Recap of the Latest Advocacy News from April-June 2023
In this Issue:
CAP’s 2023 Hill Day Compels Members of Congress to Act
Following 145 meetings with congressional offices on the CAP’s annual Hill Day, several legislators agreed to cosponsor legislation that pathologists specifically asked their representatives and senators to support. The positive response to pathologists lobbying their lawmakers was just another example of a successful 2023 Pathologists Leadership Summit in Washington, DC. The CAP’s lobbying on Hill Day yielded nine cosponsors to legislation concerning the specialty. Two members of Congress agreed to cosponsor the Saving Access to Laboratory Services Act (SALSA), which would address pending Medicare cuts to clinical laboratory services, and another seven members agreed to cosponsor the Resident Physician Shortage Reduction Act, which would address physician workforce shortages.
CAP, AMA, and 120 Medical Societies Ask Congress to Stabilize Medicare Payments
The American Medical Association (AMA), CAP, and 120 national medical professional, health, and state medical societies have urged congressional leaders to pass the bipartisan Strengthening Medicare for Patients and Providers Act (HR 2474). The legislation would provide financial stability to physician practices by including an annual inflation update for Medicare payments that is tied to the Medicare Economic Index (MEI). The CAP advocates for fair payment for the value of pathology services.
CAP Applauds Congress for Introducing SALSA to Protect Patient’s Access to Lab Tests
On March 29, Congress introduced the bipartisan, bicameral Saving Access to Laboratory Services Act (SALSA; S. 1000/H.R. 2377), which would update Medicare’s payment system for clinical diagnostic laboratory services, protect patient access to critical laboratory services, and strengthen infrastructure in clinical laboratories. SALSA will reduce the administrative burden on laboratories and ensure accurate collection of private market data through statistically valid sampling from all laboratory segments while avoiding drastic cuts to clinical laboratory payment rates.
Congress Introduces Bipartisan Legislation to Increase GME Funding
29, Reps. Terri Sewell (D-AL) and Brian Fitzpatrick (R-PA) introduced the
bipartisan Resident Physician Shortage Reduction Act of 2023. This legislation
would combat the nation’s physician shortage and improve access to health care
by expanding the number of Medicare-supported medical residency positions by
14,000 over seven years. The CAP has long
advocated for increased funding to support more GME residency slots, which
is essential to addressing critical shortages of pathologists in the coming
years and is one of the 2023 Advocacy asks.
Medicare and Federal Health Care News
AMA CPT Announces 30 New Digital Pathology Codes for 2024
Following on our success for 2023, the CAP advocated for the inclusion of 30 new CPT digital pathology codes for pathologists to use in 2024. The CAP worked with the American Medical Association (AMA) CPT Editorial Panel to develop the new digital pathology add-on codes that were posted online on June 2. The new digital pathology Category III CPT codes will be used to report additional service requirements associated with digitizing glass microscope slides for primary diagnosis.
Proposed FDA Rule on LDT Oversight Under Review by OMB
On June 14, the US Food and Drug Administration (FDA) filed a notice of proposed rulemaking for the oversight of laboratory-developed tests (LDTs) with the White House Office of Management and Budget (OMB). To regulate LDTs, the FDA is following the formal rulemaking process, during which the CAP will analyze, engage, and advocate for minimizing burden on laboratories and ensuring patient access to tests.
CMS Allows Pathologists and Lab Personnel Ability to Review Digital Slides Remotely
As the COVID-19 public health emergency ended May 11, the Centers for Medicare & Medicaid Services (CMS) updated its guidance to allow pathologists the ability to review digital slides and data remotely if they meet specific criteria. In addition, CMS changed its policy to allow clinical laboratory personnel (non-pathologists) to also review digital images and data remotely. This flexibility was granted during the early days of the pandemic and the CAP had advocated for it to continue once the public health emergency ended. Read the latest version of the CMS’s guidance.
Private Payor News
CAP Opposes Insurer Optum’s Move to Restrict 88305 Usage with Arbitrary Thresholds
The CAP has objected to the private insurer Optum’s new laboratory benefit management program and its efforts to establish limits on the number of CPT code 88305 units that will be reimbursed by specimen type. The CAP is seeking a meeting with Optum officials to further explain our position and to provide examples where it is common clinical practice to bill more 88305 codes.
ASP-CAP Amended Prior Authorization ‘Gold Card’ Bill Enacted by Arkansas Governor
11, House Bill 1271, previously amended by
the Arkansas Society of Pathologists (ASP) in collaboration with the CAP and the
Arkansas Medical Association, was enacted into law. The bill ensures health
carriers cannot deny or reduce payment for health care providers involved in
the rendering of a health care service subject to a prior authorization “gold
card.” The legislation establishes a prior authorization “gold card” waiver for
providers who have received a 90% or higher approval rate for prior
authorization requests for a particular health care service.
Landmark Network Adequacy Bill Amended by TSP, CAP Becomes Law in Tennessee
On May 5, Tennessee Gov. Bill Lee enacted a landmark network adequacy law after several years of persistent advocacy by the Tennessee Society of Pathologists (TSP) and the CAP in collaboration with the Tennessee Medical Association (TMA). The TSP, CAP, and TMA successfully advocated for several provisions to strengthen network adequacy review of health insurance plans by the state insurance commissioner.
Georgia Pathologists, CAP Help Enact Multiple Laws and Deter Adverse Legislation
The Georgia Association of Pathologists (GAP) and the CAP scored several legislative victories that protect patients and pathologists in the state. For example, the GAP- and CAP-backed legislation, Senate Bill 20, was enacted by Gov. Brian Kemp to expressly require state oversight over health plan network adequacy, including clinical laboratory services, to ensure covered persons can access in-network “the full scope of benefits and services covered under the plan.”
Texas Governor Enacts Network Adequacy Law Supported by TSP, CAP
On June 12, Texas Gov. Greg Abbott signed into law health plan network adequacy legislation (House Bill 3359) supported by the Texas Society of Pathologists (TSP) and the CAP, working with the Texas Medical Association. The new law requires preferred provider organization health plans to meet state requirements so that their enrollees can access in-network physician services, including pathology and laboratory services, at in-network facilities and geographically accessible services within the network based upon time and distance standards as expressly prescribed.