Monday, November 16, 2020

CMS Introduces New Office For Technology Policy, Coding, Pricing.

If you look at the full Org Chart for CMS, it's pretty doggone complex - PDF here, with over 15 divisions reporting to the Administrator.  In one of the largest, Center for Medicare, there's a new division called "Technology Coding and Pricing Group," headed by long-time CMS policymaker Jason Bennett. 

TCPG is going to be  "...focused on helping shepherd medtech innovators through what can be a byzantine reimbursement process that wasn’t necessarily structured with next-generation technologies in mind...."

What's up?


New Pages on the CMS Org Chart

The full org chart for CMS is online in a PDF here.  For example, offices as diverse as "Office of Legislation" and "Center for Program Integrity" report to the Administrator, who reports to the Secretary of Health.  Two of the largest centers are Center for Medicaid and CHIP Services (CMCS) and Center for Medicare (CM). 

Center for Medicare has its own  division webpage here .  Within that you'll find the familiar "Hospital and Ambulatory Policy Group" - HAPG - which runs inpatient and outpatient policy, under Carol Blackford.  There's the "Medicare Contractor Management Group," under Larry Young (keeps your MAC up and running, recontracts, and handles complaints.)  And so on.

But wait, there's more.  This fall, there is a new group here inside of "CM," the "Technology Coding and Pricing Group," TCPG. What's that?

The TCPG Is Headed by Jason Bennett

It's headed by Jason Bennett, who has a master's in public policy and has held over a decade's worth of positions at HHS and CMS - his Linked In here.

There was a brief announcement about the new TCPG, and Bennett's appointment, at Fed Health IT News, here.

How CMS Describes the Mission of TCPG

I haven't seen a full CMS press release on the TCPG position, but interestingly, there was a Linked In job listing that described the roles of the director, which is pretty much the mission statement for TCPG.  The job opening is closed, but the listing is still online here.   (My cloud copy here).

Here's how CMS presented the TCPG:

As the Director, Technology, Coding and Pricing Group, you will provide executive direction for the consideration of new technologies and their treatment in the Medicare program. You will lead the development and evaluation of national Medicare policies and standards on certain benefit structures and payment methods; the maintenance of medical coding systems; and the assessment of applications for special payment consideration for new technologies under several payment systems.

For example, I'd guess this group was involved in a set of new policies for DME coding and regulations proposed a few weeks ago in annual rulemaking (here, here.)

I list more about TCPG from Linked In, further below.

Interviews with Jason Bennett

See an interview with Bennett about the new Medicare Coverage for Innovative Technology (MCIT) program for breakthrough devices,  here.  

See a longer and very interesting interview with Bennett about the TCPG at here. In the latter interview, we read, 

  • "The Technology, Coding, and Pricing Group launched last month within CMS’ Center for Medicare. It puts under one roof functions relating to medical technology that have previously been housed in disparate parts of CMS. In conjunction, the agency has brought together a smaller, dedicated team of “navigators” who, for the next six months at least, will be focused on helping shepherd medtech innovators through what can be a byzantine reimbursement process that wasn’t necessarily structured with next-generation technologies in mind."

The TCPG, we read, was rolled out publicly in a session of the annual  October AdvaMed conference a few weeks ago.


More About TCPG:

And more from Linked In job listing:

Responsibilities [ of Head of TCPG ]

- Develop and evaluate national Medicare policies and principles for payment of new technologies for various provider types under prospective payment systems.

- Develop methodologies to adjust payments based on statutory and regulatory criteria.

- Develop, evaluate and review payment and benefits policies, regulations and instructions concerning durable medical equipment, prosthetics, orthotics and supplies items and services.

- Develop, evaluate and review policies, regulations, requests for codes, and instructions concerning HCPCS and ICD-10 coding.

- Develop, evaluate and issue data collection methods for clinical laboratory services and part B drug average sales price (ASP). Calculate payment amounts based on the collected data as required by regulation and statute.

- Oversee ambulance payment policy and required cost data collection for ground ambulance providers and suppliers.

- Oversee the data analysis contract used to monitor DMEPOS competitive bidding and other payment system assessment topics to support ongoing policy changes and monitor the impact of such changes.

- Maintain continuing liaison with provider groups, industry associations, patient organizations, medical associations, and other stakeholders that relate to Medicare benefits.

- Evaluate applications for new technology payment status under the inpatient and outpatient hospital prospective payment systems and the End Stage Renal Disease prospective payment system.