Advocacy Update

Read the Latest Issue of Advocacy Update

• Congress Avoids Government Shutdown, Extends Medicare Loan Repayment
• 160 House Lawmakers Tell CMS to Stop Medicare Cuts to Pathologists
• Nine Democratic Senators Ask Insurers About COVID-19 Testing Coverage
• HHS Releases Provider Relief Fund Reporting Guidance
• CMS Asks CAP for NGS-Data Personnel Guidance
• Last Chance to Take the September News Quiz

Congress passed a bipartisan bill, with some notable changes to the Medicare Accelerated and Advance Payment program, that will fund the government until December 11. Due to the pandemic's economic effects on pathologists and laboratories, the CAP had urged Congress to make several changes to the Medicare program, including extending the repayment deadline for participants.

The Medicare Accelerated and Advance Payments program offers expedited payments or loans to physicians during the pandemic. The legislation, which passed the House and the Senate on March 27, will lower the interest rate for these loans to 4% from 10.25%. The new bill will also extend the repayment period for loan recipients. These changes will better ensure that pathologists can utilize this support and continue to focus on the essential task of testing and providing proper treatment of patients.

Additionally, the bill also included additional mandatory spending provisions for the public health emergency and assistance to community health centers and certain teaching hospitals.

President Donald J. Trump is expected to sign the bill into law soon.

A bipartisan coalition of more than 160 members of Congress have urged federal health officials to mitigate Medicare payment cuts to pathologists and other specialists set to take effect in 2021. The CAP and its members have worked to gain congressional support to stop the Medicare cuts, which will slash payment for pathology services by 9% next year. Our lobbying efforts have convinced lawmakers that Medicare should abandon plans to cut pay to physicians.

In a September 24 letter to the Department of Health and Human Services and Centers for Medicare & Medicaid Services, Rep. Roger Marshall, MD, (R-KS) and 160 of his colleagues in the House urged the administration to engage with physicians to establish a fair and equitable payment solution that addresses the Medicare cuts. The cuts are being used to offset increases in Medicare payment to evaluation and management (E/M) services typically rendered by primary care physicians. While the lawmakers commended the increase to E/M services, they warned the administration against moving forward with sharp decreases to other physicians.

“The COVID-19 public health crisis created unprecedented disruptions in our medical community,” the letter said. “Our health care professionals have been on the frontlines, adjusting to new challenges and providing critical care to patients. Now is not the time for massive reimbursement cuts to specialists, including physical therapists, radiologists, pathologists, and surgeons, among other specialties. Instead, we need to work together to ensure a pathway forward that will empower health care professionals to recover from the last six months and to continue to offer essential health care services to America’s seniors.”

Fight the Cuts

Pathologists can further support efforts to stop the Medicare cuts by participating in the CAP’s Fight the Cuts campaign. Join hundreds of your colleagues who’ve already taken action by signing up to participate in the campaign.

On September 22, several Democratic senators asked health insurance companies about their COVID-19 testing coverage policies as some patients have received surprise bills for their tests. The CAP has engaged with lawmakers to ensure that all testing for COVID-19 should be covered without patient cost-sharing.

Sen. Margaret Hassan (D-NH) led an inquiry with ranking Senate Democrats Ron Wyden (D-OR), and Patty Murry (D-OR) asking health insurance executives for clear guidance on how they bill for COVID-19 tests. “Lack of clear and consistent [testing] guidance has caused confusion among individuals seeking testing, particularly for those who are unsure how such sudden changes will impact their coverage,” wrote Sen. Hassan.

The CAP supported the Families First Coronavirus Response Act, which prohibits individual and group health plans from imposing cost-sharing requirements or limiting access through prior authorization or other utilization management protocols for COVID-19 testing and associated health care visits.

On September 19, the HHS released Provider Relief Fund guidance outlining recipient reporting requirements, including how lost revenues will be accounted. The CAP has urged Congress and HHS to provide relief funds to pathologists and has resources available on the program.

The newly-released reporting guidance applies to program recipients that received one or more Provider Relief Fund payments exceeding $10,000.

Recipients must understand the implications of this updated guidance, especially how the HHS has decided that recipients may use program payments to cover “lost revenue.” Recipients should also monitor for updated FAQs’ and guidance for additional clarifications on reporting requirements.

The HHS has published several resources, and the CAP is here to help. Here are the HHS audit guide and the reporting requirements. For questions related to the HHS’s Provider Relief Fund, see the CAP’s guide or email smallbusiness@cap.org.

After the CMS sought the CAP’s advice and guidance on laboratory personnel and the retention of Next Generation Sequencing (NGS) Data, the CAP has provided recommendations and has on-going discussions about qualified laboratory personnel requirements. The CAP has further outlined roles and responsibilities for bioinformatic diagnostic activities, recruitment, and retention of pathology informatics personnel, the NGS data files utilization in clinical tests, and the NGS file storage guidelines.

In a September 15 letter to the CMS, the CAP recommended that “NGS laboratory personnel should have a medical degree like an MD or equivalent medical degree with appropriate subspecialty training in either pathology or medical genetics.” Additionally, NGS data personnel should have a PhD degree in an appropriate field with subspecialty experience in clinical molecular genetics.

The CAP also outlined the challenges of attracting qualified personnel. For instance, the CAP pointed out that non-health care companies will pay more compensation than traditional health care organizations for NGS data personnel. Also, the CAP discussed how health care regulatory bureaucracy could deter qualified personnel from applying as “health care regulations are numerous, which stifles innovation and development,” the CAP stated in the letter.

As for NGS data file usage and retention, the CAP recommended NGS data storage guidelines. For instance, the CAP recommended that the CMS “retain NGS data, including the files used to analyze and generate reports. Specifically, sequence read files (eg, FASTQ, uBAM, BAM, CRAM) and variant calling files (eg, vCF, gVCF) must be retained for a minimum of two years. Importantly, longer lengths of retention may be necessary for specific clinical scenarios. In addition, data files must be retained in compliance with applicable national, federal, state (or provincial) and local laws and regulations.”

It’s the last week to take the September News Quiz. Already over 100 CAP members have taken the September news quiz. See how you compare against your fellow CAP members’ by taking this month’s quiz.

Take the September News Quiz