Members and staff from the CAP’s Council on Government and Professional Affairs have developed the following FAQs to help summarize regulatory and payment issues affecting pathologists during the COVID-19 pandemic. Additional questions or comment can be sent to: firstname.lastname@example.org.
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On March 26, the CAP secured a waiver from the Centers for Medicare & Medicaid Services (CMS) to allow pathologists to work remotely. The CAP had aggressively urged the CMS to give flexibility to pathologists and laboratory personnel during the COVID-19 national emergency. Given the relaxation of federal telehealth restrictions on other health professionals, the CAP said it was critical that pathologists be given the discretion to work remotely.
More guidance from the CMS is available online.
Our successful grassroots efforts also spurred Congress to respond on March 25 with a letter signed by 37 members of the House of Representatives pressing the CMS to grant the waiver. The CAP had worked with the letter’s leaders, Rep. Buddy Carter (R-GA) and Rep. Bobby Rush (D-IL), to gather the signatures in just 48 hours.
The CAP campaign further marshaled support from the greater health care community, including the American Hospital Association, American Medical Association, American Clinical Laboratory Association, Association of Pathology Chairs, and American Society of Clinical Pathology joining our cause.
The CAP engaged with lawmakers to ensure that all testing for COVID-19 should be covered without patient cost-sharing and to support $1 billion to pay for tests provided to patients without health insurance. The Families First Coronavirus Response Act signed into law on March 19 requires Medicare, Medicare Advantage, Medicaid, and private health plans to provide coverage for COVID-19 diagnostic testing, including “the cost of a provider, urgent care center, and emergency room visits in order to receive testing.” Coverage must be provided at no cost to patients.
For private insurance plans, the law, following a clarification provided in the Coronavirus Aid, Relief, and Economic Security (CARES) Act, also mandates coverage for COVID-19 tests. The CAP worked to support a provision in the CARES Act to clarify private insurance plans should cover all COVID-19 testing allowed by the FDA without cost-sharing for patients. The law states all testing for COVID-19 is to be covered by private in
The CAP sent a letter to the CMS on March 24 stating the Medicare prices for COVID-19 tests were woefully inadequate. The CAP urged the Medicare agency to use the new CPT code for the test and establish fair payment pricing. The CAP has urged the Medicare program to use the new CPT code, 87635, to price laboratory tests for COVID-19.
A provision in the CARES Act also requires insurers to pay either the rate specified in a contract between the provider and the insurer, or, if there is no contract, a cash price posted by the provider.
On March 19, the CAP urged the CMS to give pathologists additional flexibility by extending its data submission deadline for the Merit-based Incentive Payment System (MIPS). Just two days later, the CMS agreed to give pathologists and other physicians more time to complete their 2019 MIPS submissions by April 30.
In addition, if pathologists are unable to submit their 2019 data by April 30, they will be “held harmless,” meaning that they will not be penalized but will instead receive a neutral payment adjustment. Read more
The CAP is working on multiple fronts to meet the needs of our members. Following the CAP’s advocacy requesting relief from regulatory requirements, the CMS informed the CAP that it would suspend requirements for mandatory CLIA inspections for laboratories for a period of three weeks.
The CAP also called on the agency to provide additional relaxation of certain CLIA requirements that the CAP and its members said unnecessarily impeded laboratory operations. Read more
Yes. The CAP engaged with the CMS on this issue and, on March 31, the agency released additional guidance that allows drive-thru point-of-care testing. Further, the CMS guidance also allows exceptions for laboratories operating in contiguous buildings to include parking lots.
The CAP supports the AABB as it has urged membership to consider the blood supply and develop a plan for their hospital's blood inventory during response efforts for the evolving coronavirus outbreak (COVID-19). The CAP has shared this message with its members. The CAP has subsequently engaged with AABB on additional advocacy efforts that are needed.
The CAP has been in discussions with CDC and APHL regarding the temporary suspension of PT and will assess the impact on its programs and customers to determine the feasibility of delaying PT.