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Quarterly Advocacy Update

Keeping you informed on policy issues affecting pathology and laboratory medicine.

Recap of the Latest Advocacy News from October-December 2020.

In this Issue:

COVID-19 Vaccines Administered to Health Care Personnel, Including Pathologists

Americans began receiving COVID-19 vaccinations on December 14 after the Food and Drug Administration (FDA) approved the emergency use of the Pfizer-BioNTech COVID-19 vaccine. Following the Centers for Disease Control and Prevention (CDC) recommendations for the initial phase of the COVID-19 vaccination, health care personnel, and residents of long-term care facilities first received the vaccines. Pathologists and laboratory personnel are also included in this group.

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CAP Asks CMS to Reduce COVID-19 Laboratory Reporting Burdens, Increase Testing Resources

The CAP urged the Centers for Medicare & Medicaid Services (CMS) and the Clinical Laboratory Improvements Advisory Committee (CLIAC) to reduce pathologists' reporting burdens during this unprecedented COVID-19 pandemic, especially when it comes to testing. To equip our pathologists during this crisis, the CAP asked the CMS for increased flexibility in COVID-19 laboratory data reporting, uniform coverage for clinical diagnostic laboratory tests without a practitioner order, and increase resources for testing for long-term care facilities’ staff and residents.

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CAP Demands CMS to Stop Payment Cuts for COVID-19 Tests

The CAP strongly objected to Medicare cuts to fees for certain COVID-19 tests, which the CMS announced on October 15. Additionally, the CAP asked the CMS to cease implementation of this payment structure that will cut fees for COVID-19 testing performed on a high throughput technology platform and penalize laboratories in the middle of a global pandemic.

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Who Will Lead Important Health Care Committee in the House of the 117th Congress

The CAP provides important insights on who will make health care policy decisions over the next year. The 117th Congress will officially take office on January 4, 2021, and the Democratic party will retain its majority with 222 House seats, with 209 seats for the Republicans. The CAP expects several leadership changes on key House congressional committees overseeing Medicare, Medicaid, and health care that will be pertinent to the CAP's advocacy strategy.

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Biden Nominates Becerra for HHS Secretary; Walensky for CDC Director

President-elect Joe Biden nominated California Attorney General Xavier Becerra to lead the Department of Health and Human Services (HHS). The President-elect also nominated leading infectious-disease specialist Rochelle Walensky, MD, to lead the CDC.

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Biden Names Surgeon General, Key Health Officials for Next Administration

As Biden prepares his administration to take on the COVID-19 pandemic, he tapped members of his COVID-19 task force to play key roles in his administration’s response to the national public health crisis. These individuals are public health experts and scientists who will lead national strategies to mitigate the COVID-19 pandemic.

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CAP Advocacy Saves Pathologists Up to $85 Million in 2021 as Congress Mitigates Medicare Cut

Following a sustained and aggressive lobbying campaign against Medicare payment cuts to pathologists by the CAP, Congress mitigated the cut by adding $3 billion to next year’s Medicare fee schedule and delayed implementation of a new evaluation and management add-on code for three years (the implementation delay is expected to restore roughly 3% to pathologists each year). The result amounts up to $85 million more for pathologists in 2021, according to an analysis by the CAP.

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CAP Pushes Congress to Stop Medicare Cuts in Year-End Spending Deal

With Congress maneuvering to complete its year-end business before the holidays, the CAP lobbied congressional lawmakers and staff to stop -9% Medicare cuts to pathologists in 2021. In addition, key congressional health care committee leaders agreed to a legislative compromise on surprise medical bills that now includes several of the CAP’s policy priorities. On behalf of its members, the CAP uses all its extensive advocacy resources to positively influence legislation.

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Bipartisan, Bicameral Support Increases to Mitigate Medicare Cuts

With the CAP actively lobbying lawmakers to protect the value of pathology services, bipartisan support in Congress gained momentum to mitigate the impact of Medicare cuts to pathologists’ reimbursement. Pathologists also utilized the CAP’s grassroots advocacy program to contact their federal legislators to fight the Medicare cuts.

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CAP Praises Bipartisan House Bill to Delay Steep Medicare Cuts to Pathologists

The CAP applauded Reps. Ami Bera, MD, and Larry Bucshon, MD, for their leadership on the introduction Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, which would delay Medicare cuts to pathology practice until 2023.

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CAP Advocacy Results in UnitedHealthcare Delaying Test Registration

Because of the CAP’s advocacy, UnitedHealthcare announced that it will further delay its laboratory test registry until December 1, 2021. After continued discussions with the CAP over concerns of overburdening laboratories during the current pandemic, UnitedHealthcare announced it delayed implementation of its test registry program by one year and pushed back the deadline to ensure compliance.

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Blue Cross of NC Updates Pass-Through Billing Policy

The CAP asked Blue Cross and Blue Shield of North Carolina (Blue Cross NC) to modify its proposed professional pathology billing guidelines, which are intended in part to inhibit the practice of “pass-through” or client billing. In response, the Blue Cross NC updated their reimbursement policy stating that “pass-through” billing will be prohibited and that the “professional practice or laboratory performing the services” will directly bill for those services. The CAP supports the intent of the policy but is evaluating the policy for increased reporting burdens on laboratory medicine.

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Ohio Pathologists, CAP Oppose Out-of-Network Legislation

The Ohio Society of Pathologists (OSP) and the CAP opposed legislation negotiated by the state's medical society to pay for out-of-network services at 100% of the Medicare rate or the median in-network rate. The legislation passed the Ohio House and is pending in the Ohio Senate. The CAP partners with state pathology societies to strengthen advocacy efforts at the state level.

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Michigan Governor Signs CAP-MSP Amended Out-Of-Network Bill

On October 23, Michigan Gov. Gretchen Whitmer signed into law out-of-network billing legislation, which was successfully amended by the Michigan Society of Pathologists (MSP) and the Michigan State Medical Association. Both the MSP and the CAP worked with the Michigan State Medical Society’s physician coalition to advocate for critical changes to the bill.

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CAP Urged Medicare Advisory Panel to Ensure Accurate Clinical Lab Reimbursement Rates

The CAP expressed concerns to the Medicare Payment Advisory Commission (MedPAC) regarding accurate clinical laboratory reimbursements rates in response to the public meeting in September. The CAP asked that any recommendations to the CMS clinical laboratory fee schedule ensure a broad representation of the laboratory market.

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2020 MIPS Extreme and Uncontrollable Circumstances Exception Deadline Extended

The CMS extended the 2020 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception application deadline to February 1, 2021. For pathologists, physicians, and other clinicians who are unable to meet requirements for MIPS in 2020 due to COVID-19, the CMS will allow hardship exception requests. The CAP has advocated for MIPS reporting relief for pathology practices in light of the pandemic.

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Medicare Finalized Payment regulations for Pathology Services in 2021, CAP Continues to Fight the Cuts

The CAP provided its members with a detailed payment impact table and webinar program with our analysis of the final 2021 Medicare Physician Fee Schedule. As was expected, the CMS will follow through with significant payment cuts to pathologists and other specialists in 2021.

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