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- California Pathologists Secure Favorable Reimbursement Law
On July 27, California Gov. Gavin Newsom signed a comprehensive health care budget trailer bill (AB 133), which raised the Medi-Cal rate methodology to 100% of Medicare for clinical or laboratory services and prevents future retroactive reimbursement reductions and recoupments. Additionally, the law notably expands Medi-Cal coverage to low-income undocumented adults aged 50 and older. The California Society of Pathologists (CSP) successfully advocated for increasing the Medi-Cal payment rates to 100% of Medicare as reflected in the new law. The CAP works closely with state pathology services to advocate for equitable reimbursement for pathology services.
“Though the new rates won’t take effect until 2022, this was the culmination of a legislative effort over a number of years supported by the CSP” stated Executive Director of CSP, Robert J Achermann, JD.
Previously, the 2021-2022 State Budget included relief on Medi-Cal laboratory rates including certain anatomic pathology codes. The Medi-Cal utilized a rate methodology of no more than 80% of Medicare or the lowest of enumerated criteria. Numerous retroactive recoupments to labs and pathology groups have been made since due to “a lack of timeliness in Medi-Cal updating their rates.” Beginning on July 1, 2022, the raised Medi-Cal rates will be implemented.