STATLINE

Read the Latest Issue of STATLINE

• CAP Lists Who Leads Key Congressional Committees Important to Pathologists in 2019
• Webinar: A New Congress – What they need to know to make the right decisions for pathology
• An Accurate Diagnosis: No One Knows More About Pathology than You - Register for 2019 Policy Meeting
• For 2019 Data Collection, CMS Updates PAMA Laboratory Requirements

The 116th Congress took office on January 3 and Democrats took control of the House of Representatives with Republicans still controlling the Senate. The House shifted to a Democrats majority with 235 House seats, to 199 for the Republicans. In the Senate, the Republicans remain in control with 53 seats, while Democrats have 47 Senate seats.

With these shifts and retirements there have been several new leadership changes on key congressional committees overseeing Medicare, Medicaid, and health care reform. 

The CAP and its advocacy office in Washington, DC, listed the House committees oversee health care-related issues and will be led by:

• Rep. Frank Pallone (D-NJ), chair of the Energy and Commerce Committee and Rep. Greg Walden (R-OR) will serve as the ranking member on that committee. Rep. Anna Eshoo (D-CA) will chair the House and Energy Health Subcommittee with Rep. Michael Burgess (R-TX) as the ranking member.
• Rep. Richard Neal (D-MA) is the new committee chair of the Ways and Means Committee and Rep. Kevin Brady (R-TX) is the ranking member on the committee. Rep. Lloyd Doggett (D-TX) will chair the Ways and Means Health Subcommittee and Rep. Devin Nunes (R-CA) will be the ranking member. 

For the Senate, committees overseeing health care issues, will be led by:

• Sen. Chuck Grassley (R-IA) is the new the chair of the Finance Committee, and Sen. Ron Wyden (D-OR) will remain the ranking member.
• Sen. Lamar Alexander (R-TN) remains the Senate Health, Education, Labor and Pensions (HELP) Committee chair and Sen. Patty Murray (D-WA) is the ranking member.

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Date. February 26, 2019
Time: 1 PM ET- 2 PM ET

With the 2018 mid-term election, almost 100 new members of Congress have started and need your help to learn more about the importance and impact that Pathology has in health care. Join Donald Karcher, MD, FCAP, chair of the CAP Council on Government and Professional Affairs, David Gang, MD, FCAP, chair of the Federal and State Affairs Committee, and Jennifer Forsyth, MD, FCAP, a member of the Federal and State Affairs Committee, to learn about how your voice matters to help educate the new Congress on health care issues important to pathologists. Register  today for this complimentary webinar hosted by the CAP.

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An accurate diagnosis is perhaps the most critical factor in effective patient care. No one knows this more than you. Connect with and educate legislators and policy experts on the value that pathology brings to the health care continuum.

Register and join us at the:

2019 Policy Meeting
April 29—May 1
Marriott Metro Center, Washington, DC

Make pathology’s impact on patient care heard in Washington.

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On January 22, the Centers for Medicare & Medicaid Services (CMS) hosted a call regarding new laboratory reporting requirements for collecting 2019 data on private payer rates for clinical laboratory services. The data collected will be used to set future Clinical Laboratory Fee Schedule (CLFS) rates. The new laboratory reporting requirements primarily impacts hospital outreach laboratories. During the call, the CMS informed participating laboratories that starting January 1:

1. Medicare Advantage plan payments will be excluded from total Medicare revenues (the denominator of the majority of Medicare revenues threshold)
2. Hospital outreach laboratories that bill for their non-patient laboratory services using the hospital's national provider identifier (NPI) must now use Medicare revenues from the Form CMS-1450 14x Type of Bill to determine whether they meet the majority of Medicare revenues threshold and low expenditure threshold.

Under the Protecting Access to Medicare Act of 2014 (PAMA), applicable laboratories are required to report private payor rates paid for clinical diagnostic laboratory tests to the CMS so the data can be used to calculate Medicare payment rates. With these two revisions, the 2018 Physician Fee Schedule (PFS) expanded the number of laboratories now required to submit data to the agency.

The CMS also provided clarification that for hospital outreach laboratories using the hospital’s NPI and not its own, the majority of Medicare revenues threshold is calculated by taking the PFS and the CLFS revenue derived from the Form CMS-1450 14x Type of Bill for the hospital outreach lab (numerator) over the total Medicare revenue derived from the Form CMS-1450 14x Type of Bill (denominator). The CMS acknowledged that this is meant to require most hospital outreach laboratories to report but emphasized that these laboratories still have to meet the low expenditure threshold. Officials also announced that additional guidance will be available on the CMS PAMA website. The CAP has additional resources available on its PAMA webpage.

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