Advocacy Update

• CAP Urges Quick Action on Additional COVID-19 Funding
• CAP Statement: Supporting Gender-Neutral Blood Donor Screening
• Biden Administration Proposes to Fix the ACA ‘Family Glitch’
• HHS Reopens Reporting for Provider Relief Funds, Answering Call from AMA, CAP
• Massachusetts Pathologists Oppose Scrapping Payment System in No Surprises Act
• Do More than Belong—Participate
• Test Your Advocacy News Intelligence

The CAP, along with the members of the Cancer Leadership Council, urged congressional leaders to move quickly to approve additional resources for the nation’s COVID-19 response.

Lawmakers in early April initially reached a deal for an additional $10 billion in COVID funding, well short of the $22.5 billion in emergency funds that President Joe Biden had requested. The $10 billion would come from unspent funds from the American Rescue Plan. Half of the money will be used on vaccines and testing while the other half will go toward therapeutics. The deal did not include any money for global efforts to combat the virus.

However, the deal fell apart due to a separate action by the administration concerning the pandemic and immigration policy. The deal could still move forward as the $10 billion agreement would be fully paid for.

The Cancer Leadership Council’s Requests

In an April 1 letter to leaders in the House and Senate, the Cancer Leadership Council noted that the COVID-19 pandemic is not over for many cancer patients, including those who are immunocompromised because of their disease or treatment. There are additional tools that can be used by the immunocompromised, including certain monoclonal antibodies and antiviral treatments, but the products are in short supply and will dwindle further without additional federal funds to purchase them. In addition, rapid, high-quality testing is still needed to identify patients eligible for therapy and ensure that patients are receiving the most appropriate care for their clinical circumstances.

“Please act immediately to ensure that cancer patients and other immune compromised individuals have access to tests, vaccines, monoclonal antibodies, antiviral therapies and other tools to identify, prevent or treat COVID-19 infections,” the council writes. “More federal funds are the key to protecting access for the immune compromised, for whom the pandemic may never be over.”

The council also requested that funds remain available for a strong public health response to the pandemic, including clear communication to immunocompromised individuals to help them managed the risks of COVID-19 and clear communication to the public regarding the vulnerabilities and needs of immune compromised people.

The Cancer Leadership Council includes the CAP and 15 other groups, including the American Society for Radiation Oncology, the Association for Molecular Pathology and the Cancer Support Community.

The CAP recognizes that the nation’s blood supply must be both safe and sufficient to meet the needs of patients and ensure people are healthier because of excellence in laboratory medicine, including the blood banks which pathologists lead. The CAP strives for inclusivity and diversity in all our endeavors, and strongly supports gender-neutral blood donor screening based on individualized risk assessment for HIV infection instead of sexual identity.

In response to the impact of the COVID-19 pandemic on the blood supply shortage, in April 2020, the US Food and Drug Administration (FDA)—the regulatory body that oversees the US blood supply and blood centers—shortened donor deferral periods from 12 months to 3 months. These measures update previous (December 2015) FDA recommendations for reducing the risk of blood transmission-related infections, including human immunodeficiency virus (HIV), that precluded men who have sex with men (MSM) from becoming donors. Despite these updates, the US still faces a severe national blood shortage crisis—particularly with O negative and O positive type red blood cells.

More inclusive and more objective blood donor screening may increase both the safety and the availability of the nation’s blood supply.

Blood banks in several European countries and Israel already have instituted gender-neutral blood donor screening measures, and HealthCanada is currently reviewing a similar recommendation from the Canadian Blood Services.

Currently, the FDA and leading blood collection organizations are sponsoring the pilot ADVANCE (Assessing Donor Variability And New Concepts in Eligibility) Study to evaluate alternatives to its current deferral policy for MSM to examine if different questions could be used in the donor history questionnaire. Local blood centers are partnering with LGBTQ+ community centers in eight metropolitan cities across the country to help recruit study participants.

Blood donors take great pride in making irreplaceable contributions to the health of their communities. The CAP supports participation in the ADVANCE Study, and the ability of safe and eligible individuals, regardless of sexual identity, to give life-saving blood donations needed every day.

CAP President Emily Volk, MD, FCAP published this statement on April 5, 2022. The statement was authored by members of the CAP Transfusion, Apheresis, and Cellular Therapy Committee: Glenn Ramsey, MD, FCAP, Chair; Monica Pagano, MD, FCAP, Vice-chair; Joanne Becker, MD, FCAP; Julie Cruz, MD, FCAP; Patricia Kopko, MD, FCAP; and Susan Stramer, PhD, MS.

The Biden Administration on April 5 proposed a rule to strengthen the Affordable Care Act (ACA) by fixing the “family glitch,” something the CAP and other medical groups had been urging for months. The glitch affects about 5 million people and has made purchasing an affordable, high-quality marketplace health insurance plan difficult for certain families.

With the family glitch, families of workers facing unaffordable premiums for coverage offered through their employers remain ineligible for premium and cost-sharing subsidies to purchase ACA marketplace coverage. As a result, families affected by the glitch are left to either pay a significant percentage of their income for family coverage or go uninsured.

Under the rule proposed by the Treasury Department and the Internal Revenue Service, family members of workers who are offered affordable self-only coverage but unaffordable family coverage may qualify for premium tax credits to buy ACA coverage. Should the proposed change be made, it’s estimated that 200,000 uninsured people would gain coverage, and nearly 1 million Americans would see their coverage become more affordable.

The CAP has urged Congress to fix the glitch as part of strengthening and expanding access to health care coverage. Similarly, the American Medical Association (AMA) had called for this change in a September 29, 2021, letter to Chiquita Brooks-LaSure, administrator of the Centers for Medicare & Medicaid Services (CMS). In the letter, the AMA noted that the family glitch has significant consequences for the coverage options, health, and finances of impacted families of workers, especially those with lower incomes. The average employee contribution for self-only coverage was estimated to be $1,243 in 2020, while the average contribution for family coverage was estimated to be $5,588.

The proposed rule is slated to take effect January 1, 2023, in time for the next open enrollment period. According to the White House, the proposed rule would amount to the most significant administrative action to improve implementation of the ACA since its enactment.

Due largely to efforts led by the American Medical Association (AMA), the CAP, and other organizations, the Health Resources and Services Administration (HRSA) reopened the reporting period for recipients of Period 1 Provider Relief Funds (PRF). Providers were supposed to have reported through a HRSA PRF portal by the November 30, 2021, deadline, but a number of physician practices missed the deadline.

In a March 31 letter to HRSA, the AMA, CAP, and 30 other national medical specialty societies noted that small and rural practices appeared to be particularly impacted by the potential recoupment of funds they faced as a result of failing to report. These practices were greatly impacted by the COVID-19 surges in many ways that may have prevented or delayed the required reporting, the groups wrote. They requested that HRSA reopen the Period 1 reporting period for at least 60 days and engage in a targeted campaign to reach those who have yet to comply.

HRSA, an agency under the Department for Health and Human Services (HHS), has agreed to reopen the reporting period but only for 10 days. Those physicians who received more than $10,000 in provider relief funds and failed to submit their period 1 report should act immediately. Between Monday, April 11, and Friday, April 22, 2022, at 11:59 PM ET, providers may submit a late reporting period 1 request. Physician practices should receive information about how to submit a request directly from HRSA via e-mail. Providers who plan to submit a Request to Report Late Due to Extenuating Circumstance, but have not registered in the PRF Reporting Portal, should complete registration prior to submitting their request. Registration instructions are on the PRF Reporting Webpage.

During this reopening period, a provider must choose an extenuating circumstance(s) that prevented compliance with the original reporting deadline, such as severe illness or death, impact by a natural disaster or lack of receipt or reporting communications. While attesting to an extenuating circumstance is required, no supporting document or proof is required.

If HRSA approves the extenuated circumstances form, the provider will receive a notification to proceed with completing the reporting period 1 report shortly thereafter. Providers will have 10 days from the notification receipt date to submit the late report in the PRF reporting portal.

The CAP and other groups will continue to advocate for more flexibility and more information to ensure physician practices have an adequate opportunity to come into compliance.

The Massachusetts Society of Pathologists (MSP) strongly opposed Senate Bill 2774 which establishes a default out-of-network commercial reimbursement rate for emergency and non-emergency services. The CAP worked closely with Congress to develop the bipartisan No Surprises Act and supports MSP in its efforts to oppose the proposed legislation.

In testimony sent on April 7 to the chairs of the state Joint Committee on Health Care Financing, MSP President Rebecca Osgood, MD, FCAP, opposed the adverse legislation as it favors health insurance payers to the detriment of patients. Under federal law, Massachusetts patients receiving unanticipated out-of-network services at in-network facilities and hospitals are only liable for in-network payment amounts and are removed from billing disputes.

However, the legislation would displace the federal law by mandating payments for out-of-network services to be the median-in-network rate. Additionally, the proposed out-of-network rate is not keyed to a respective year which fails to account for inflation unlike the federal law.

The utilization of median-in-network rates to pay for out-of-network services could lead to severe consequences. For instance, such arrangements may prompt insurers to terminate contracts with physicians who are currently paid more than the median rate and serve as a disincentive to contract with physicians.

Previously, the MSP and CAP have strongly opposed these efforts in Massachusetts. In the summer of 2021, MSP had testified against establishing a default out-of-network commercial reimbursement rate for emergency and non-emergency services and urged regulators to follow the federal No Surprises Act.

The CAP and MSP will continue to partner in opposition with the Massachusetts Medical Society (MMS).

Risks for pathologists and the patients we serve are escalating rapidly with constant congressional and executive action on health care.

We are facing, without action by every member, these potential consequences:

1. A devasting 3% cut in all pathology services in 2023 to pay for other increases in evaluation and management services
2. Ever-widening shortages in the pathologist workforce without funding and commitment to expand GME slots
3. A much-needed improved preparedness plan for the next untimely pandemic

The 2022 Pathologists Leadership Summit offers an agenda to strengthen your knowledge of these key issues, so on our Annual Hill Day, you will be prepared to confidently deliver pathology’s message concerning these issues in a manner that is relevant and impactful to lawmakers.

“The more individual voices we have, the louder our message will be to those who set the rules and make the rules. If we want to influence them to make sure that the rules that they set focus on quality patient care and making sure that pathologists can get paid for that quality patient care, we need that voice to be as loud as possible.” - Annual Hill Day Participant

With free registration for CAP members, the ability to earn up to 7.75 CME, and a hybrid meeting format, there’s no better opportunity for you to participate in the process— to be an advocate for positive change and use your influence.

How much happens—is up to you.

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