Advocacy Update

• Legislation Introduced to Stop Medicare Cuts
• Preview HOD/PLS 2025 with Dr. Donald Karcher
• Bipartisan Proposal Aims to Expand Medical Training
• Executive Orders Continue to Affect Health Programs
• Advocacy Win: Medicare Contractors Change Genetic Testing Coverage
• CMS Reviewing Pathology MVP Comments
• Register for the CAP's Fourth LDT Webinar by March 20

On January 31, Reps. Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), introduced an updated version of the Medicare Patient Access and Practice Stabilization Act. This bipartisan bill will stop the latest round of payment cuts and provide physicians with a much-needed two percent payment increase, approximately half of the MEI estimate for this year.

Rep. Greg Murphy, MD (R-NC), issued the following statement after reintroducing the bipartisan bill. If passed, the legislation would prospectively cancel the 2.50% cut to pathology services that took effect in January and increase Medicare pay by 6.62% for the rest of the year.

The CAP continues to strongly oppose the ongoing cuts to physician reimbursement and is actively working with lawmakers to enact short- and long-term Medicare payment reforms.

Pathologists have an opportunity to make their voices heard on key policy issues under consideration in Congress at the House of Delegates/Pathologists Leadership Summit April 26–29 in Washington, DC.

Listen to CAP President Donald Karcher, MD, FCAP, share why pathologists should attend the annual summit and his experience advocating for pathologists and patients on Capitol Hill.

A new bipartisan draft plan proposes expanding graduate medical education (GME) training.

Introduced in December by Sens. Bill Cassidy, MD (R-LA), Catherine Cortez Masto (D-NV), John Cornyn (R-TX), and Michael Bennet (D-CO), the draft Medicare GME proposal would add 5,000 new Medicare-funded GME residency positions or slots, to train new doctors from 2027 through 2031. Additionally, the plan would specifically target shortages in rural and underserved areas, which would get priority when new slots are distributed.

Sen. Cassidy, who chairs the Health, Education, Labor, and Pensions (HELP) Committee, and his colleagues requested additional feedback from stakeholders regarding this draft proposal. The CAP responded by advocating for additional GME slots similar to the 14,000 proposed in the Resident Physician Shortage Reduction Act, and a pathology carve out for slots.

Expanding graduate training programs is critical to addressing workforce shortages and meeting growing patient care demands and continues to be an advocacy priority for the CAP.

The CAP will provide additional updates as it becomes available.

President Donald J. Trump has signed executive orders that directly and indirectly affect federal health care agencies and policies. While the Administration has rescinded its budgetary memo that froze federal funding, other executive orders related to federal agencies have not been lifted. Federal programs are still under review, pausing a wide variety of scientific communications, grantmaking activities, and participation in public meetings.

The White House also issued a statement on imposing tariffs on Canada, Mexico, and China. The CAP is monitoring this action for its potential to impact the availability of laboratory supplies in the US.

The impact of these policies remains fluid in a rapidly changing environment. The CAP will continue monitoring all White House activities and update members on the evolving changes in health care policy affecting pathologists and patients.

Novitas and FCSO Medicare Administrative Contractors (MACs) have released their finalized "Genetic Testing for Oncology: Specific Tests" local coverage determinations (LCDs), L39365 and L39367, respectively.

After extensive advocacy efforts by the CAP and other stakeholders, changes have been made, including:

• The finalized policy no longer delegates coverage for genetic tests that are excluded from one of three knowledgebases (eg. NCCN guidelines, OncoKb, and ClinGen). However, the knowledgebases will continue to serve as evidence resources.
• In another notable change, the MACs removed the proposed limitation that Genetic tests for hereditary cancer syndromes included in the LCD could only be performed once per beneficiary’s lifecycle. The CAP successfully argued that the decision to retest a patient should be undertaken by treating providers who can best assess the incremental benefit of repeat testing for additional mutations. Additionally, as science advances and additional tests become available that help contribute to the management of patient care, the LCDs now allow repeat testing for hereditary cancer syndromes.
• The extremely narrow list of diagnostic codes used in billing have also been expanded.

The coverage policy is scheduled to take effect on April 24.

The Centers for Medicare and Medicaid Services (CMS) is reviewing comments submitted by the CAP on a candidate Pathology MIPS Value Pathway (MVP) developed by CMS. MVPs are a new part of the Merit-Based Incentive Payment System (MIPS) that aims to group meaningful Improvement Activities, quality, and cost measures together in a defined framework that allows more relevant comparisons between clinicians.

The CAP submitted comments on the specific candidate on January 24. In the latest comments, the CAP raised concerns with quality measures developed by a billing company, MSN Healthcare Solutions. The comments also raise concerns about the lack of relevant Improvement Activities for pathologists. Furthermore, since all MVPs must include a cost measure, CMS has added a general cost measure to this MVP. However, CMS is aware that this cost measure is not attributed to pathologists and has indicated that developing a cost measure for pathology is a priority. If CMS intends to move forward with this MVP, it will appear as part of the 2026 Quality Payment Program proposed rule in the summer of 2025.

The CAP has been engaging with CMS to influence the composition of a Pathology MVP to ensure it is meaningful for pathologists. The CAP will continue meeting with CMS regarding this MVP and advocating to influence the scope and timing of such a cost measure if it were to be developed.

Join the CAP on Thursday, March 20, at 1:00 PM ET for the fourth webinar in our laboratory-developed tests series. Gain a better understanding on the necessary steps to comply with the FDA's Stage 1 rule for quality system complaints.

This webinar will guide you through the new requirements, focusing on practical solutions tailored for laboratories. Presenters are Bobbi Pritt, MD, FCAP, Deeona R. Gaskin, JD, MPH, and Earle S. Collum, MD, FCAP.

Register online