Economic Review ( ICER ) is opening a national call for suggestions on how to improve ICER's value assessment framework to the methods that underpin ICER's evidence reports on new drugs and other health care interventions.   Based on the feedback received, draft revisions will be published to ICER's value assessment framework on August 16th, then go out to public comment on those proposed revisions through October 11th, and post the final updated framework on December 18th. This final framework will be applied to all assessments initiated in 2020 and beyond.
- An undisclosed number of patients at Medical Oncology Hematology Consultants in Newark, N.J., received letters alerting them about a data breach incident that occurred on June 7 or June 8 of last year. Officials launched an investigation, which ended March 14, and discovered that the cyberattack singled out an email account at the practice that contained patient names, medical data, health information, financial data, Social Security numbers, dates of birth and government-issued IDs. Health IT Security
Though company safety depends on them, educational sessions and other ways to address cybersecurity among employees can become so common that employees fail to appreciate the seriousness of protecting company -- and customer -- data. Nudging workers' behavior, such as by using sensors and lights, can remind them to exercise good cybersecurity judgment, experts say. The Conversation (UK)
CMS News 
National Coverage Analyses. Chimeric Antigen Receptor (CAR) T-cell Therapy for Cancers CMS will not be issuing a final National Coverage Determination on CAR T-cell therapy for cancer. The agency didn't give any reason for the delay in finalizing the proposal that was released in February, but a decision is forthcoming.
- America's Health Insurance Plans (AHIP) urged the CMS to proceed with caution on a national coverage determination for chimeric antigen receptor T-cell therapies , noting that there is limited evidence supporting the effectiveness of the pricey cancer treatments. AHIP said data is needed on long-term efficacy and safety as well as nonmedical costs, and more clarity is needed around patient registries for patients treated with CAR T-cell therapies.
The Centers for Medicare & Medicaid Services (CMS) has taken steps to improve oversight of recovery audit contractors (RACs) and reduce provider burden by better targeting program integrity efforts. Key improvements made to the RAC program over time include fewer audits for providers with low claims denial rates and increased transparency in RAC review topics, which must be proposed by CMS and opened for public comment before being finalized. Additionally, RACs are subject to heightened standards for maintaining accuracy. Since these changes were implemented, complaints about RAC-related burden have decreased, according to CMS Administrator Seema Verma. 
- For the latest breaking CMS reimbursement news, read Bobbi Buell's e-Reimbursement Newsletter (May 16) covering quarterly release of new J-codes, 340B, RACs, proposed Medicare inpatient rule and ICD-10-CM for 2020, among other topics at 

Affiliate Association News   
The Community Oncology Alliance is launching a major national campaign to highlight the negative impact of pharmacy benefit managers (PBMs) on patients with cancer. The "PBM Abuses" campaign will ensure that PBM middlemen abuse of patients with cancer is not lost in policy deliberations in Washington. For the past several months the California Oncology Weekly, under MOASC News, has been asking for oncology practices to please provide their "horror" stories of the obstruction to timely access to oncology care. COA collects reports of real-life patient horror stories in dealing with PBMs and cancer care that capture the suffering experienced at the hands of PBMs due to delayed access to care, denial of coverage, arguments with physicians over proper treatment, and even failure to receive medications. These include patient PBM horror stories like those recently published in the Columbus Dispatch and STAT News.
- The ASCO Annual Meeting 2019 (May 31-June 4) abstracts have been released and are available at .

Data abstraction for ASCO's QOPI Round 1 will close on June 3. Round 1 final reports will be available approximately two weeks after the round closes. Learn more at 
The Doctor's Company, the nation's largest physician-owned medical malpractice insurer, offers up to a 10% premium discount to physicians whose practices have achieved QOPI Certification. Learn more at .
ASCO's Oncology Practice Conference takes place in San Diego on September 5. Focused on the business of cancer care, this conference will address the needs of practice administration and operations, with timely and practice strategies for the challenges faced by all those involved in the business of cancer care. Learn more and register at .
Join ASH on September 6-7, 2019, at the Fairmont Chicago, Millennium Park for the 2019 ASH Meeting on Hematologic Malignancies to gain knowledge that can help you make an immediate impact in your practice. The meeting will feature top experts in the field, comprehensive clinical content, the latest clinical research, and opportunities to interact with colleagues in an intimate, small group setting with no competing sessions. The program content will be structured as "How I Treat" presentations, which will highlight each speaker's evidence-based treatment approaches, present cutting-edge scientific data that can be translated into new strategies for diagnosis and treatment, and address what to do in cases where there is no data. For more details, or to register, please visit the  ASH Website .
The ASCO Quality Care Symposium, September 6-7 in San Diego, encompasses the latest strategies and methods for quantification of patient experience, provider efficiency, clinical outcomes, and quality and safety in the cancer care field. The Symposium will include a variety of sessions that will cover the latest science in precision and personalized medicine. Oral abstract presentations will feature the highest-quality science submitted to the Symposium and Poster Walks will allow for networking while exploring the presentation of the newest science. This meeting will bring leaders in quality improvement science together to participate in stimulating conversation with opportunities for networking among physicians, nurse practitioners, physician assistants, and others. ASCO Quality Care Symposium .
- ACCC's Spring Update to the 2019 Patient Assistance & Reimbursement Assistance Guide is now available at .
NCCN has published the following updates at : acute lymphoblastic leukemia (V2.2019), breast cancer screening (V1.2019), colon cancer and rectal cancer (V2.2019), lung cancer screening (V1.2020), penile cancer (V2.2019), Waldenstrom's macroglobulinemia/lymphoplasmacytic lymphoma (V2.2019).

Industry News
- AbbVie and Genentech BioOncology inform ANCO and MOASC that the United States Food and Drug Administration has approved Venclexta for adult patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). Visit Genentech's Hematology hub for educational resources and perspectives.
- EMD Serono informs ANCO and MOASC that the United States Food and Drug Administration has approved Bavencio in combination with axitinib for first-line treatment of patients with advanced renal cell carcinoma (RCC). 
- Seattle Genetics will host an educational program entitled Frontline Advancements: Clinical Data Overview of Echelon 1 and Echelon-2 with Caroline Behler, MD, California Pacific Medical Center, on May 22 at Vintner's Inn in Santa Rosa. RSVP to or (510) 501-6164.


In This Issue


Spotlight On Oncology
August 17, 2019

 5th World Congress on Controversies in Breast Cancer (CoBrCa): When is Less More? 
(Use code cobrca10 for ANCO Member Discount;
San Francisco, September 4-6) 
(NCCN, San Francisco, September 27-28) 
8th International Cancer Metastatis Congress
(San Francisco, October 25-27) 
Supportive Care in Oncology
(ASCO, San Francisco, October 25-26) 
The  Medical Oncology Association of Southern California (MOASC) is a leading oncology society that advances and protects the ability of cancer patients to obtain, and the ability of the oncology physicians to provide, optimal cancer care. The  Association of Northern California Oncologists (ANCO) is an association of hematologists/oncologists dedicated to promoting high professional standards of cancer care by providing a forum for the exchange of ideas, data, and knowledge. The material contained in the California Oncology Weekly is intended as general information for ANCO and MOASC members. Because diagnostic, treatment, contracting, coding, and billing decisions should be made on a case-by-case basis, any such information contained in the California Oncology Weekly may not apply in any given situation. Members are encouraged to contact their own consultants or advisors to obtain specific advice on matters relating to contracting, coding, and billing. The information contained in California Oncology Weekly should not be used as a substitute for such advice. This publication provides a summary of regulations affecting oncology and its business practices. Reading this newsletter does not substitute for understanding regulations and verifying the validity of every claim. This information is time-sensitive and is subject to change. MOASC or ANCO accepts no liability for any statements or articles herein. CPT codes are owned and trademarked by the American Medical Association.  All Rights Reserved.



MOASC: P.O. Box 161, Upland, CA 91785 | P (909) 985-9061 | F (909) 804-5006|

ANCO: P.O. Box 151109, San Rafael, CA 94915 |  P (415) 472-3960 | F (415) 472-3961 |