Advocacy Update

November 15, 2022

In this Issue:

CAP Asks CMS to Examine Remote Work Practices After Emergency Declaration Ends

The CAP recently asked the Centers for Medicare & Medicaid Services (CMS) to evaluate remote sign-out practices for pathologists after the public health emergency ends.

At a November 9 meeting of the Clinical Laboratory Improvement Amendments Committee (CLIAC), which recommends changes to CLIA regulations, the CAP sought to address the evolution of laboratory practice and technology while also cautioning the CMS from making changes that result in diminished quality and oversight. The CAP testified before CLIAC regarding the CMS continuing with remote work sign-out of cases after the public health emergency declaration is rescinded but study these practices for unintended consequences. The CAP also recommended updates to proficiency testing (PT) requirements to address the total testing process.

Joe Saad, MD, FCAP, Vice-Chair of the CAP Council on Government and Professional Affairs, provided testimony to CLIAC. In his testimony, Dr. Saad outlined how the CAP supports the continuation of the remote sign-out waiver for the duration of the public health emergency declaration. However, the CAP recommended CLIAC examine potential unintended consequences that could cause patient safety and testing quality issues.

Dr. Saad also stated that laboratories should perform PT by observing the same process that they do for patient samples, including moving samples among multiple sites to complete all aspects of testing. Doing so should not constitute intent to commit proficiency testing referral.

The CAP will work closely with the CMS to ensure appropriate regulations and policies as clinical laboratory testing evolves.

CAP Urges CMS to Streamline Medicaid, CHIP to Improve Health Care Equity and Reduce Burden

The CAP urged the CMS to reduce the administrative burden for physicians and patients in Medicaid and the Children’s Health Insurance Program (CHIP) to health equity in both programs. As physicians and stewards of laboratory medicine, the CAP and its members are committed to achieving health equity and addressing health care disparities to ensure quality, accessible patient care.

The CAP responded to a proposed regulation to improve Medicaid and CHIP on November 7. In a letter to the CMS, the CAP acknowledged the agency’s initial steps to streamline Medicaid and CHIP eligibility and enrollment processes, reduce administrative burden, and increase enrollment and retention of eligible individuals.

The CAP also said that "without accessible health insurance, patients are more likely to delay seeking needed medical care, including diagnostic testing, and screening services. Access to preventative care, cancer, and other screening services, as well as treatment for chronic illnesses and mental health disorders, are essential for communities of color and other underserved populations. The CAP supported ways to improve and expand Medicaid to ensure increased health care coverage, especially for low-income people, and address health care inequalities and disparities in the US health system.

In Congress, the CAP has supported legislation to enable a better understanding of the social determinants that drive health care disparities in the United States. For example, the CAP supports the Social Determinants Accelerator Act to improve health care data collection between federal agencies and establish a federal council to develop plans addressing determinants plaguing beneficiaries in the Medicaid program. The legislation would provide needed grants and assistance to state, tribal, and local governments to deploy strategies addressing determinants in their own communities.

Florida MAC to Retire Special Stains LCD that is Scientifically Inaccurate

First Coast, the Medicare Part A/B Medicare Administrative Contractor (MAC) for Florida, announced it is retiring its Special Histochemical Stains & Immunohistochemical Stains local coverage determination (LCD) L36234, effective December 11, 2022. The CAP has long advocated for the withdrawal of this LCD since it was issued in 2015 citing, among other issues, the policy’s medically and scientifically inaccurate language and its attempt to define good pathology practice.

The CAP submitted comments to First Coast in response to its proposal to retire the LCD. In its June 30, 2022, letter, the CAP urged First Coast to remove the LCD because the literature cited to support the MAC’s coverage position was outdated and it did not reflect current practice standards for the reasonable and necessary use of immunohistochemistry stains and special stains.

In its decision to retire the LCD, First Coast said the LCD and its corresponding Billing and Coding Article A57708 neither reflect the current standard of practice nor have a significant impact on Medicare expenditures.

What Will Be the Impact of the Final Fee Schedule on Your Practice?

On November 1, the CMS released the final 2023 Medicare payment regulations, including the final Medicare Physician Fee Schedule and the Quality Payment Program regulations.

On Monday, December 5 at 3 PM ET/ 2 PM CT, the CAP will offer a complementary live webinar where CAP experts will review final regulations that will impact Medicare payment for services and pathologists’ participation in the quality initiatives. Webinar presenters will be the Council on Government and Professional Affairs Chair Jonathan Myles, MD, FCAP; Economic Affairs Committee Chair Stephen Black-Schaffer, MD, FCAP; and Quality and Clinical Data Registry Affairs Committee Chair Diana Cardona, MD, FCAP.

Register today

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