INFLUENCING PUBLIC POLICY

INFLUENCING PUBLIC POLICY

INFLUENCING PUBLIC POLICY

THE CAP IS FIGHTING TO ENSURE THAT PATHOLOGISTS ARE REIMBURSED PROPERLY FOR THEIR LIFE-SAVING WORK AND THAT POLICIES NATIONALLY AND STATEWIDE PUT PATIENTS FIRST.

THE CAP IS FIGHTING TO ENSURE THAT PATHOLOGISTS ARE REIMBURSED PROPERLY FOR THEIR LIFE-SAVING WORK AND THAT POLICIES NATIONALLY AND STATEWIDE PUT PATIENTS FIRST.

THE CAP IS FIGHTING TO ENSURE THAT PATHOLOGISTS ARE REIMBURSED PROPERLY FOR THEIR LIFE-SAVING WORK AND THAT POLICIES NATIONALLY AND STATEWIDE PUT PATIENTS FIRST.

CAP Advocates for Patients and Pathologists

Pathologists Secure House Passage for Local Coverage Determination Reform

Following a successful CAP-led campaign to influence public policy, the US House of Representatives passed the Local Coverage Determination Clarification (LCD) Act on September 12. This was a key victory for patients, making the process for what Medicare covers more transparent and based on scientific evidence.

Pathologists helped secure 82 sponsors from the House of Representatives to achieve overwhelming support for the legislation. Key provisions concerning pathologists in the bill are:

  • Open and recorded Medicare Administrative Contractor (MAC) Carrier Advisory Committee meetings
  • Upfront disclosure of evidence as well as the rationale MACs use to deny coverage
  • Additional options for challenging an LCD
  • Annual reports to Congress on the number of LCD appeals and actions taken

Bill sponsorship increased after the 2018 Policy Meeting, when 78 CAP members lobbied the offices of 135 members of Congress on May 1.

Advocacy was further augmented by 370 CAP members sending more than 1,000 emails and social media messages to their representatives in Congress through the CAP’s grassroots program, PathNET. Digital advertising placements targeting Capitol Hill also supported the legislation.

The CAP’s political action committee, PathPAC, kept pathologists’ messages visible and in central focus throughout the year. During the 2018 cycle, PathPAC donated more than $189,000 to members of key congressional committees with jurisdiction over health care policy. CAP members also attended several events with members of Congress, hosted fundraisers, and flew to Washington to lobby their elected officials.

Protecting the Value of Pathology Services

Through advocacy to protect the value of pathology services, overall Medicare payments to pathologists were projected to increase from 2017 through 2019. Due to the CAP’s engagement with the CMS and other stakeholders, advocacy achieved positive changes, resulting in payment increases for pathology services between the proposed and final Medicare Physician Fee Schedule regulations (see graph).

CAP Advocates for Patients and Pathologists

Pathologists Secure House Passage for Local Coverage Determination Reform

Following a successful CAP-led campaign to influence public policy, the US House of Representatives passed the Local Coverage Determination Clarification (LCD) Act on September 12. This was a key victory for patients, making the process for what Medicare covers more transparent and based on scientific evidence.

Pathologists helped secure 82 sponsors from the House of Representatives to achieve overwhelming support for the legislation. Key provisions concerning pathologists in the bill are:

  • Open and recorded Medicare Administrative Contractor (MAC) Carrier Advisory Committee meetings
  • Upfront disclosure of evidence as well as the rationale MACs use to deny coverage
  • Additional options for challenging an LCD
  • Annual reports to Congress on the number of LCD appeals and actions taken

Bill sponsorship increased after the 2018 Policy Meeting, when 78 CAP members lobbied the offices of 135 members of Congress on May 1.

Advocacy was further augmented by 370 CAP members sending more than 1,000 emails and social media messages to their representatives in Congress through the CAP’s grassroots program, PathNET. Digital advertising placements targeting Capitol Hill also supported the legislation.

The CAP’s political action committee, PathPAC, kept pathologists’ messages visible and in central focus throughout the year. During the 2018 cycle, PathPAC donated more than $189,000 to members of key congressional committees with jurisdiction over health care policy. CAP members also attended several events with members of Congress, hosted fundraisers, and flew to Washington to lobby their elected officials.

Protecting the Value of Pathology Services

Through advocacy to protect the value of pathology services, overall Medicare payments to pathologists were projected to increase from 2017 through 2019. Due to the CAP’s engagement with the CMS and other stakeholders, advocacy achieved positive changes, resulting in payment increases for pathology services between the proposed and final Medicare Physician Fee Schedule regulations (see graph).

MEDICARE PAYMENTS TO PATHOLOGISTS BY CMS REGULATORY CYCLE

policy-medicaregraph-desktop

A $22 Million Difference: Advocacy on the Medicare Fee Schedule in 2017, 2018, and 2019

MEDICARE PAYMENTS TO PATHOLOGISTS BY CMS REGULATORY CYCLE

policy-medicaregraph-desktop

A $22 Million Difference: Advocacy on the Medicare Fee Schedule in 2017, 2018, and 2019

Recent examples of CAP efforts to increase or maintain reimbursements or mitigate decreases to reimbursements for physician work value components of pathology services include:

  • Fibrinolysins (85390)—The CMS, which is the agency administering the Medicare program, agreed with the CAP’s recommendation to increase the physician work relative value unit (RVU) for CPT code 85390.
  • Fine-Needle Aspiration Biopsy (10021, 10004–10006)—The CMS agreed with most of the valuation recommendations from the CAP and its coalition partners for the new and revised codes.
  • Blood Smear Interpretation (85060)—The CMS agreed with the CAP’s recommendation to maintain the physician work RVU for CPT code 85060. After a proposed decrease by the Medicare agency, the CAP defended its recommended value.
  • Bone Marrow Interpretation (85097)—While the CMS did not agree with the CAP’s recommendation to increase payment for CPT code 85097, the government agreed to maintain the value of the service.

CAP Fights for Laboratories in Courts

To mitigate large cuts to clinical laboratory services, the CAP filed amicus briefs supporting a lawsuit against the government to halt implementation of the new clinical laboratory rates. The CAP further called on Congress to amend the statute instituting market-based reforms to Medicare’s clinical laboratory fee schedule. Following the CAP’s advocacy directly with the CMS, the agency agreed to improve its data collection.

Recent examples of CAP efforts to increase or maintain reimbursements or mitigate decreases to reimbursements for physician work value components of pathology services include:

  • Fibrinolysins (85390)—The CMS, which is the agency administering the Medicare program, agreed with the CAP’s recommendation to increase the physician work relative value unit (RVU) for CPT code 85390.
  • Fine-Needle Aspiration Biopsy (10021, 10004–10006)—The CMS agreed with most of the valuation recommendations from the CAP and its coalition partners for the new and revised codes.
  • Blood Smear Interpretation (85060)—The CMS agreed with the CAP’s recommendation to maintain the physician work RVU for CPT code 85060. After a proposed decrease by the Medicare agency, the CAP defended its recommended value.
  • Bone Marrow Interpretation (85097)—While the CMS did not agree with the CAP’s recommendation to increase payment for CPT code 85097, the government agreed to maintain the value of the service.

CAP Fights for Laboratories in Courts

To mitigate large cuts to clinical laboratory services, the CAP filed amicus briefs supporting a lawsuit against the government to halt implementation of the new clinical laboratory rates. The CAP further called on Congress to amend the statute instituting market-based reforms to Medicare’s clinical laboratory fee schedule. Following the CAP’s advocacy directly with the CMS, the agency agreed to improve its data collection.

CAP Advocates for Patients and Pathologists

Pathologists Secure House Passage for Local Coverage Determination Reform

Following a successful CAP-led campaign to influence public policy, the US House of Representatives passed the Local Coverage Determination Clarification (LCD) Act on September 12. This was a key victory for patients, making the process for what Medicare covers more transparent and based on scientific evidence.

Pathologists helped secure 82 sponsors from the House of Representatives to achieve overwhelming support for the legislation. Key provisions concerning pathologists in the bill are:

  • Open and recorded Medicare Administrative Contractor (MAC) Carrier Advisory Committee meetings
  • Upfront disclosure of evidence as well as the rationale MACs use to deny coverage
  • Additional options for challenging an LCD
  • Annual reports to Congress on the number of LCD appeals and actions taken

Bill sponsorship increased after the 2018 Policy Meeting, when 78 CAP members lobbied the offices of 135 members of Congress on May 1.

Advocacy was further augmented by 370 CAP members sending more than 1,000 emails and social media messages to their representatives in Congress through the CAP’s grassroots program, PathNET. Digital advertising placements targeting Capitol Hill also supported the legislation.

The CAP’s political action committee, PathPAC, kept pathologists’ messages visible and in central focus throughout the year. During the 2018 cycle, PathPAC donated more than $189,000 to members of key congressional committees with jurisdiction over health care policy. CAP members also attended several events with members of Congress, hosted fundraisers, and flew to Washington to lobby their elected officials.

Protecting the Value of Pathology Services

Through advocacy to protect the value of pathology services, overall Medicare payments to pathologists were projected to increase from 2017 through 2019.

Due to the CAP’s engagement with the CMS and other stakeholders, advocacy achieved positive changes, resulting in payment increases for pathology services between the proposed and final Medicare Physician Fee Schedule regulations (see graph).

MEDICARE PAYMENTS TO PATHOLOGISTS BY CMS REGULATORY CYCLE

policy-medicare-graph-mobile

A $22 Million Difference: Advocacy on the Medicare Fee Schedule in 2017, 2018, and 2019

Recent examples of CAP efforts to increase or maintain reimbursements or mitigate decreases to reimbursements for physician work value components of pathology services include:

  • Fibrinolysins (85390)—The CMS, which is the agency administering the Medicare program, agreed with the CAP’s recommendation to increase the physician work relative value unit (RVU) for CPT code 85390.
  • Fine-Needle Aspiration Biopsy (10021, 10004–10006)—The CMS agreed with most of the valuation recommendations from the CAP and its coalition partners for the new and revised codes.
  • Blood Smear Interpretation (85060)—The CMS agreed with the CAP’s recommendation to maintain the physician work RVU for CPT code 85060. After a proposed decrease by the Medicare agency, the CAP defended its recommended value.
  • Bone Marrow Interpretation (85097)—While the CMS did not agree with the CAP’s recommendation to increase payment for CPT code 85097, the government agreed to maintain the value of the service.

CAP Fights for Laboratories in Courts

To mitigate large cuts to clinical laboratory services, the CAP filed amicus briefs supporting a lawsuit against the government to halt implementation of the new clinical laboratory rates. The CAP further called on Congress to amend the statute instituting market-based reforms to Medicare’s clinical laboratory fee schedule. Following the CAP’s advocacy directly with the CMS, the agency agreed to improve its data collection.

Simplifying the Complexities of Medicare’s MIPS to Help Pathologists

As the rules for Medicare’s quality programs got tougher in 2018, the CAP provided pathologists with the guidance and support to optimize performance in the second year of the Merit-based Incentive Payment System (MIPS). As a result of its five initiatives to help pathologists meet performance requirements and maximize Medicare bonus potential, the CAP:

  1. Ensured hundreds of pathologists participating in the 2017 MIPS Reporting Solution met requirements and realized full reimbursement potential before the March 2018 deadline
  2. Enrolled more than 600 pathologists (half of whom used automated data integration) at nearly 60 practice locations in the Pathologists Quality Registry in 2018, enabling them to fully comply with MIPS requirements and to improve the quality of patient care
  3. Secured CMS approval for the inclusion of 21 registry-specific pathology measures, providing pathologists more reporting options under MIPS’s quality category for 2019
  4. Collaborated with the CMS to identify and publish the subset of pathologist-relevant improvement activities, saving pathologists time and making it easier to attest to activities
  5. Advocated for fair MIPS performance scoring so pathologists are not disadvantaged due to the unique circumstances of their practice settings

And, through meetings and other lobbying activity with Medicare officials, the CAP effectively urged the CMS to reduce the burdens pathologists encounter in complying with MIPS by seeking to introduce greater flexibility for pathologists as non-patient-facing physicians in a system designed for patient-facing physicians.

Simplifying the Complexities of Medicare’s MIPS to Help Pathologists

As the rules for Medicare’s quality programs got tougher in 2018, the CAP provided pathologists with the guidance and support to optimize performance in the second year of the Merit-based Incentive Payment System (MIPS). As a result of its five initiatives to help pathologists meet performance requirements and maximize Medicare bonus potential, the CAP:

  1. Ensured hundreds of pathologists participating in the 2017 MIPS Reporting Solution met requirements and realized full reimbursement potential before the March 2018 deadline
  2. Enrolled more than 600 pathologists (half of whom used automated data integration) at nearly 60 practice locations in the Pathologists Quality Registry in 2018, enabling them to fully comply with MIPS requirements and to improve the quality of patient care
  3. Secured CMS approval for the inclusion of 21 registry-specific pathology measures, providing pathologists more reporting options under MIPS’s quality category for 2019
  4. Collaborated with the CMS to identify and publish the subset of pathologist-relevant improvement activities, saving pathologists time and making it easier to attest to activities
  5. Advocated for fair MIPS performance scoring so pathologists are not disadvantaged due to the unique circumstances of their practice settings

And, through meetings and other lobbying activity with Medicare officials, the CAP effectively urged the CMS to reduce the burdens pathologists encounter in complying with MIPS by seeking to introduce greater flexibility for pathologists as non-patient-facing physicians in a system designed for patient-facing physicians.

The Pathologists Quality Registry, a CMS-approved qualified clinical data registry (QCDR), was developed by the CAP in collaboration with FIGmd, the leading registry vendor for specialty societies.

As a QCDR, the Pathologists Quality Registry offers participating pathologists exclusive access to more measures relevant to the care they provide, plus simplified options to gain additional points in other MIPS categories.

In its second year, the Pathologists Quality Registry offered participants flexible data collection options via a web interface or automated data integration for small and large pathology practices. In 2018, the registry successfully interfaced with laboratory information and billing systems to exchange quality improvement data and simplify reporting for pathologists.

As part of its strategy to influence public policy, the CAP provided expert guidance and tools to make sense of the complex requirements and assist pathologists in succeeding in MIPS. Pathology-specific educational materials helped pathologists understand the new payment rules, reduce the burden of complying, and position their practices to maximize Medicare bonus potential.

New Research Generated by Policy Roundtable

The CAP published the 2018 Practice Leaders Survey Report, providing the latest socioeconomic data on pathology practices’ structure and ownership status, case volume and revenue mix, practice staffing, and problems incurred with coverage and payment for services. The 2018 survey was the second biennial advocacy survey targeting pathology practice leaders. The following are among the most notable findings:

The Pathologists Quality Registry, a CMS-approved qualified clinical data registry (QCDR), was developed by the CAP in collaboration with FIGmd, the leading registry vendor for specialty societies.

As a QCDR, the Pathologists Quality Registry offers participating pathologists exclusive access to more measures relevant to the care they provide, plus simplified options to gain additional points in other MIPS categories.

In its second year, the Pathologists Quality Registry offered participants flexible data collection options via a web interface or automated data integration for small and large pathology practices. In 2018, the registry successfully interfaced with laboratory information and billing systems to exchange quality improvement data and simplify reporting for pathologists.

As part of its strategy to influence public policy, the CAP provided expert guidance and tools to make sense of the complex requirements and assist pathologists in succeeding in MIPS. Pathology-specific educational materials helped pathologists understand the new payment rules, reduce the burden of complying, and position their practices to maximize Medicare bonus potential.

New Research Generated by Policy Roundtable

The CAP published the 2018 Practice Leaders Survey Report, providing the latest socioeconomic data on pathology practices’ structure and ownership status, case volume and revenue mix, practice staffing, and problems incurred with coverage and payment for services. The 2018 survey was the second biennial advocacy survey targeting pathology practice leaders. The following are among the most notable findings:

Simplifying the Complexities of Medicare’s MIPS to Help Pathologists

As the rules for Medicare’s quality programs got tougher in 2018, the CAP provided pathologists with the guidance and support to optimize performance in the second year of the Merit-based Incentive Payment System (MIPS).

As a result of its five initiatives to help pathologists meet performance requirements and maximize Medicare bonus potential, the CAP:

  1. Ensured hundreds of pathologists participating in the 2017 MIPS Reporting Solution met requirements and realized full reimbursement potential before the March 2018 deadline
  2. Enrolled more than 600 pathologists (half of whom used automated data integration) at nearly 60 practice locations in the Pathologists Quality Registry in 2018, enabling them to fully comply with MIPS requirements and to improve the quality of patient care
  3. Secured CMS approval for the inclusion of 21 registry-specific pathology measures, providing pathologists more reporting options under MIPS’s quality category for 2019
  4. Collaborated with the CMS to identify and publish the subset of pathologist-relevant improvement activities, saving pathologists time and making it easier to attest to activities
  5. Advocated for fair MIPS performance scoring so pathologists are not disadvantaged due to the unique circumstances of their practice settings

And, through meetings and other lobbying activity with Medicare officials, the CAP effectively urged the CMS to reduce the burdens pathologists encounter in complying with MIPS by seeking to introduce greater flexibility for pathologists as non-patient-facing physicians in a system designed for patient-facing physicians.

The Pathologists Quality Registry, a CMS-approved qualified clinical data registry (QCDR), was developed by the CAP in collaboration with FIGmd, the leading registry vendor for specialty societies. As a QCDR, the Pathologists Quality Registry offers participating pathologists exclusive access to more measures relevant to the care they provide, plus simplified options to gain additional points in other MIPS categories. In its second year, the Pathologists Quality Registry offered participants flexible data collection options via a web interface or automated data integration for small and large pathology practices. In 2018, the registry successfully interfaced with laboratory information and billing systems to exchange quality improvement data and simplify reporting for pathologists.

As part of its strategy to influence public policy, the CAP provided expert guidance and tools to make sense of the complex requirements and assist pathologists in succeeding in MIPS. Pathology-specific educational materials helped pathologists understand the new payment rules, reduce the burden of complying, and position their practices to maximize Medicare bonus potential.

New Research Generated by Policy Roundtable

The CAP published the 2018 Practice Leaders Survey Report, providing the latest socioeconomic data on pathology practices’ structure and ownership status, case volume and revenue mix, practice staffing, and problems incurred with coverage and payment for services.

The 2018 survey was the second biennial advocacy survey targeting pathology practice leaders. The following are among the most notable findings:

SOURCES FOR PATHOLOGY PRACTICE REVENUE

policy_plspiechart_fpo
policy-piechart-legend-mobile

Nearly 1/3 of practice revenues, on average, come from commercial health plans and 1/3 from Medicare.

policy_microscope_icon_fpo

Pathologist-owned practices dropped from

49%
in 2016
to 38%
in 2018
policy_pathologists_icon_fpo

57%

Survey respondents leading practices with 5 or fewer pathologists

policy_buildings_icon_fpo

Pathology practice hiring exceeds number of retiring pathologists

SOURCES FOR PATHOLOGY PRACTICE REVENUE

SOURCES FOR PATHOLOGY PRACTICE REVENUE

policy_plspiechart_fpo

Nearly 1/3 of practice revenues, on average, come from commercial health plans and 1/3 from Medicare.

policy-piechart-legend
policy_plspiechart_fpo

Nearly 1/3 of practice revenues, on average, come from commercial health plans and 1/3 from Medicare.

policy-piechart-legend
policy_microscope_icon_fpo

Pathologist-owned practices dropped from

49%
in 2016
to 38%
in 2018
policy_pathologists_icon_fpo

57%

Survey respondents leading practices with 5 or fewer pathologists

policy_buildings_icon_fpo

Pathology practice hiring exceeds number of retiring pathologists

policy_microscope_icon_fpo

Pathologist-owned practices dropped from

49%
in 2016
to 38%
in 2018
policy_pathologists_icon_fpo

57%

Survey respondents leading practices with 5 or fewer pathologists

policy_buildings_icon_fpo

Pathology practice hiring exceeds number of retiring pathologists

State Advocacy Protects the Future of Pathology

To strengthen the profession of pathology, the CAP’s strong partnerships with state pathology societies bolstered advocacy efforts with legislatures and governors.

Network Adequacy and Out-of-Network Balance Billing

Advocacy on health plan network adequacy and out-of-network balance billing included leading a multispecialty coalition of hospital-based physicians to address various state legislative proposals. State legislative action on balance billing occurred in more than a dozen states.

In New Jersey, the governor enacted out-of-network legislation that did not include an adverse fee schedule and maintained the patient save harmless protections of prior state law advocated by the New Jersey Society of Pathologists. The Massachusetts Society of Pathologists and the CAP secured a clarification from the Massachusetts State Insurance Department requiring health insurance payers to hold patients financially save harmless for out-of-network bills.

Multiple state medical societies advocated for state legislation to establish standards for health plan network adequacy in Washington and Tennessee. In New Hampshire, state legislation was enacted to require state regulatory oversight over health plan network adequacy, including pathology. For more than four years, the CAP and the New Hampshire Society of Pathologists have advocated for enactment of the network adequacy requirement for pathology and laboratory services.

The Arizona Society of Pathologists and the CAP led efforts to seek administrative clarification on that state’s compliance with federal standards on out-of-network pathology/laboratory access for patients and the out-of-network payment requirements in the state Medicaid program.

policy-state-path-map-all

Direct Billing/Anti-Markup

The Rhode Island Society of Pathologists and the CAP defended a state direct billing law for pathology and laboratory services against a repeal effort. The Florida Society of Pathologists and the CAP ensured that the Florida clinical laboratory licensure law’s repeal did not void the section of state law that prohibits clinical laboratory inducements, kickbacks, and markups.

Genetic Testing

Wyoming enacted a genetic information privacy law that ensures clinical laboratories and pathologists will not be inadvertently impeded by the protections afforded to patients. The new law prohibits the collection, retention, and disclosure of genetic information without the informed consent of the individual or an authorized representative, with some exceptions.

State Advocacy Protects the Future of Pathology

To strengthen the profession of pathology, the CAP’s strong partnerships with state pathology societies bolstered advocacy efforts with legislatures and governors.

policy-state-path-map-all

Network Adequacy and Out-of-Network Balance Billing

Advocacy on health plan network adequacy and out-of-network balance billing included leading a multispecialty coalition of hospital-based physicians to address various state legislative proposals. State legislative action on balance billing occurred in more than a dozen states.

In New Jersey, the governor enacted out-of-network legislation that did not include an adverse fee schedule and maintained the patient save harmless protections of prior state law advocated by the New Jersey Society of Pathologists. The Massachusetts Society of Pathologists and the CAP secured a clarification from the Massachusetts State Insurance Department requiring health insurance payers to hold patients financially save harmless for out-of-network bills.

Multiple state medical societies advocated for state legislation to establish standards for health plan network adequacy in Washington and Tennessee. In New Hampshire, state legislation was enacted to require state regulatory oversight over health plan network adequacy, including pathology. For more than four years, the CAP and the New Hampshire Society of Pathologists have advocated for enactment of the network adequacy requirement for pathology and laboratory services.

The Arizona Society of Pathologists and the CAP led efforts to seek administrative clarification on that state’s compliance with federal standards on out-of-network pathology/laboratory access for patients and the out-of-network payment requirements in the state Medicaid program.

Direct Billing/Anti-Markup

The Rhode Island Society of Pathologists and the CAP defended a state direct billing law for pathology and laboratory services against a repeal effort. The Florida Society of Pathologists and the CAP ensured that the Florida clinical laboratory licensure law’s repeal did not void the section of state law that prohibits clinical laboratory inducements, kickbacks, and markups.

Genetic Testing

Wyoming enacted a genetic information privacy law that ensures clinical laboratories and pathologists will not be inadvertently impeded by the protections afforded to patients. The new law prohibits the collection, retention, and disclosure of genetic information without the informed consent of the individual or an authorized representative, with some exceptions.

State Advocacy Protects the Future of Pathology

To strengthen the profession of pathology, the CAP’s strong partnerships with state pathology societies bolstered advocacy efforts with legislatures and governors.

Network Adequacy and Out-of-Network Balance Billing

policy-state-maps-healthplannetwork

Advocacy on health plan network adequacy and out-of-network balance billing included leading a multispecialty coalition of hospital-based physicians to address various state legislative proposals. State legislative action on balance billing occurred in more than a dozen states.

In New Jersey, the governor enacted out-of-network legislation that did not include an adverse fee schedule and maintained the patient save harmless protections of prior state law advocated by the New Jersey Society of Pathologists. The Massachusetts Society of Pathologists and the CAP secured a clarification from the Massachusetts State Insurance Department requiring health insurance payers to hold patients financially save harmless for out-of-network bills.

Multiple state medical societies advocated for state legislation to establish standards for health plan network adequacy in Washington and Tennessee. In New Hampshire, state legislation was enacted to require state regulatory oversight over health plan network adequacy, including pathology. For more than four years, the CAP and the New Hampshire Society of Pathologists have advocated for enactment of the network adequacy requirement for pathology and laboratory services.

The Arizona Society of Pathologists and the CAP led efforts to seek administrative clarification on that state’s compliance with federal standards on out-of-network pathology/laboratory access for patients and the out-of-network payment requirements in the state Medicaid program.

Direct Billing/Anti-Markup

policy-state-maps-directbilling

The Rhode Island Society of Pathologists and the CAP defended a state direct billing law for pathology and laboratory services against a repeal effort. The Florida Society of Pathologists and the CAP ensured that the Florida clinical laboratory licensure law’s repeal did not void the section of state law that prohibits clinical laboratory inducements, kickbacks, and markups.

Genetic Testing

policy-state-maps-genetictesting

Wyoming enacted a genetic information privacy law that ensures clinical laboratories and pathologists will not be inadvertently impeded by the protections afforded to patients. The new law prohibits the collection, retention, and disclosure of genetic information without the informed consent of the individual or an authorized representative, with some exceptions.