College of American Pathologists
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March 24, 2011
© 2011 College of American Pathologists
Special Report
CMS to Extend Delay of Signature Requirement
Agency Grappling with How to Finalize Rule Withdrawal

March 24—While CMS officials have publicly indicated support for withdrawing the signature requirement provision of the 2011 Physician Fee Schedule (PFS), the CAP has learned that the agency will continue to delay implementation as officials determine how to rescind this policy.

In a March 11 letter to Rep. Michael C. Burgess, MD (R-TX), CMS Administrator Donald M. Berwick, MD, reiterated support for rescinding the requirement. “We are currently researching whether a regulation rescinding the requirement could be published before April 1, 2011,” he wrote. This communication was in response to letters sent by leaders from the House of Representatives and the Senate in early February urging the agency to further delay implementing the rule as officials reconsidered the regulation. These letters were a result of efforts by the CAP and other members of the Clinical Laboratory Coalition (CLC), who asked Congress to contact the CMS Administrator regarding this issue.

However, because the signature requirement was part of a final rule—this year’s PFS—it is more difficult to rescind. In fact, the CAP has learned the agency must first issue a notice and request for comment. After the comment period closes, CMS will likely issue a final rule rescinding the requirement later this year. In the meantime, agency officials have indicated to the College and other industry stakeholders they will extend the current enforcement delay. This delay was set to expire after the agency completed education efforts throughout the first quarter of this year. While agency officials did not announce a specific expiration date, implementation was expected to begin on or around Apr. 1.

The CAP has been at the forefront of raising concern about this requirement, initially proposed last year as part of the 2011 PFS. Specifically, the College’s comments centered on the increased administrative burden to practices and health care providers—including pathologists—and the potential delay in testing due to lack of signed requisitions. In mid-January, The College and members of the CLC met with CMS’s Blum to emphasize concerns with the regulation and educate the agency about the problems it would present. This meeting followed the CAP’s support of an AMA House of Delegates proposal, as well as a letter from the College to CMS officials in December asking to delay implementation.

Stay tuned to Statline for updates on further developments on the signature requirement.

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