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January 4, 2017

In This Issue:

Advocating to ensure health care plans maintain adequate networks of providers, the CAP joined with the American College of Radiology and the American Society of Anesthesiologists to call on the Idaho Governor to reject legislation that favors health insurance plans and instead take a different approach to dealing with network adequacy and out-of-network balance billing.

As an update to the November 8, 2016 STATLINE article , the Coalition of Hospital Based Physicians sent a letter on December 20 to Idaho Governor C.L. "Butch" Otter opposing draft legislation that would establish governmental price controls over out-of-network bills by hospital-based physicians. Idaho Insurance Department officials previously rejected the opposition of physicians and the Coalition and proceeded to recommend to the Governor a legislative proposal to ban balance billing and limit out of network payments to physicians.

According to the Coalition, "the legislative proposal from the Idaho Insurance Department to regulate payments by health insurance plans to out-of-network based providers rejects the widely acknowledged need for maintaining marketplace equilibrium between physicians and health insurance payors, and, instead, decidedly favors health insurance payors over physicians and the patients they serve." The proposed legislation would deny out-of-network Idaho physicians the legal authority to negotiate appropriate payment with health insurance plans for medical services.

"Even more so, the Idaho Insurance Department is proposing to statutorily tie physician out-of-network payment to 'the carrier's contracted rate,'" the groups say in their comments. "The scope of the Idaho legislation that keys to in-network rates as proposed by the Department is unprecedented in the nation."

This legislation will devaluate physician services reflected in both the contracted rates and non-contracted rates; the dismantling of physician networks by both plans and providers; and a decreased availability in physician services that will come as a result of the state's unfavorable reimbursement environment.

The CAP has long been a proponent of network adequacy and along with the American Medical Association has urged individual states and the Department of Health and Human Services to establish policies that will help ensure network adequacy as a way of reducing out-of-network bills from providers.

Read the full letter.

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The US Department of Justice Drug Enforcement Agency (DEA) recently reversed most of the changes to its registration renewal process that was previously slated to become effective January 1, 2017. This change may affect some laboratories, as the new change would affect the DEA Form 225a, or the 2017 DEA Form 225, that is for Analytical Laboratory.

On December 20, 2016, the DEA reversed its decision and posted a notice that it is retaining its current policy and procedures, with one minor change, regarding registration renewals.

Starting January 2017, the DEA will no longer send its second renewal notification by mail. Instead, an electronic reminder to renew will be sent to the email address associated with the DEA registration.

The DEA will otherwise retain its current policy and procedures with respect to renewal and reinstatement of registration.

DEA officials advise that the ability to renew a registration online after the expiration date will no longer be available. If a registrant fails to complete the renewal process by midnight EST on his or her expiration date, that registrant will be forced to restart the application process for a new DEA registration. The original registration will not be reinstated, according to the agency.

Similarly, paper renewal applications received after the expiration date will not be accepted. If the agency fails to receive a registrant's paper renewal materials by the expiration date, they will be returned, and the registrant will need to submit an application for a new DEA registration.

If you want to check your registration expiration date, please contact the DEA Registration Service Center at 1-800-882-9539 or email and include your DEA Registration number in your email.

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Beginning on January 1, 2017, the Protecting Access to Medicare Act (PAMA) required certain laboratories to submit private payor rates for clinical laboratory tests. The CAP developed pathology-specific PAMA resources, including an informative infographic and podcast, to help laboratories understand regulatory requirements and upcoming deadlines. These resources and additional tools can be found on the CAP PAMA resources web page.

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